I felt proud to be a Massachusetts resident as I listened to Governor Patrick’s state of the state address a couple of weeks ago. However, unlike the Governors of Vermont and Maine in their state addresses, Governor Patrick never mentioned the words “drug epidemic”; “addiction”; “heroin” or “prescription drugs”. As a physician with years of experience in both Emergency Medicine and Addiction Medicine and as a resident of the South End in Boston, I was disappointed by Governor Patrick’s omission although I do not doubt that our governor cares deeply about this scourge to our society. But how can we talk about the fiscal health of the Commonwealth without drawing attention to the tremendous societal costs of the disease of addiction; and even if one does not want to acknowledge that this is an illness with biological/genetic; psychological and sociological components, one cannot deny its horrific cost in terms of tax payer dollars, and public health and safety.
NIMBY – Not In My Back Yard – is the rallying cry heard from many politicians and citizens when asked if there is a drug problem in their neighborhood or if they would welcome a drug treatment facility. “Sure, maybe we have a problem, but it’s not that bad” or “it’s really worse in the next neighborhood over”, or “the next town over” or “the next state over.” Baloney – it’s in all of our yards and is as prevalent as the ragweed that grows in all of our lawns! It does not matter if we live in the city, suburbia, the Northeast Kingdom of Vermont or Downeast Maine – it is truly everywhere and New England has an especially high incidence of heroin and opiate drug addiction.
To truly understand the magnitude of this problem we need to examine the economic impact of addiction to society. There have been reports that when one considers the cost of drug use related to law enforcement, crime, judicial costs, incarceration, emergency room visits, hospitalizations, lost job productivity, and workers compensation; not to mention the deterioration of societal priorities or the overall risk to the public in terms of spread of disease (Hepatitis C & HIV) or secondary health and safety consequences such as domestic abuse or childhood asthma … the overall national annual cost exceeds $180 Billion. Moreover, as an example, to treat one heroin addict in an outpatient medication based treatment center with admission and yearly annual exams, laboratory screening for HIV and Hepatitis C, group and/or individual counseling on a regular basis, and frequent random drug testing, the cost for this patient in Massachusetts is approximately $5,000 per year. Halfway houses can cost $20,000 or more per year and incarceration of this patient costs upwards of $50,000 per year. And even if one wants to ignore the scientific evidence that treating a heroin or “Oxy” opiate addict with a replacement medication such as methadone or buprenorphine is not simply trading one addiction for another, one cannot deny the documented fact that patients who enter into this type of treatment have an approximate tenfold decrease in criminal activity.
I hope that our current state legislators and all our local politicians and citizens will look critically at the facts and not adopt a NIMBY approach to drug addiction that is ruining lives and stealing our tax dollars by inadequately treating and preventing this epidemic from expanding. Just look at some recent regional and national statistics:
- The Boston metropolitan area had the highest rate of ER visits for “illicit drugs” of any of the 11 major cities in the entire country;
- Greater Boston region ranked first in ER treatment for heroin overdoses, with a rate of 251 per 100,000 – nearly 4 times the national rate;
- MA Emergency Rooms see 4 times the number of cases featuring heroin compared to the rest of the country
- Opiate abuse-related MA hospital visits > 35,000/year;
- 950% increase in abuse of Oxycontin and other opioids in MA in the last 10 years;
- MA had > 102,789 people admitted to hospitals for substance abuse in fiscal year 2011;
- Heroin use in past 3 years has doubled since reformulation of Oxycontin;
- An estimated 20 million people nationally need treatment for substance abuse but only 15% – 20% receive it;
- 2% of US citizens are opioid dependent;
- Heroin supply & purity is up and costs are down (as little as $4/bag);
- In Massachusetts, in one year, 916 persons died as a direct consequence of drug use. This far exceeds those who died from motor vehicle accidents (397) and firearms (207); and
- Massachusetts drug-induced deaths exceeded the national rate
But how should we attack this problem? There is no easy answer but we need to look at both the supply and demand. We have tried to cut back on the supply side for decades, yet we are again facing a heroin/opiate epidemic, most notably in New England. Yes, we can arrest and incarcerate all the current drug pushers, big and small, and we can continue to burn the fields of the countries that produce opium; but the profits of this organized occupation of drug production and distribution is so great that others rapidly fill the void. Just ask the Taliban how much money they make now that Afghani opium production has markedly increased since the beginning of the war. So, I ask that the citizens of the Commonwealth of Massachusetts and elsewhere take a fresh look at this issue and make some of the hard decisions; decisions that can only be made by fully understanding, whether or not we believe addiction is a disease or a weakness of moral character, that expanded access and funding for treatment makes fiscal sense. We must cut back on the demand to stand a chance of limiting the financial damage. And to our politicians, I know this is a politically hot issue, but lives and dollars are at stake and it is time to lead the charge to educate through scientific fact and not out of fear. I commend Governor Shumlin of Vermont for spending his entire state of the state address on this essential economic issue and his call to attack the epidemic on the demand side (treatment); recognizing that putting more people in jail may make us feel good on the short term, but does not solve the problem. Governor LePage of Maine addressed the issue of drug addiction as an economic issue as well, but he unfortunately spoke not of increased funding for treatment and access to care, but only of expanded law enforcement and judicial response.
