Sunday, May 25, 2014
ALCOHOLICS ANONYMOUS WAS PROCLAIMED the correct treatment for alcoholism over seventy-five years ago despite the absence of any scientific evidence of the approach’s efficacy, and we have been on the wrong path ever since. Today, almost every treatment center, physician, and court system in the country uses this model. Yet it has one of the worst success rates in all of medicine: between 5 and 10 percent, hardly better than no treatment at all.
Most of the expensive, famous rehab centers that base their treatment on the Twelve Steps likewise have offered no evidence for their effectiveness. Most of them don’t even study their own outcomes.
One would hope we could turn to science for careful studies of AA and its effectiveness. But science has failed us: the AA question was considered settled almost before it was asked, and what studies exist that claim to substantiate AA have been riddled with problems in both methodology and analysis. Nobody has ever carefully and rigorously reviewed these studies and reported the results to the public. In this book, we do just that.
The failure of addiction treatment in our country is especially discouraging since there are better ways to both understand addiction and treat it, and it’s costing us thousands of lives and billions of dollars. With this book, we hope to begin a more productive conversation.
A Note About Format This book was written by both of us, but because Lance has devoted his career to understanding addiction, we have decided to write it in the first person. Zachary’s equal contributions are everywhere, however, from the quality of the writing to his sharp understanding of good and bad science. Neither of us could have written this book alone.
What Do Prosecutors and District Attorneys Say About 911 Good Samaritan Laws?
With the drug overdose epidemic still raging, 911 Good Samaritan and Naloxone Access laws are sweeping the country as states struggle to seek solutions that can turn back the tide of deaths. Currently, 18 states have implemented naloxone laws, 14 have medical amnesty laws on the books, and many more have introduced bills to their general assemblies. But while law enforcement, public health advocates, and people directly affected by drug overdose are front and center in these debates, state prosecutors and district attorneys also play a critical role in advocacy efforts -- often for, but sometimes against, these laws.
Within the legislative system, associations of prosecutors and district attorneys carry a lot of clout and their support for a bill can be essential to its passage. Case in point, in 2009 overdose prevention advocates in Washington state helped introduce a 911 Good Samaritan bill, but it quickly encountered opposition from the Washington Association of Prosecuting Attorneys and the Washington Association of Sheriffs and Police Chiefs, two organizations with enormous political leverage. The associations argued that the bill, which granted limited immunity from some drug charges to people who sought help for an overdose, sent the "wrong message" on drug laws. As the 2009 legislative session came to a close, it seemed clear that the bill could not move forward with such powerful opposition, so advocates convened a working group of stakeholders, including lawyers, law enforcement, public health advocates and people who had lost loved ones to overdose, to make the case for the law.
"In the end we were able to change [the associations'] minds," explains Mark Cooke, Policy Counsel with the ACLU of Washington, one of the main advocacy organizations for the bill. "Law enforcement officers and prosecutors realized that most people don't get in trouble for low level possession in overdose situations anyways, and if we can save one life, it is worth passing the law. Also, law enforcement from college campuses were some of the most vocal proponents for the 911 Good Samaritan bill, which was inspired by similar amnesty laws on college campuses."
When the legislative session reconvened in 2010, the Washington Association of Sheriffs and Police Chiefs came out in support of the 911 Good Samaritan bill, and the Association of Prosecuting Attorney's agreed not to oppose it. That year Washington became the second state in the nation (behind New Mexico) to implement a 911 Good Samaritan law, paving the way for a dozen other states to follow suit in the coming years.
Most recently, Georgia passed a similar medical amnesty and naloxone access law through their general assembly. The bill is currently awaiting signature from Governor Nathan Deal, and will take effect immediately. District Attorney Danny Porter says that prosecutors in Georgia opposed the original version of the bill because it included immunity for people who provided the drugs that resulted in an overdose. One of the main arguments of opponents concerned a case in North Georgia where a mother had given methadone to her child because she wanted to sleep. The child overdosed and died.
"We had to work with the author of the bill to reduce the range of immunities to a scope that was acceptable to prosecutors," says D.A. Porter. "We were able to reach an agreement quickly and help move the bill with our political leverage. We had no problem with the underlying social aspect of the bill. Kids who overdose shouldn't be afraid to get help."
Mike Noone, First Assistant to the District Attorney in Chester County, has been part of advocacy efforts for a 911 Good Samaritan law in Pennsylvania. The bill is currently being debated, but Noone is optimistic that it will pass.
"Our office advocates for the law because it's important to encourage people to do the right thing if they are in an overdose situation and people are dying," he says.
Prosecutors' support for overdose prevention laws seems to indicate a paradigm shift away from the harshly punitive drug laws of the late 20th century towards a more health-centered approach to drug addiction. Attorney Corey Davis, Deputy Director for the Network for Public Health Law, Southeastern Region, has been studying and advising stakeholders on naloxone access laws since 2010 and has noticed the shift in attitudes.
"I think there's been a changing tide in perceptions of the war on drugs in general," he says. "We see a growing acceptance of marijuana, both for medical and recreational use, relaxation of the crack/cocaine disparity, and reductions in state prison populations after many years of steady increases."
There are some who argue that the shift has to do with the danger and prevalence of prescription drugs, which are often abused by people of power and affluence. With the crack cocaine epidemic focused mostly in inner cities, or methamphetamine use most popular in poor rural areas, it was easy for people who make and enforce laws to crack down hard on drug users. But now, with drugs and overdose creeping into their own medicine cabinets, their own homes, with the suburban and middle class children of powerful people at risk, the laws are starting to change.
Attorney Mark Sigmon, a lawyer with Graebe Hanna & Sullivan PLLC in Raleigh, N.C., lost a family member from a narcotic overdose and now supports laws that encourage people to seek help for an overdose and increase access to the opiate overdose antidote, naloxone.
"For many years it was widely accepted among lawyers and judges that the penalties for drug crimes were too harsh, but no politician wanted to run on reducing those penalties. However, that ice is beginning to thaw," he says. "I believe that when both common sense and data suggest that we can save lives at relatively little cost [with naloxone and 911 Good Samaritan laws], there's no reason not to do it. To sacrifice those lives because of irrational discomfort or stigma is not just bad policy, it's immoral."
Attorney Davis agrees. "We now have a fair amount of evidence as to what works to reduce the likelihood that a person will commit crime, from quality pre-school and lead abatement all the way through evidence-based drug treatment and structured social learning," he says. "We also have a lot of evidence as to what works to get people who are using drugs problematically, particularly opioids, to start using them more responsibly or stop using them altogether. It's time we started making laws based on evidence instead of centuries-old prejudices."
That prosecutors and district attorneys, who were once 911 Good Samaritan and naloxone law's stiffest opponents, are now often its main advocates, is testament to the winds of change in the United States. What's left now is for advocates to continue to capitalize on this momentum so that policy change translates into real results -- lives saved and families prevented from grieving.