The Drug Holocaust part 2

The Drug Holocaust 2

 

A year ago I tried to make the argument that the attempts to control the supply of illegal intoxicants led primarily by the U.S. Government for the last 100 years has been incorrectly characterized as a "drug war" and should and perhaps someday will more accurately be characterized as an "addict holocaust." After all doesn't a war require that both sides fight to some extent? The war on drugs while sold as a war on suppliers has been a war on minorities and on the poor. While pictures of sad and unkempt dealers on the news followed by pictures of cellophane wrapped products sitting on a table with uniformed law enforcement standing at attention behind continue to be commonplace we never see videos of captured cops standing next to armed addicts being forced to read a manifesto denouncing their role in the war. It is the government that attacks and the poor who suffer, the poor and addicted who suffer most of all. Sometimes it seems like we are finally ready to try something else. There are programs popping up here and there attempting to replace the ineffective punitive models of the past and present that were effective enough to lead us to what might be the worst addiction epidemic ever. Everyone knows that heroin use has increased dramatically but few know so has alcohol use as has death from alcohol related diseases. Hard to blame that on pain pills. But even as these new encouraging models appear the dehumanizing effects of the old (and current) way are so powerful that progress may be impossible.

Consider this headline from npr.com 

Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

You may have to cut and paste the link to read the article and if that doesn't work there's a link to it on the Grey's Recovery Facebook page.

http://www.npr.org/sections/health-shots/2017/03/21/520830183/doctors-consider-ethics-of-costly-heart-surgery-for-people-addicted-to-opioids?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20170321

The article is not as terrible as the headline makes it sound. The ethical guidelines discussed are more about connecting a patient with drug treatment than leaving them to die because they continue to shoot heroin.

"Daly says that the guidelines are not some kind of moral test. Instead, they are meant to help doctors connect patients with a primary care physician or set them up with addiction counseling."

"This is not the patient proving to the medical team that they are worthy of a new valve, that they are worthy of the surgery," Daly says. "We wanted to make sure that that could not happen."

But it could happen. It does happen, it will continue to happen. For those of you working in the field ask your clients what their last emergency room visit was like. If you work in a traditional abstinence based program the treatment your clients receive will shock you. If you work in a methadone clinic you will be appalled. See you can't wage a war on a substance. A substance can't be your enemy. You can only wage a war on the people who use that substance and the enemy in any war must be less than human.

Why isn't the answer to the question "How many times should you replace the same heart valve?" as simple as saying "as many times as you can"? Why isn't a cheaper more effective solution to the problem even discussed? The cardiac problems of IV opiate users aren't caused by the drug they are caused by the "war" on the drug. Impure products and dirty needles cause the infections mentioned in the article. A cheap solution that would be more effective than any surgery would be to make needles free and easily accessible and to provide a safe supply of opiates.

The new administration has made it clear that not only do they plan to continue the failure of the drug Holocaust and plan to make matters worse by resuming the prosecution of cannabis users. I expect minimal resistance by those affected with the addiction disorder as the sit in the recovery group I run and argue for even harsher drug policy. The holocaust has not only devastated individuals, families, and communities across the globe, it has produced Hitler's willing executed and the end no longer appears to be in sight.

Don't Let the Boogieman Be Your Boss

The regulating bodies for the mental health/chemical dependency field place a huge burden on the professionals in the field and that is never more apparent than when a client dies. You will lose clients. If you stay in the field for any length of time some will die. Some will die of health problems, some from violence, some will take their own lives, some will fall victim to very bad luck, and some will die of unintentional overdose. When this happens one or all of the regulation bodies will descend upon your organization and comb through your treatment notes. They may ask you uncomfortable questions, they may seem like the inquisition. You may feel unduly blamed, you may be unduly blamed and more than likely you will to some degree blame yourself. One of the worst things that can come from this is the professionals involved leave the experience thinking they can never let this happen again.

The worst policy and professional decisions are the ones motivated by fear. They usually take one of two forms, discharging a client who is deemed "too risky" to keep in your program because gods forbid they die on your watch, or putting so many unrealistic requirements on the client that they disengage or are driven away from treatment. While the death of a client under your care will require that you prove you did everything possible to keep the client alive, the death of a client shortly after discharge only requires you tried some type of intervention before the discharge. Threatening the client with discharge if they don't do A, B, and C counts as an intervention, no matter how unrealistic A, B, and C may be counts as an intervention and the regulating bodies will check that you documented the threat and leave confident you did everything you could.

So we can sleep at nigh we tell ourselves the clients brought this on themselves, that the clients failed we did not fail them. We tell ourselves we did it for the client's own good. When that fails us we resort to the Nuremberg defense, we say we didn't have a choice because if we had not discharged, if we don't continue to discharge similar clients, they will take away our licenses. The problems with this are legion so I'll just mention a few.

1) "They" the regulating bodies are not after our licenses. Not only have I never seen a counselors license revoked for continuing to treat a client who is struggling, I have never even heard of it happening. The counselors I've heard who lost their licenses (I don't know any personally) lost them for gross incompetence or unethical behavior like entering into a sexual relationship with a client. The regulating bodies need people doing our jobs so they can keep their jobs. The boogieman isn't real.

2) Even if you are answerable to a regulating body that will revoke a counselor's license for a sound clinical decision, our job is to help people to recover from substance use problems, it is not to protect our license. Usually doing the first doesn't exclude the second but to do this job right may sometimes requires a little courage.

Fear based decisions are almost never good clinical decisions if you let the boogieman be your boss you will hurt the people who need you the most.

Sent from my iPad