As the death of Philip Seymour Hoffman’s has again reinforced, drug addiction, including heroin abuse, is an equal opportunity disease affecting all socioeconomic strata; and knows no boundaries. This is not a problem of the welfare state or the poor or less fortunate. It is NOT NIMBY!! The disease is present in our impoverished neighborhoods as well as our wealthy suburban communities and in our resort towns and backwoods of New England. Establishing treatment centers for addiction in one’s own locale should be worn as a badge of honor, no different than establishing a cancer treatment center or cardiac center; both of which are illnesses that may be related to the disease of addiction. NIMBY no longer works!
Steven Kassels, MD has been Board Certified in Addiction Medicine and Emergency Medicine. He currently serves as Medical Director of Community Substance Abuse Centers (with treatment facilities throughout New England) and has authored the book, “Addiction on Trial: Tragedy in Downeast Maine”.
Written By Steve Kassels M.D.
THE HEROIN EPIDEMIC & NIMBY – Op-ed submitted to the Boston Globe was originally published @ Addiction on Trial and has been syndicated with permission.
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Excellently written article. While we have our own share of heroin addiction in the Chicago Metro area (yes, in affluent NIMBYs especially amongst teens), we are well aware of New England’s issues. Having worked in a jail, it was disheartening to see sick people locked up for various non-violent crimes (for the most part, that’s code that they were caught and “punished”). It’s also quite discouraging to hear Gov. LePage focusing on conventional criminal justice as the main answer. All three states do have Drug Courts which have solid success records. Per the NADCP:
+ Drug Courts Reduce Crime
•FACT: Nationwide, 75% of Drug Court graduates remain arrest-free at least two years after leaving the program.
•FACT: Rigorous studies examining long-term outcomes of individual Drug Courts have found that reductions in crime last at least 3 years and can endure for over 14 years.
•FACT: The most rigorous and conservative scientific “meta-analyses” have all concluded that Drug Courts significantly reduce crime as much as 45 percent more than other sentencing options.
+ Drug Courts Save Money
•FACT: Nationwide, for every $1.00 invested in Drug Court, taxpayers save as much as $3.36 in avoided criminal justice costs alone.
•FACT: When considering other cost offsets such as savings from reduced victimization and healthcare service utilization, studies have shown benefits range up to $27 for every $1 invested.
•FACT: Drug Courts produce cost savings ranging from $3,000 to $13,000 per client. These cost savings reflect reduced prison costs, reduced revolving-door arrests and trials, and reduced victimization.
•FACT: In 2007, for every Federal dollar invested in Drug Court, $9.00 was leveraged in state funding.
+ Drug Courts Ensure Compliance
•FACT: Unless substance abusing/addicted offenders are regularly supervised by a judge and held accountable, 70% drop out of treatment prematurely.
•FACT: Drug Courts provide more comprehensive and closer supervision than other community-based supervision programs.
•FACT: Drug Courts are six times more likely to keep offenders in treatment long enough for them to get better.
+ Drug Courts Combat meth addiction
•FACT: For methamphetamine-addicted people, Drug Courts increase treatment program graduation rates by nearly 80%.
•FACT: When compared to eight other programs, Drug Courts quadrupled the length of abstinence from methamphetamine.
•FACT: Drug Courts reduce methamphetamine use by more than 50% compared to outpatient treatment alone.
