Addiction, Community and State: A Review

Abstract

As clinicians, we are well aware of the importance of drug supply, price, availability, and access in propagating and maintaining illicit drug use, abuse, and addiction. However, we tend to be silent on these topics, leaving them to elected and appointed government leaders. The author proposes that our remaining silent is analogous to an infectious disease expert remaining silent on water supply and sewage in the midst of a cholera epidemic. It is not only unseemly for us to remain silent, it is unprofessional at best and unethical at worst. Governmental means of addressing the social genesis of addiction and illicit drug supply falls under the general rubric of statecraft. Our elected leaders, our appointed governmental leaders, and our publicly supported workers (e.g., police, courts, schools, health care workers, social agencies) can and do exert influences either favoring or counteracting illicit drug supply, use, abuse, and addiction. Public officials can and do learn the exercise of statecraft in addressing a large range of social needs, such as housing, transportation, security, a safe food supply, and so forth. They can and should develop knowledge, skills, and experience in the exercise of statecraft vis-a-vis drugs. This article reviews the relevant literature on this topic. In addition, the author reflects on his observations on "addiction statecraft" in several countries over the past three decades. He underscores the need to consider elements such as community deterioration, corruption of police and other officials, and social anti-drug strategies that have worked as well as those that have not worked. Public leaders must also take stands regarding intervention and treatment programs that are not widely popular, such as those involving methadone. The author argues that we speak out authoritatively on "addiction statecraft." In undertaking such social roles, we must take care to speak out of our own collective wisdom and experience, rather than out of personal bias or personal agendas.

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

“…Some state and federal prisons permit MAT for opioid-dependent prisoners, but the US criminal justice system has generally been reluctant to accept MAT (Magura et al, 2009; McMillan and Lapham, 2005; Nunn et al, 2009; Rich et al, 2005; Westermeyer, 2000). In 1999, a 202-court survey found that 39% of drug courts made methadone available to participants (Peyton and Gossweiler, 2001).…”

Buprenorphine and methadone maintenance in jail and post-release: A randomized clinical trial

“…A major obstacle to expanded access to methadone maintenance for inmates in the U.S. is the unfortunate and undeserved stigma that has come to be associated with it, i.e., a common belief among the public (Blansfield, 1996), treatment providers (Kang et al, 1997), and public authorities, including the criminal justice system (Simpson and Knight, 1998; Westermeyer, 2000; McMillan and Lapham, 2005), that methadone “substitutes one addiction for another” and is not a true tool of recovery. For example, staff of a large Southwestern jail “described a tremendous amount of animosity towards drug addicts and lumped methadone maintenance treatment recipients together with heroin addicts and criminals.” They were also concerned about methadone’s euphoria-inducing potential: “methadone is just another crutch, a way to stay numb” (McMillan and Lapham, 2005).…”

Drugs and Substances Reported in Emergency Department Presentations with Acute Recreational Drug / Substance Toxicity

“…Drug abuse predominantly represents a major problem worldwide that is included in clinical as well as legal aspects [1,2]. According to the World Drug Report in 2018, about 275 million people worldwide (roughly 5.6% of the global population aged 15-64 years) used illicit drugs at least once in 2016 [3].…”