By Polina Ukrainets
As a student of psychology and public health and as someone that grew up in Baltimore, I see the issue of addiction as an extremely important one. For decades there have been debates on how to handle addiction and whether it is a problem of criminal justice or of public health. Lately, and fortunately, there have been increasing attempts to make it the latter.
In an article published in the Baltimore Sun [i], Dr. Leana Wen, Baltimore’s health commissioner, explains a new statewide initiative called LEAD that will focus on treatment of addiction rather than on incarceration. LEAD has already been found to be successful in downtown Seattle. The article notes that a defining feature of the initiative is that “there is no arrest at all”. I think that this is an extremely important step to help addicts without throwing them into what is often called the “revolving door” of the criminal justice system. The program also seeks to help addicts while they are in prison and immediately upon release to assist them in returning to the community while decreasing the risk of relapse. In Baltimore, the heroin epidemic is climbing, with the number of overdoses having doubled since 2010. The drug economy contributes greatly to Baltimore’s high crime rates, another major area of concern. It is time that we accept that jailing addicts will not cure this widespread health issue and implement programs like LEAD that can holistically help the community.
The drug crisis is not confined to Baltimore, or to heroin. The New York Times reports similar patterns with anti-anxiety drugs [ii]. They report that the rate of overdoses involving benzodiazepine prescriptions was 0.58 per 100,000 adults in 1996 and rose to 3.07 per 100,000 adults in 2013. Interestingly, this article notes that much public attention is on the abuse of opioid painkillers, which often leads to heroin abuse. When reading about Baltimore, that was certainly the case. When reading the comments on the New York Times article, a commenter that claimed to suffer from chronic pain and to use prescription painkillers properly even called the attention on opioid abuse a “hysteria” and a “shameful witch hunt.” Reading these comments really made me think about how people outside of the public health community view these issues of addiction.
Between all of the public health classes I have taken, I have seen Elizabeth Pisani’s TED Talk “Sex, drugs, and HIV” [iii] countless times, and each time I find something interesting and relevant in it. Pisani is a public health researcher that has worked with a number of at-risk populations, one of which being heroin addicts in prison. She discusses the sharing of needles in prison as a major contributor to HIV transmission but presents an extremely interesting point: in an addict’s mind, not using the shared needle would mean not getting high, therefore the use of the shared needle is perfectly rational to the addict. Pisani goes on to discuss clean needle programs and their success in various countries, noting that they are not popular in the U.S. and asks the question: why? Pisani then shows what I think is an extremely accurate and powerful visual (taken directly from the TED Talk video):
As I was reading the comments on the previously mentioned news articles and reflecting on the general public view of drug users, I immediately thought of this image. The public wants to put their money and efforts into bright, hopeful children rather than hopeless addicts.
As public health professionals, I think it is our responsibility to research, raise awareness, and provide treatment and support to this vulnerable population.