Drug Treatment vs. Drug War

President-elect Joe Biden was once one of the leaders in the idea that criminalizing drug offenses would lead to control of our country’s massive drug problem. The three-strikes laws filled our prisons with low-level drug offenders while doing nothing to actually get people OFF drugs.

Luckily, we have experienced a massive tide change in how we think about substance use disorders. Many states voted in this past election to decriminalize or even legalize marijuana, while Oregon legalized even “harder” drugs such as heroin and hallucinogenic mushrooms. Biden himself has turned away from a philosophy where law enforcement reigns as the rulers of how to deals with our drug problem, and has instead shifted to a public health perspective in which the focus will be prevention and treatment.

Many, however, are still skeptical of Biden due to his past actions and beliefs. As the data becomes available for how bad it has become during this pandemic, including 2020 overdose death totals, we will be able to see more clearly what is necessary. As a healthcare provider, I know that police involvement and jail time doesn’t help. I also know that at a certain tipping point, treatment may not work either unfortunately.

For example, I once cared for a man, a former alcoholic who had 30 years sober, living a stable life with a job. But then, his girlfriend left him. He went out and got drunk, started a fight, and fell down some stairs. He showed up in my ICU with a subdural hemorrhage (SDH) as well as a small subarachnoid hemorrhage (SAH)– both classic injuries from a traumatic fall. Over his days in the ICU, we talked at length about his sobriety and plans for the future. This was his first fall off the wagon, as you might say. He had a job and a house. He spoke to his boss, who guaranteed to hold his job for him until he got better. He wanted treatment after he recovered from his head injury. I had such hope for him.

He never came back to the ICU. But about 8 months later, I heard from a nurse upstairs “on the floor” that he had died. He drank himself to death, ended up homeless. He probably “lived” in one of the neighborhoods around the hospital, and recognizing him, the medics always brought him back to us. He had declared his “code status” to be DNR, meaning that if he were to experience a cardiac or respiratory arrest (ie, code), he did not want to be resuscitated. And he wasn’t.

In the end, I really think focusing on treatment and prevention will get people help earlier in the disease process, instead of landing them in jail over and over–or worse, finding them dead. We need to treat substance use disorders instead of punishing those who suffer from them.