Saving Our Nose and Our Face

by James Cavuoto, editor

Anyone who’s been watching news coverage of the Alex Murdaugh murder trial in South Carolina is by now familiar with the grisly details in that case. But regardless of the eventual outcome and regardless of what one might think about the defendant’s character, it’s hard not to be moved by the toll that opioid addiction has taken on his life, and his family members. If nothing else, the case highlights the inescapable fact that addiction can afflict wealthy, upper-class people as well as those in urban, low-income environments.

That said, the impact that addiction to alcohol and other drugs has on society is more visible in big cities, where homeless tents spring up like mushrooms and victims of property crimes pay the price for the unprescribed and highly proscribed drugs made more expensive by their illegal status. But the economic burden is much more than the cost of the drugs themselves. Taxpayers foot the bill for medical costs associated with overdoses and other health impacts, plus the not insignificant cost of policing, prosecuting, and imprisoning users and purveyors of illegal drugs.

Clearly, a new strategy is needed to replace our failed war on drugs, which makes the wars in Iraq and Afghanistan look like ringing successes by comparison. One approach that has been tried are safe consumption centers such as OnPoint NYC, which provide users with medical and mental health care, addiction treatment options, hygiene and respite, and other critical support. While programs like this have helped clean up neighborhoods and mitigate many health problems, they have attracted criticism from many people who believe people addicted to drugs need harsh consequences, not coddling. This attitude, which is at the root of the war on drugs philosophy, seems at odds with conservative political ideology, which values minimizing government spending. A recent article in the New York Times points out that we spend roughly five times as much incarcerating people with substance use disorders as it would cost us to treat them. A recent study from Rand reports that our economy is losing a trillion or so dollars every year in productivity, health care costs, and criminal justice expenditures, among other things.

Perhaps what’s needed is a new program that appeals to both progressive and law-and-order mindsets. We envision a new form of drug treatment center—or drug prison, depending on your point of view—that keeps addicts off the street until they are free from addiction. These centers/prisons would house addicts, who would sign up voluntarily, and offer them all the services that safe consumption centers currently offer, plus housing, meals, and amenities above and beyond what they would find in a typical state prison. The catch is that these patients/inmates can check in, but they can’t check out until they can demonstrate that they are sober for six months.

And what would motivate these people to accept that bargain? Simple. Free and unlimited access to whatever drug they’re addicted to, which they could use with medical supervision to prevent overdoses and other health problems. Of course during their stay/incarceration, they would also have access to addiction therapies and could choose to participate in a clinical trial of new neuromodulation therapies to treat addiction. The presumption is that if addicts can abstain for six months in an environment where their drug of choice is freely available, they stand a much better chance of remaining drug free in the outside world once they are released. Those who cannot pass the six-month test will remain longer as guests/inmates at a fraction of the cost we currently spend to apprehend, prosecute, and incarcerate them presently. Oh, and the purveyors of illicit drugs who profit from the current proscription regime will find it much harder to make a living when they have to compete with other outlets who offer free product at a higher quality.

One of the common sayings that’s heard in recovery settings is the serenity prayer, which instructs us to accept the things we cannot change. It is time for our society to recognize that we cannot change the nature of addiction just by criminalizing drugs. But we can change the economic and societal impact that addiction has on us. Rather than cut off our nose to spite our face by continuing to pour money into a failed war on drugs, we can save face—and lives—by addressing the problem in a manner that is both humane and cost effective.