+ Drug Courts Restore Families
•FACT: Parents in Family Drug Court are twice as likely to go to treatment and complete it.
•FACT: Children of Family Drug Court participants spend significantly less time in out-of-home placements such as foster care.
•FACT: Family re-unification rates are 50% higher for Family Drug Court participants.
Hopefully, these legislators are simply not aware of their existence and need to be know that compassionate and socioeconomic justice does exist in all three states. Taking the funding from the ineffective “DARE” Programs and investing in more realistic prevention programs might also help. I know I sound very simplistic at this moment, but this is does not seem like the correct forum for theses and nitty-gritty, roll up the sleeves discussion. I look forward to hearing other viewpoints and how communities across the country have successfully drilled NIMBY into public consciousness.
We actually just rolled out a new forum for just that purpose, but as of now it is a ghost town. If you get a few people together who would like to take advantage of it we would be happy to facilitate. Email matt@socialjusticesolutions.org.
Sue: The statistics you quote are quite powerful. It has been reported that for every dollar we spend on alcohol and drug prevention we save $5.60 and for each dollar invested in alcohol and drug treatment saves $7.00. Unfortunately trying to effect change by talking just about the humanitarian cost falls on too many deaf ears. In order to reach a greater number of our neighbors and politicians and to change their hearts and minds about the disease of addiction, we must also address the issues through a detailed financial analysis of the cost savings. Thanks for your input. Much appreciated!
First of all let me thank you for bringing not only awareness but total truths about this demon of opiate addiction. This is an issue that I will never stop writing letters, emails ect… About. The system is so backwards I not only work in an emergency room and deal daily with this demon of addiction but also have a child who has struggled himself with heroin addiction. To tell our families story would be too long but feel free to watch my you tube video called drugs and the broken system it sums it up. Well seeing first hand the effects of this not only with my son but to countless young, old, men,woman this does not discriminate . Until there is change to the whole system this is never never going to get better. We have at least five patients nightly seeking rehab from addiction to opitates many who have been in and out of every rehab in Massachusetts maybe one if lucky actually has insurance other thas mass health a huge problem in this state ! I could on for days the stories I hear blows my mind many also get checks either welfare, social security food stamps free cell phones the list goes on … These are young able bodied kids that are receiving Ssdi for anxiety are you kidding??? In every case this somehow goes from an addiction to drugs to a psych diagnose? They then are prescribed clonopin, seroquil, lithium the list goes on often abusing these as well. They tell stories of selling food stamps at local stores to crooked store owners wanting to make an extra buck so say they receive $200 a month in food stamps they sell them for $100 and have money for their habit and the store owner makes out $100 bucks. I see kids as young as eighteen with more prescription meds than an eighty year old! They all have the same request asking for the so called night meds are you kidding ….. Just last week I had a young man also a heroin addict who is prescribed 90 percocets a month and 120 cloniopin a month he was 25 years old what is going on with this insane prescribing I just don’t understand how this epidemic is going to get better if this kind of irresponsible behavior continues? The healthcare system cost are not the only cost like you have spoken about in your article but the legal cost are outrageous as well. My son also is incarcerated due to his drug abuse also , that system is a huge joke they also abuse just. like on the street the prescription drugs. Gabapentin called jonnies in jail is highly abused lyrica now called Larry’s is another suboxin goes for $120 a piece often being brought in by workers who also want to earn a few extra bucks!!! The whole system is broken ! Until change in every aspect of this epidemic is changed it will never be better how about rehabs (drug free) rehabs that last longer than a week that teach life skills, help get people truly clean a mind free from all drugs hey that’s a thought. Maybe someday being able to be a contributor to society rather than a taker. Our economy would be so much better off……
Robin: Thank you for sharing your comments and I agree with much of what you say and you are courageous to share your personal story and your concerns. I have written my book to try to reach a large segment of the population that either would not choose to read about addiction or are in denial of the many aspects of our health care, law enforcement and judicial systems that are daily not appropriately dealing with the issues of substance use and mental illness. We can do better and we must. We must continue to speak out. I hope my book will change hearts and minds of neighbors, public officials and politicians that the disease of addiction must be dealt with from a demand point of view otherwise the humanitarian and economic costs will continue to be a scourge to society. If you do read “Addiction on Trial”, and if you do think it can be effective to change attitudes, please let others know. Thank you again for being courageous and outspoken. Steve