Who is Biased Against Prison and Sentencing Reform?

https://www.amazon.com/Get-Tough-Smart-Winning-Addiction-ebook/dp/B07YXGRHX1 

Get Tough & Smart - How to Start Winning the War on Drug Addiction (2019)

How serious is the U.S. Opioid Crisis?

In 2012, cumulative American drug overdose deaths exceeded our deaths in the Second World War.[1] In 2017, there were 70,237 drug overdose deaths in the U.S.[2] By 2021, our total drug overdose deaths will exceed all U.S. war deaths.[3] Our current incarcerated population in American prisons and jails, many of whom are addicts or drug traffickers, is over three times all U.S. war deaths. American addiction is more deadly than war. Addict deaths represent fully wasted lives. “For every drug overdose that results in death, there are many more nonfatal overdoses, each one with its own emotional and economic toll.”[4] “In 2015, an estimated 547,543 emergency department visits occurred for all drug-related poisonings in the U.S.” and “rates were highest among persons aged 15–19.”[5]

“The overall mortality rate for unintentional drug poisonings in the United States grew exponentially from 1979 through 2016. This exponentially increasing mortality rate tracked along a remarkably smooth trajectory for at least 38 years. By contrast, the trajectories of mortality rates from individual drugs have not tracked along exponential trajectories.”[6] We focus much attention on the current Opioid Crisis, but it is a sub-epidemic. In the larger picture we see skyrocketing overdose mortality rates that transcend specific drugs, ages, races, time course and geographic distribution. Skyrocketing overdose mortality represents reckless overconsumption of illegal narcotics. The years from 1979 through 2016 saw the growth of massive incarceration.

We are losing or have already lost the old War on Drugs. American life expectancy has declined for three years in a row on account of increases in drug overdoses, chronic liver disease and suicide,[7] all three linked to drugs and alcohol. To avoid reversal of the American Dream, we must change strategy and tactics.

Overdose survivors sometimes have permanent brain injury due to oxygen deficiency during overdoses. “Approximately one quarter of those entering brain injury rehabilitation are there as a result of drugs or alcohol, while nearly 50 percent of people receiving treatment for substance misuse have a history of at least one brain injury.”[8] Skyrocketing drug overdoses over time produce even less intelligent and capable addicts. “The opioid epidemic has led to the creation of a new term: Toxic Brain Injury.”[9]

What caused it?

Here are some causes. We can fault the following situations, factors, people, tendencies, organizations and conditions for making our opioid crisis worse in the USA:

Illegal drug cartels who make, process, lucratively sell and distribute heroin, morphine, fentanyl, pain pills and opioids generally.

Declining prices for and increasing purity for heroin over the last few decades.

Total failure and sometimes back-firing of Just Say No!, D.A.R.E. and other drug prevention campaigns aimed at youth.

Inventors and manufacturers of the powerful opioids fentanyl and carfentanil … and all the other addictive opioid drugs, legal and illegal.

American influence in Afghanistan that has allowed Afghanistan to become the #1 supplier of opium and its derivatives.

Gateway drugs of alcohol, nicotine and marijuana.Workplace, sports and motor vehicle accident injuries leading to increased demand for opioid pain pills.

Chronic pain from whatever condition.Inability of addicts to know what they are taking, measure proper doses or know the effects of mixing two or more different drugs together.“

“Catch and Release” of overdosed addicts.

Resuscitating overdosed addicts and releasing them soon thereafter, without diverting them to drug abuse treatment, and the repeating of this process multiple times.

Toxic brain injury due to overdoses and consequent deprivation of oxygen as breathing slows or stops.

Addicts addicted to opioids.

Too many people who are depressed, have mental illnesses, are at low points in their lives, have addictive personalities, etc.

The super-strong psychological process of denial.

Addiction is a disorder or disease which causes the addict to deny they have a disorder or disease.

Pharmaceutical companies like Purdue Pharma oversold opioid pain pills and misrepresented the likelihood of addiction.

Social Security Disability claimants used pain as one reason they sought disability … and then they had to stay in pain to continue benefits.

Treating pain as the 5th Vital Sign, including legislation requiring it to be assessed.

Overprescribing physicians and “pill mills.”

The FDA allowed OxyContin and other opioid pain pills to carry misleading labels.

The CDC withdrew pain medication from too many people and encouraged them to turn to heroin.

The DEA for making medication-assisted treatment too restrictive or cumbersome for physicians to qualify.

Dr. Mitchell Max and the American Pain Society.

The White House for appointing Drug Czars in a democracy where czars have no power, implying that the federal government had a handle on things.

American prosperity and disposable income.

Music lyrics over the last 50 years that extolled drugs and made them more enticing.

Freewheeling consumer culture that emphasizes doing what feels good.

Ineffective drug abuse treatments and therapies.

