Obama heroin strategy a positive step, but not big enough, advocates say

WASHINGTON (Sinclair Broadcast Group) — Drug treatment saved Anthony Alvarado’s life.

“If I didn’t have treatment, if I didn’t have therapy, I wouldn’t be having this conversation today,” said Alvarado, a recovering heroin addict and president of Rise Together, an advocacy group that provides outreach and drug education to students in Wisconsin.

According to the Centers for Disease Control and Prevention, heroin-related overdose deaths nearly doubled in the U.S. between 2011 and 2013, and they quadrupled between 2002 and 2013.

Increased heroin use has been seen among men and women of most age groups and income levels in recent years.

“It really truly is from our perspective, in hindsight, a public health issue, and it needs to be treated that way,” Alvarado said.

The biggest challenges for an addict seeking recovery, he said, are access to treatment and finding the willingness to ask for help. The two issues are somewhat intertwined; the lack of access to treatment is one of the things that made it so hard for him to seek help.

“We have to look at the disease of addiction like any other disease that we have,” he said

Someone who is sick can go to a doctor, get help, get treatment that is covered by insurance, and get referrals for post-treatment options and support without stigma and without fear of arrest.

“All those resources are at your fingertips if you’re a diabeticWhy can’t we have that for addiction?” he said.

The White House Office of National Drug Control Policy announced $13.4 million in new funding Monday to address trafficking, distribution, and use of heroin, much of it focused on public health and education initiatives. Alvarado called those measures “a great direction and a great start.”

“It’s so comforting to hear that something’s being done rather than nothing.”

Of $13.4 million in funding for High Intensity Trafficking Areas (HIDTA) announced Monday, $2.5 million will go specifically to the Heroin Response Strategy, a partnership among five HIDTA programs covering 15 states.

The White House described the program as “a collaborative network of public health-public safety partnerships to address the heroin/opioid epidemic from multiple perspectives.”

A public health coordinator will oversee regional reporting of overdose information and issue alerts about heroin-related threats. A public safety coordinator will work to ensure that support and intelligence are provided to law enforcement agencies to disrupt the heroin supply.

The program also entails development of a training curriculum to prepare first responders to handle heroin and opioid-related incidents.

“This administration will continue to expand community-based efforts to prevent drug use, pursue ‘smart on crime’ approaches to drug enforcement, increase access to treatment, work to reduce overdose deaths, and support the millions of Americans in recovery,” Director of National Drug Control Policy Michael Botticelli said in a statement.

Experts and drug policy reform advocates were optimistic about this latest step from an administration that has displayed openness to drug policies that put treatment and prevention before enforcement.

“That’s been a shift that’s been going on in the Obama administration for a long time,” said Sanho Tree, fellow and director of the Drug Policy Project at the Institute for Policy Studies.

“I think the Obama administration has taken the wide view on our nation’s drug policy,” said Grant Smith, deputy director of national affairs for the Drug Policy Alliance.

“Our national drug policy really is a large ship, and it’s going to take time to change the direction of that ship,” Smith said, and Monday’s announcement does indicate that the direction is changing toward a more balanced approach.

“It’s clear that the White House is engaged in looking at this, is supportive of communities that are doing this work,” he said.

Nazgol Ghandnoosh, PhD, a research analyst with the Sentencing Project, said the administration has been evolving toward a “harm-reduction approach” to drug policy since 2009, “not just using punishment and the threat of punishment to shake people out of this addiction.”

The shift to a harm-reduction-driven drug policy is far from complete, but Ghandnoosh said the Obama administration has been moving in this direction since officials stopped talking about a “war on drugs” in 2009.

The new heroin response program comes amid an ongoing push by advocacy groups for reforms in addiction and mental health policy, according to Abby Hendrix, president of Stop Heroin Now, an organization that educates the public about addiction and advocates for treatment.

“This strategy is definitely a step in the right direction. Heroin addiction must be addressed with support and treatment versus criminalization and institutionalization,” she said.

“There is no better time than now, as this issue cannot wait another day,” Hendrix said. “Another day means brothers, friends, daughters, parents, and individuals in society that are losing their battle with addiction and even more that are struggling to reach recovery.”

Approximately 120 people die each day in the U.S. from drug overdoses, the Drug Enforcement Agency said last month.

“We need an all-of-society response – to improve opioid prescribing practices to prevent addiction, expand access to effective treatment for those who are addicted, increase use of naloxone to reverse overdoses, and work with law enforcement partners like DEA to reduce the supply of heroin,” CDC Director Tom Frieden said in a July press release.

According to Tree, enforcement-driven drug policies have at times produced the opposite of the results that were intended.

