Obama’s Heroin Strategy: Treating Addiction or Arming the Drug War?

An empty vial of Narcan (Naloxone), a drug used to combate opiate overdose. (Photo: P. Judy)An empty vial of Narcan (Naloxone), a drug used to combate opiate overdose. (Photo: P. Judy)Quincy, Massachusetts, has had a heroin problem for years, but the police are not chasing down heroin users. Some drug users are even flagging the police down for help. That’s because Quincy police are not focused on arresting drug users, but they are ready to come to their aid if they overdose.

Police in Quincy have successfully administered the opiate antidote naloxone nearly 400 times since their department became the first in the country to train its officers to carry and administer the drug five years ago. Naloxone, also known by the brand name Narcan, temporarily blocks the effects of opiates on the brain, and, when administered correctly, can reverse a potentially fatal overdose.

Quincy police point overdose victims toward drug treatment resources instead of pulling out the handcuffs and taking them to jail. A mountain of research shows that incarceration is not an effective form of drug treatment for most people addicted to opiates, and the threat of arrest can deter drug users from calling an emergency number for help when an overdose occurs in their midst.

Suspected drug dealers are not so lucky. In June, police busted up a “heroin delivery service” operating in Quincy and surrounding south Boston suburbs with raids on three houses that resulted in four arrests and the seizure of 350 grams of heroin with an estimated street value of $150,000, according to the Quincy police. The alleged drug dealers were all arrested on multiple felony charges.

The Quincy Police Department’s policies mirror the Obama administration’s new pilot strategy for combating rising rates of heroin use and overdoses: Treat people living with addiction, and arrest the dealers. When the White House unveiled the plan last week, mainstream and even progressive media outlets declared that the initiative marked a shift in focus from punishing drug users to treating them.

Drug reform advocates, however quickly criticized the plan for failing to put enough emphasis on drug treatment, while funding the same kind of drug war-era law enforcement strategies that have exponentially increased the nation’s prison population while doing little to curb drug use.

The Drug Policy Alliance (DPA) said the strategy took “one step forward” and “two steps back.”

“Half of what they’re doing is right – the focus on health and overdose prevention – but the other half, the side that focuses on the failed arrest and incarceration policies of the past is destined to ruin lives and fail,” said Bill Piper, director of the group’s national affairs office.

The plan, known as the Heroin Response Strategy, is funded with a $2.5 million chunk of $13.4 million in funding for the High Intensity Drug Trafficking Area (HIDTA) program, a drug war project created by Congress in 1988 to foster coordination between law enforcement agencies in areas of the country where a lot of illegal drugs are supposedly sold.

The funding will allow regional HIDTA programs operating in 15 East Coast and Appalachian states hard hit by heroin to hire a drug intelligence officer and a public health expert to “target heroin trafficking and support prevention efforts,” and “foster a collaborative network of public health-public safety partnerships,” according to the Office of National Drug Control Policy (ONDCP).

The drug officers are supposed to track heroin-trafficking patterns and help cops on the street bust dealers. The public health officials are supposed to analyze overdose data to identify heroin batches cut with dangerous adulterants and set up naloxone training programs for cops and first responders so the life-saving drug can be distributed for use in areas where it is needed most.

Patrick Heintz, a former corrections officer and drug counselor with the reform group Law Enforcement Against Prohibition, said the focus on public health was merely window dressing for a policy that essentially funds the drug war.

“This is kind of like putting lipstick on a pig,” Heintz told Truthout.

Naloxone Is a No Brainer, But What About Treatment?

Heintz agreed with the DPA that putting a sliver of federal law enforcement funding toward tracking overdoses and distributing naloxone is a positive step toward confronting a documented increase in opiate abuse and overdose deaths.

“The very least we could do is provide resources to save someone’s life,” Heintz said.

