Substance abuse (both drug and alcohol) closely correlates to the nation’s crime rate. In fact, prison populations physically reflect this association. According to the National Council on Alcoholism and Drug Dependency (NCADD):
80% of offenders abuse drugs or alcohol;
Nearly 50% of jail and prison inmates are clinically addicted;
Approximately 60% of individuals arrested for most types of crimes test positive for illegal drugs at arrest.
The correlation between alcohol and crime seems clear and straightforward. It tests as a factor in 40% of all violent crime, and according to the Department of Justice, 37% of incarcerated felons (state and federal) were drinking at the time of their arrests. Alcohol intoxication clearly plays a role in U.S. crime; but though drugs may also play a similar role, its association to crime is more complex. The expense of alcohol usually does lead people to commit crimes in order to get a drink. The black market cost of drugs, however, as well as the physical and psychological cravings they produce, will provide ample incentive for an addict to commit crimes in order to service an exhisting habit. In 2004, 17% of state prisoners and 18% of federal inmates said they committed their current offense in order to get money for drugs. Moreover, 60-80% of drug abusers will commit a new crime, usually drug related, after release from prison.
Consequently, drug addiction obviously plays a substantial role in the occurrence of crime. It would be reasonable to argue, therefore, that effective treatment for drug dependency would prove an effective tool both to control criminal behavior and to reduce prison populations. Ironically, drug treatment in general–and treatment for offenders in particular–fails to be as effective as it might be—despite remarkable success stories and flattering statistics. Why?
Drug Treatment: Ineffective for Two Reasons
First, it is admittedly expensive. Detox alone can cost from $1000-$1500 per patient. Inpatient rehabilitation for 30 days can run $6000 per patient or more, and outpatient rehabilitation will cost $5000 or more for 90 days. When compared, however, to the social costs of untreated substance abuse and prison incarceration, these figures actually appear economically attractive. Nonetheless, the expense does get in the way of offender treatment. In 2015, for example, the NCADD reported that out of 1.9 million juvenile arrests involving substance abuse and addiction, fewer than 69,000 received abuse treatment.
Second, the tools to treat drug addiction often backfire. This is an historical fact, not a critical observation. Drugs designed to free the addict from the oppression of the habit have also been addictive. Consequently, they have often become the addict’s drug of choice, simply exchanging one addiction for another. Today, heroin addicts on a maintenance program of methadone may simply augment the clinic’s allotment of that drug by purchasing more on the black market. Thus they carry on their opioid addiction using a different opioid formula.
A History of Irony
Irony #1: Opium Indulgence
This represents the kind of irony characterizing the history of substance abuse and its treatment. The poppy, a beautiful flower, is the source of opium, a raw pain-killing substance regularly cultivated and harvested in the East, where it has been widely used for centuries.
The British East India Company assumed a monopoly on its trade in the mid 18th century. Tragically, Europe and America imported the drug eagerly and adopted its unregulated use. Though legal, the opium dens of the 19th century certainly oppressed the lives of the poor, taking what little money they had and offering a dangerous environment in which to indulge in drug-induced dreams.
But businessmen, aristocrats, authors, actors, and even, allegedly, notables of the Old West, such as Wild Bill Hickok and Kit Carson, indulged in this habituating recreation. It was no less destructive and addictive for them than it was for the poor, but wealthier people could extend the degenerative spiral. Sir Author Conan Doyle in his Sherlock Holmes story, “The Man with the Twisted Lip,” describes such a place in Victorian England.
Upper class women in America and England, however, typically avoided the opium dens and even public drinking. Instead, they privately indulged at home in a 10% opium/90% alcohol “medicine” called laudanum, frequently prescribed by physicians for “female problems.” It became a popular and dangerous vice. Elizabeth Barrett Browning, for example, used it habitually for physical and psychological ills. Historians, however, disagree over the role the drug played in her death.
Irony #2: Morphine Epidemic
Refinements continued in the processing of opium. Ironically, these refinements led in 1810 to the development of morphine, named after the Greek god of dreams, Morpheus. Morphine led opioids from brothels and the dimly lit Oriental drug dens to the most respectable hospitals. Physicians heralded morphine as a wonder drug for its ability to control severe pain. American physicians and hospitals gained access by 1850, but by 1860, doctors raised public alarm over its addictive misuse. This problem was about to get worse.
The American Civil War (1860-1865) tested to the full morphine’s ability to control pain. Its success in dulling the agony of battlefield injuries and Medical Corps amputations also added huge numbers of veterans from both sides to the growing morphine epidemic—so many, in fact, that the epidemic became known as the “soldier’s disease.” The addiction resisted available treatments, and doctors despaired of effectively managing the growing drug problem. In fact, many doctors found their medical access to the drug an irresistible gateway to their own addiction. The public and the government tolerated the public sale of opioids and other drugs, allowing, for example, in 1885 a modest percentage of cocaine to be sold in the soft drink, Coca-Cola. Time for another irony.
Irony #3: Heroin to the Rescue
This “rescue” came from Germany in 1874, in the form of a new opioid named heroin. It was so titled because medical experts saw this drug as the chemical answer to all that was wrong with morphine.
Supporters touted it as a treatment for general opioid addiction. Quickly imported into the United States, physicians used it as a tool to fight the morphine epidemic. Of course, heroin proved to be even more addictive. Addicts simply switched their addiction, making heroin their drug of choice.