Law enforcement agencies have been catching the less competent drug dealers, “selectively breeding for super-traffickers,” he said. “It’s a very Darwinian process.”

Criminalizing drugs takes agricultural commodities that are very cheap to grow and makes them astronomically more valuable on the street, Tree said, essentially subsidizing drug traffickers by inflating the price.

In fact, many advocates say the current heroin problem itself is the unintended result of the mishandling of the rise in prescription opioid abuse in the last 10-15 years.

As doctors overprescribed oxycodone and other opioid-based painkillers, patients grew addicted to them. The DEA then cracked down on the doctors and the drugs without taking enough steps to reduce the demand, Tree said.

The price of the prescription opioids on the black market skyrocketed and street heroin became a much cheaper alternative for addicts.

“This has enormous public health implications,” Smith said.

Prescription opioids are regulated and stable, but heroin can be cut with other substances and the user has no idea how potent a given batch is, which makes it easy to overdose.

One aspect of the new Heroin Response Strategy is distributing alerts about dangerous batches of heroin to health authorities.

Another important step that has been proposed by the Obama administration is expanding the use of naloxone, a drug that counteracts the effects of heroin overdoses, which many states now allow their first responders to administer but is expensive.

“Nobody, nobody needs to die from an opiate overdose,” Tree said.

According to Tree, naloxone is impossible to abuse but some “cowardly politicians” are afraid to endorse it because they think it sends the message that they are being permissive and encouraging drug use. He suggested that some people feel overdose deaths send a message to other drug users about the dangers they face.

“We’ve been letting people die for a very long time, and the messages haven’t gotten throughLet’s keep them alive first. The rest is negotiable,” he said.

Experts agree that more money should be spent on treatment-based responses to the heroin addiction problem, but some said the initial 15-state Heroin Response Strategy program should provide enough data to determine whether this approach is effective.

“There’s a lot of other ideas that have gotten off the ground with fewer participants than that,” said Darrel Stephens, executive director of the Major Cities Chiefs Association, a professional organization of police executives.

Alvarado, of Rise Together, said it seemed like a reasonable size for a pilot program to test the strategy, but “I don’t feel it’s anywhere close to the amount of funding that should be put into these types of programs.”

“I think the public health component is a valuable one,” said Smith, of the Drug Policy Alliance.

“It’s peanuts compared to how much money is devoted to the supply-side strategies” that have been failing for years, though. He said the new program will be valuable in providing a better real-time understanding of overdoses and could potentially reduce the demand for drugs.

He expressed concern, however, that the initiative is within the framework of HIDTA, which was created in the 1980s to target high-level drug traffickers and is still seen as largely an enforcement-oriented program.

Some advocates are even less impressed with the latest move by the White House.

“It’s kind of like fighting a house fire with a water pistol approach. It’s still more of the whack-a-mole drug reduction policy that’s failed for the last 40 years,” said Patrick Heintz of Law Enforcement Against Prohibition, a former corrections officer and substance abuse counselor.

Heintz does not feel the new program represents a shift away from law enforcement-driven drug policies.

“What’s so insane about is that we’ve been doing the same thing for 40 years and nothing’s changed except the enormous wealth accumulation by the criminality,” he said.

“It seems like we’re missing the point, missing the mark by miles.”

Heintz said the only effective way to deal with drugs is to treat them as a public health issue and regulate them.

“You can’t incarcerate your way out of a public health problem,” he said. “It’s like trying to arrest your way out of obesity.”

While he praised efforts to make naloxone more readily available and train first responders to use it, saving the lives of people who are already overdosing is the “bare minimum” the government could be doing to deal with the heroin problem.

Others in law enforcement see the Heroin Response Strategy as a positive step.

Darrel Stephens of the Major Cities Chiefs Association, himself a former police chief, said local law enforcement agencies have been struggling with heroin for years and it is good to see the issue getting some attention.

“What’s been missing historically in our efforts to deal with the substance abuse problem is not enough emphasis on treatment and prevention,” he said. The law enforcement side of the equation is important and drug dealers need to be held accountable, but for users and addicts, “jail makes little sense because there’s no treatment available.”

If the public health, education, and training aspects of the new program prove effective, he believes they could be applied to other illegal drugs as well.

“I think it’s a strategy that definitely would work with other drugs as well,” Stephens said, including methamphetamine, cocaine, and prescription drugs. “Treatment is actually a better option for all of them.”

It is significantly cheaper than incarceration in the long run, too.

“Prison hasn’t been effective and jail hasn’t been effective at all,” Stephens said. “If you can try a lower cost alternative that may have some promise, why not?”