Deaths related to prescription painkillers like hydrocodone and oxycodone quadrupled from 1999 to 2011 as sales of the drugs increased at a similar rate, according to the Center for Disease Control. Painkiller overdose deaths dropped in 2012 for the first time in over a decade and remained steady as heightened oversight at medical facilities and federal crackdowns reduced prescribing rates. However, the number of heroin-related deaths has skyrocketed in recent years as people who’ve become addicted to painkillers turn to street drugs to find their fix.

While naloxone can bring someone back from the brink of death during an overdose, it’s not a treatment for opiate addiction, which can be hard to come by unless you have access to a quality treatment facility and the money or health insurance to pay for it. (Of course, it is possible to recover without seeking external treatment, but many people find that medication and/or intensive counseling are critical to their recovery.)

“They don’t need 15 drug intelligence officers,” Heintz continued. “They need 1,500 treatment professionals in facilities where [drug users] can get treated on demand. Drug addicts don’t want to go through another day of being sick, and they do want treatment, but there is no place to get it.”

“On demand” means treatment is available when someone with a substance abuse disorder chooses to seek treatment, not by the order of a police officer or a drug court. Some people who are arrested for drug possession don’t need or want treatment.

ONDCP spokesman Mario Moreno Zepeda, however, told Truthout that the Heroin Response Strategy is just one part of the Obama administration’s “public health and public safety” approach to reduce heroin and painkiller abuse. The strategy also includes supporting “community-based prevention efforts, educating prescribers and the public about preventing prescription drug abuse … and increasing access to medication-assisted treatment and recovery support services to help individuals sustain their recovery from opioid use disorders.”

Medication-assisted treatment, also know as MAT, combines therapy with opiate replacement drugs such as methadone and Suboxone. Although MAT has a history of being socially stigmatized and controversial, years of research suggest that it’s one of the most effective treatments for opiate addiction. The Department of Health and Human Services recently announced $100 million in new funding for expanding substance abuse disorder treatment at community health centers, including MAT. The department also made $11 million in grants for MAT available in 11 states.

There is still a long way to go. Even Michael Botticelli, Obama’s latest drug czar who has been lauded as a champion of compassionate reform and announced the response strategy last week, suggested that some people who seek treatment in the response strategy’s 15 target states may not be able to find it.

“Many of our treatment systems are operating at capacity [and] have long waiting lists,” Botticelli said during a recent interview with NPR. “Many parts of the country don’t have a specialty treatment program, but they do have a community health center. So, focusing on increasing the capacity within our hospital systems and primary care facilities becomes really important for us.”

Fueling a “High Intensity” Drug War

Congress barred HIDTA funding from supporting drug treatment back in 1998, so the Heroin Response Strategy does not provide further funding for addiction treatment at hospitals and primary care facilities. It does, however, fund the sort of law enforcement crackdowns on drug trafficking that have repeatedly failed to stop drug use during the past four decades of the war on drugs.

“That was the bone that was thrown at the drug warriors to show them in fact that they are not irrelevant yet, even though they should be,” said Sunho Tree, director of the Drug Policy Project at the Institute for Policy Studies.

Tree was referring to the law enforcement agencies that participate in the HIDTA programs that Obama’s heroin strategy is based around, which have long been criticized by drug policy reformers. The DPA claims that HIDTAs “lack congressional oversight” and have failed at their original purpose of busting high-level drug traffickers. Instead, the programs “generally waste resources pursuing individuals engaged in low-level drug crimes.”

Tree called HIDTA programs “a longstanding boondoggle” that remains popular among lawmakers who fear being labeled “soft on drugs” and use the programs to siphon federal funding back to their home districts. The programs, he said, have a history of encouraging police to make a high number arrests in order to qualify for more funding. This gives cops the incentive to focus on poor, low-level drug offenders who are much easier to pick off than big-time traffickers.

“We haven’t changed the reward mechanisms for any of our bureaucracies,” Tree said. “They should be measured on outcomes rather than a body count. How many people have you helped, how many drug overdoses have you stopped, not how many people you can round up and prosecute, which of course is the low-hanging fruit of low-level offenders.”