Though declared illegal by the 1924 Heroin Act, its abuse continued to grow. Criminal markets thrived. Addicts sacrificed their days and nights to the needle, suffered painful withdrawal symptoms when they couldn’t get a supply, and frequently forfeited their lives in overdose.
During Prohibition, the Depression, and even World War II, opioid addiction (opium, morphine, cocaine, and heroin) continued to prey upon the lives of the rich and the poor.
Though the war interrupted the world’s supply of opium for a time, new suppliers soon emerged to meet the demand. America offered an eager market. Though originating before 1920, the term “junkie” became familiar in popular culture during the 1950s. It applied to anyone suffering addiction to heroin or other opioids. Today, it refers to any addiction.
From 1965-1970, the number of heroin addicts in the U.S grew to three-quarter million, creating havoc particularly in the nation’s inner cities. But the malady had also spread to suburban schools and college campuses. Though psychedelic drugs (e.g. LSD) offered some competition, America’s involvement in Vietnam opened a floodgate into the U.S. of opioid smuggling and veterans who had become addicted during their Vietnam tour of duty. Consequently, heroin continued to create new addicts, make obscene profits for drug dealers, and generate yearly casualties. Again, time for another irony.
Irony #4: Methadone
In the late 1930s, the German pharmaceutical industry synthesized methadone, another pain killing opioid that most people today associate with the treatment of heroin addiction. In the mid-1960s, New York experienced a spike in heroin-related deaths and the spread of disease by addicts sharing needles. This led to the “drastic solution,” the use of methadone as a tool to help addicts break the heroin habit. The Methadone Clinic was born. In a few years, it had spread nationwide.
Methadone works to reduce narcotic cravings, ease withdrawal symptoms, and even block the addictive euphoria associated with opioid use. Usually given in tablet form, methadone has been available for decades in treatment clinics to help addicts free themselves from the needle. Despite reported success, however, methadone has received mixed reviews.
Under supervision, methadone effectively treats opioid habituation, giving addict freedom. But critics charge that addicts can also abuse methadone, becoming addicted to that drug. Moreover, those who successfully stopped using heroin with methadone have continued on maintenance for years, unable to stop using the replacement drug. Again, this essentially swaps one addiction for another. So the cure for heroin addiction has become an addiction itself. Enter the most recent irony.
Recent Irony: Suboxone
Marketed as a painkilling drug in the 1980s, suboxone (a combination of buprenorphine and naloxone) has emerged as a powerful anti-opioid therapy for those addicted to heroin or other opioids. Suboxone is a synthetic opioid, administered as sublingual strip or as an orange pill. The drug blocks the effects of opioid intoxication and allows addicts to detoxify their bodies. The naloxone component blocks brain receptors from binding to opioids, thus eliminating the high. The drug also manages cravings and withdrawal symptoms. Some experts see it as a more effective treatment for opioid addiction than what methadone provides.
But like methadone, suboxone is also addictive. That’s a weakness. Addicts can habituate themselves to that drug, too. So the tool designed to free them can also enslave—again, trading one addiction for another.
King of the Prison Drug Trade
Despite its promise, suboxone has become the prisoner’s drug of choice and “king of the jailhouse drug trade.” Ironically, the anti-narcotic opioid now enjoys a keen demand in the nation’s prisons—including Indiana’s. The drug can come in paper thin dissolvable strips—cheap, easy to hide, and undetectable by drug dogs. In 2015, the Indiana Department of Corrections confiscated more than 2400 strips of suboxone. What got through is unknown. How much were the confiscated strips worth? On the street, a strip will cost $10-$12; in prison, that strip will go for up to $100. Do the math.
The profit margin offers quite an incentive for prison employees to get into the smuggling business, especially since suboxone is so difficult to detect. How do inmates get the drug? Indiana investigators say that it is sent by mail, smuggled in by visitors, or delivered by bribed prison employees. In Indiana, prison investigations of drug smuggling have led to the arrests of several correctional officers and prison staff.
An addictive opioid, suboxone suffers from the same problems as methadone—long maintenance periods and illicit use. The swapping of addictions seems to be the recurring theme in drug treatment history.
One more disturbing fact, fentanyl, which drug dealers have been adding to heroin in recent years, can defeat suboxone’s ability to block the brain’s opioid receptors. That’s not good news. The ironies continue.
Will the Ironies End?
One hope that might bring this history of ironies to an end rests in the development of new technologies. Treating opioid addiction by using another opioid seems intrinsically risky. But those are the tools available today. In the future, chemicals that ease withdrawal, block opioid euphoria, and manage drug cravings, may have chemical structures that addicts cannot abuse. That would free them from drug dependency without risking a new addiction. Lofexidine, for example, is such a drug and now awaits FDA approval.
To reduce crime and lower prison populations, we should all pray for a drug treatment like this. Of course, some addicts may toss away even such an ideal intervention and go back to the habit that destroys their lives. That’s always a choice. But having a non-addictive intervention would offer hope even to these addicts. Bad choices need not be permanent. Making it easier to change them would save lives—and money.
David Richardson
SOURCES:
Posted by davidmx3000 
Senator Elizabeth Warren has apparently changed her mind on vouchers. In a book she co-authored in 2003, The Two-Income Trap: Why Middle-Class Parents Are (Still) Going Broke, she supported them. In her challenge to Betsy DeVoss’ nomination as Secretary of the Department of Education, she has changed her mind.
INDY RE-ENTRY FOCUS 