The Pulse: On The Front Lines Of The Overdose Epidemic

Jan 28, 2016

Naloxone, pictured here, can reverse an overdose in seconds. Michelle McKenzie's PONI program offers training in how to use the nasal spray or injected versions.
Credit Kristin Gourlay / RIPR

Rhode Island’s drug overdose epidemic has not abated. But there has been some progress in marshaling more resources to fight it. The General Assembly recently reinstated the Good Samaritan law, which protects people who call 911 for someone who’s overdosing. 

And the governor’s overdose prevention task force has nearly finished some plans for implementing a long list of recommendations to curb overdose deaths. But will this work bring real change?

On this week’s The Pulse, Rhode Island Public Radio’s Kristin Gourlay talks with Michelle McKenzie for some perspective. She heads the Miriam Hospital’s Preventing Overdose and Naloxone Intervention program, working with addicts and people in recovery one-on-one to try to save lives. 

More commentary

Michelle McKenzie offered some additional thoughts about drug use and abuse and its intersection with the criminal justice system. There's more to it than passing laws, she says, and there are some good examples of what works to help prevent drug abuse as well as boost addicts' ability to recover and be reintegrated into society. A lightly edit version of her commentary follows:

Michelle McKenzie writes:
Approaching addiction and drug use through the criminal justice lens is not only ineffective but detrimental:

1)    Disparate enforcement - drug use happens in all walks of life, yet individuals who are arrested and prosecuted are overwhelmingly poor and often minorities. In Rhode Island, overwhelmingly, people who are dying and in treatment for opioid use are white, but do the arrest rates reflect that? It seems incomprehensible that they wouldn’t. But I bet they don’t.

2)    As promoted by the Substance Abuse and Mental Health Administration and based on the work of researchers like Bill White and Alexandre Laudet, recovery is more likely when people have the resources available to them to support their recovery – we call it recovery capital (see http://www.recoveryanswers.org/recovery/addiction-ary/recovery-capital/). By definition, when someone is criminally justice involved, they are stigmatized and face barriers to employment, housing, keeping their children, etc. In Rhode Island, they literally remain involved in the criminal justice system for years post incarceration via probation (though, hopefully that is changing with the recommendations of the Governor’s Justice Reinvestment Working Group (https://csgjusticecenter.org/jr/ri/) . Even post probation, people are marked as an “ex-offender” for the rest of their lives.

3) Violence at home and abroad that has been spawned by the drug war.

The list goes on. What the current drug policy has absolutely not accomplished is decreased access to drugs, decreased drug use or decreased harm to individuals or communities as a result of drug use.

It’s interesting to me that it is common now to hear repeatedly by law enforcement and politicians say that we ‘can’t arrest our way out of the problem.’ It is not at all clear what that translates into. So, far, not much in the way of moving away from the criminal justice approach.

What are alternatives? Decriminalization of drugs is definitely an approach. Portugal is an example where that has been instituted. Here are some links to information about that experiment:

https://www.unodc.org/documents/ungass2016/Contributions/Civil/Transform-Drug-Policy-Foundation/Drug-decriminalisation-in-Portugal.pdf

http://www.drugpolicy.org/sites/default/files/DPA_Fact_Sheet_Portugal_Decriminalization_Feb2015.pdf

http://mic.com/articles/110344/14-years-after-portugal-decriminalized-all-drugs-here-s-what-s-happening#.t5NI03vcM

http://www.drugwarfacts.org/cms/Portugal#sthash.HVdzZ3Qz.dpbs

https://www.whitehouse.gov/ondcp/ondcp-fact-sheets/drug-decriminalization-in-portugal-challenges-and-limitations (ONDCP response to data coming out of Portugal)

Decriminalization alone can’t be enough though. Portugal also invested a lot of funds to augment the public health and harm reduction resources, create jobs and provide an adequate social safety net – all things that contribute to recovery capital.

What is fascinating to me is that so many people who are not obviously socially marginalized have been susceptible to opioid addiction. Clearly there was a tremendous increase in access to opioids. There are definitely people who would be genetically predisposed toward addiction. But genetic predisposition isn’t destiny. Being socially marginalized may contribute. But it’s not just the socially marginalized who are susceptible.

Criminal justice reforms are necessary, then, but insufficient. It takes more along the lines of what Portugal has done – bolstering the social safety net, investing in public health – to achieve real progress.