HIDTA’s purview has expanded from five original regional programs to now cover about 60 percent of the US population across 45 states, so there is a good chance that you live in a so-called “high intensity” drug trafficking area, according to the DPA. This expansion appears to defeat the program’s original purpose of focusing resources on top-priority areas. The expansion also points to the ongoing failure – and perhaps absurdity – of drug war policies focused on reducing supply by arresting people who sell drugs. Even if resources were focused on top priority areas, there is plenty of evidence to suggest that law enforcement crackdowns waste resources and continually fail to effectively stop drug trafficking.

“Poverty is your real problem here,” Tree said. “Maybe you want to address that instead of throwing more people in prison.”

Clusters of overdoses across the country have been tied to batches of heroin cut with powerful drugs like fentanyl, and Tree said that disrupting trafficking networks only increases the chance that dealers will cut their drugs with dangerous adulterants.

“This concept of, ‘Let’s disrupt more and more and push against these trafficking networks’ is actually leading people to cut their drugs with fentanyl, and then you have these various dosages and impurities, and that’s when it gets very dangerous,” Tree said.

Sparking a “Cultural Shift”

Not all reform advocates are discouraged by Obama’s heroin strategy. Daniel Raymond is a spokesman for the Harm Reduction Coalition, a national coalition of groups that provide people and communities with syringe exchange programs, overdose prevention resources and safety supplies that reduce the harm caused by drugs. He said Obama’s heroin strategy may not be perfect, but it is a politically realistic and welcome step toward treating addiction as a public health issue.

“It’s embedding a public health sensibility into the law enforcement response,” Raymond told Truthout.

Raymond pointed out that Congress, not Obama or any other president, established the HIDTA program and appropriates its funding, and the White House’s drug control office is simply tasked with deciding what to do with it. The money is earmarked for law enforcement – and statutory limits like the congressional ban on funding treatment programs limit what reformers in the Obama administration can do with it – so they got creative.

“They are using law enforcement money and pulling it in a public health direction,” Raymond said. “Because it’s a small amount of money, it seems symbolic, but these small things start to add up.”

Raymond said that teaming law enforcement up with public health analysts is a helpful shift in the right direction. The HIDTA in New York City, for example, has already pioneered a data-sharing partnership with public health officials, which has helped providers understand where and why people are overdosing so they can target areas for naloxone distribution.

Obama’s heroin strategy also provides political cover for police in communities like Quincy that have not waited for the blessing of lawmakers to start treating drug abuse as a public health issue instead of a criminal one. Cops and public health officials in Massachusetts have no time to wait – 1,008 deaths in the state were linked to opiates last year, more than ever before.

Raymond pointed to Gloucester, a city about an hour and half drive north of Quincy in Essex County, which reported 123 opiate overdoses last year. Gloucester police recently launched their own initiative to fight overdoses by treating addiction as a disease, not a crime.

In June, Gloucester police began inviting anyone struggling with drug addiction to bring their remaining drugs and paraphernalia right to the police station, where police can safely dispose of them. Instead of charging them with a crime, the police immediately assign them a drug counselor who starts walking them through the process of detoxing and finding treatment at two local clinics that support the effort.

The police pledged not to arrest anyone, but the deal is not legally binding. The police launched the plan after a community meeting in the mostly white, middle-class city, suggesting that public perception of the police is generally a trusting one – a perception that is quite different than that of many communities of color regularly targeted by police violence.

Naloxone is now available at local pharmacies without a prescription, and the Gloucester police are using money confiscated from drug dealers to purchase naloxone for those who don’t have health insurance or can’t afford it. The number of participants in the Gloucester program reached 100 earlier this month, and the police department’s Facebook page is full of comments from participants and their families thanking the police for their help.

“I’ve never arrested a tobacco addict, nor have I ever seen one turned down for help when they develop lung cancer, whether or not they have insurance,” Gloucester Police Chief Leonard Campanello wrote in a May 4 Facebook post that has since gathered 33,300 likes. “The reasons for the difference in care between a tobacco addict and opiate addicts is stigma and money. Petty reasons to lose a life.”

With Quincy and Gloucester as models, other police departments in Massachusetts have begun to change their policies toward drug users. This is exactly the kind of “cultural shift” in law enforcement’s approach to drug control that Raymond said the Obama administration is promoting with its Heroin Response Strategy.

“The White House is trying to harness this moment around getting the law enforcement response to the opioid epidemic grounded in public health instead of the traditional, ‘Let’s arrest all the users; let’s arrest all the dealers,’ that kind of old drug war mentality,” Raymond said.

Other reformers, however, point out that if drugs were truly being treated as a public health issue, the police would not be involved at all.

Politics Versus Policy: Talking Public Health While Waging Drug War

Critics say the Obama administration should put its money where its mouth is. The federal drug control budget has continued to grow since the war on drugs began 40 years ago and totaled roughly $25 billion in 2015, according to the DPA. A majority of the funding – about 55 percent – still goes to law enforcement efforts aimed at stopping the flow of drugs by cracking down on trafficking, while less than 45 percent is devoted to education, prevention and treatment.

The 2016 budget is not much different, and local and state governments spend an additional $25 billion on drug control every year.

Most police departments in the United States have not switched to treating drug users as patients instead of criminals, and critics like Tree and Heintz warn that the drug war mentality will live on as long as the government keeps supporting programs like HIDTA.

“If they wanted to switch law enforcement’s perception of this, they would take the responsibility of addiction totally away from law enforcement personnel,” Heintz said.

Heintz and Tree said that, if the Obama administration were serious about treating heroin and opioid drugs as a public health issue, it would remove federal barriers to research trials of safe injection sites where drug users can inject drugs under medical supervision. Such facilities have reduced rates of incarceration and blood-borne diseases in parts of Canada and Europe.

Ideally, they said, drugs like heroin should be legalized and regulated, which would pull the rug out from under drug dealers and ensure that drugs do not contain deadly adulterants. Heroin-assisted treatment, which involves administering pharmaceutical grade heroin to those who have failed to respond to other treatments, has been shown to reduce illicit drug use and criminal behavior while improving health and well-being. Heintz and Tree also noted that naloxone should be available across the country without a prescription, a goal that has only been achieved in a handful of states, although 30 states have passed laws in recent years that have removed barriers to accessing the drug.

Unfortunately, such reforms seem like common sense to advocates but remain politically unpopular even as public opinion continues to shift toward favoring the legalization and decriminalization of drugs.

“This is the problem with politics versus policy,” Tree said. “Politicians want to look like they are doing something, and the easiest way to do that is with a police presence.”

Raymond said Congress also has to be held responsible for reforming drug policy, and with influential lawmakers from both parties throwing their support behind Obama’s heroin strategy, it seems like an appetite for reform is growing on Capitol Hill.

Raymond pointed to language in the House version of a government spending bill that would lift part of a longstanding ban on allowing federal funding to support syringe exchanges, which made national headlines earlier this year after an HIV outbreak among injection drug users in rural Indiana forced conservative politicians to reconsider their opposition to the programs. The proposed language would not lift the ban on using federal money to pay for clean needles, but it would allow funding for staffers and substance-abuse counseling.

Will these reforms move forward? It may all come down to how the Obama administration measures the success of its HIDTA heroin response pilot. If success is measured by the number of lives saved by cops carrying naloxone and drug users referred to treatment, instead of the number of people convicted of drug crimes, Raymond said, then that would mark a “huge cultural shift” that could serve as a model for the rest of country. That’s a big “if,” however, as those metrics have yet to change, according to Tree. In the meantime, millions of federal dollars continue to pay for cops on the drug beat, a clear sign the war on drugs is not over yet.