Drug abuse treatments misrepresented as to effectiveness.

Making “relapse” a dirty word in drug abuse treatment circles.

Societal and community disapproval of methadone clinics and prejudice against methadone.

Both stigma concerning drug addiction and the lack of stigma for certain aspects of drug addiction.

Outdated laws.

Handling of drug addiction through criminal legal actions to the near-exclusion of civil and administrative actions and remedies.

Loss of parental control over drug-addicted children when children reach age of majority.

The ever-increasing number and variety of drug analogs and new drugs.

Ignorance of initiates as to different ways and methods to become addicted (i.e. smoking, snorting, injecting or ingestion).

People and institutions enabling drug addicts.

People thinking they can try heroin, meth and cocaine once without getting addicted … or twice without getting addicted … or on an irregular basis without getting addicted.

Ignorance of addiction, warning signs, medication-assisted treatment, brain function, neurology, psychology, and of effective drug abuse treatment.

The pleasure-seeking portions of the human brain.

Failure to study or take note of the only democratic nation in the world to completely overcome their opioid problems: Singapore.

Failure to study or take note of the European nations who have approached addiction differently, namely Portugal and Switzerland.

Dirty needles that impart HIV and hepatitis C.

Extensive and porous borders and huge territory to police.

Chinese fentanyl manufacturers.

Inadequacy of incarceration as punishment or deterrence for drug offenses.

Propensity of released prisoners and addicts leaving residential treatment to overdose due to loss of tolerance to opioids.

Wage stagnation, automation and industries moving to low wage countries.

The decline of communities throughout the Rust Belt, Appalachia, the Deep South, Midwest and West.

Poverty making drug dealing more attractive and drug taking more exciting.

Drug traffickers operating in a private enterprise mode out-competing inefficient, slow, bureaucratic governments.

Bitcoin and Dark Web transactions enabling drug traffickers.

Mental problems making addiction more problematic and difficult to address successfully.

All of the social, family, genetic and personal problems and factors that make drug addiction more likely and problematic.

Exponential increase in overdose mortality since 1979, eventually leading to skyrocketing overdose mortality rate in the USA.

What is the solution?

Reform. I studied incarceration over the course of a decade, have written on the subject, and am dead-set against the massive inert incarceration we now have in the U.S. I already had behavior modification and work systems in mind when the Opioid Crisis hit. My ideas and proposals include ways to put prisoners and drug addicts to productive and profitable work and use substitute punishments in lieu of incarceration. The same punishments will help fight addiction and massive incarceration at the same time. Most opponents of massive incarceration tend to be on the liberal side, while I am a conservative. It is lonely far outside the box.

The United States has through various means increasingly subsidized its worst elements and now supports the largest group of full-time welfare recipients in the world, the U.S. prison and jail populations. Prisoners need to work, but special interest laws keep them inactive most of the time. Prisoners could labor for private manufacturers, not the monopolistic money-losing prison industries run by governments. If they made goods like light bulbs, stainless steel rebar, dress shirts, vending machines and toys that are now only made overseas, U.S. labor would benefit. To do this, I propose a safety-oriented laissez-faire business model, free of restrictions on prison-made goods and prison labor. Most federal and state statutes governing labor-management relations and most laws imposing liability against employers would need to exempt prison industries and labor. Over the last decades, others proposed similar reforms to get prisoners working, but we have not revitalized tiny prison industries or put many prisoners to productive labor in the private sector. I was just the latest voice advocating the revitalization and therefore privatization of prison industries and labor, but newer voices have picked up the refrain.

The multiple goals of this book are to decrease crime, drug addiction and incarceration. This means improving drug treatments, deterring teenagers from drugs and crime, boosting the American economy and encouraging legislative experimentation at the State and local levels. We should make punishments just, faster and more effective deterrents, less expensive and visible in the community. We have to attack the demand for addictive narcotics while we minimize the sources.

Drugs generally produced massive incarceration and drug addiction, which justifies studying the sick symbiotic connections and analyzing the gigantic problems together. Punishing crime supports the war on drug addiction and vice versa. As the Chief of the Bureau of Organized Crime in the Chicago Police Department put it, “So in Chicago, our violent crime is our drug problem, and our drug problem is our violent crime problem.”[1] I outline the many links and similarities between crime, drug addiction, criminals and addicts. We must hold addicts and offenders fully accountable over the course of years.

Drugs create addiction, and the old War on Drugs gave birth to massive incarceration. Below are multiple ways to accomplish the general goals of drastically reducing each of those social problems. Others will have new solutions, so my list is by no means exhaustive, exclusive or guaranteed. I propose we attack our problems in different ways in each State simultaneously. Some proposals could be implemented now because they are legal, practical or already in place. Most of the proposals would require legislation at the State or U.S. levels. The majority of my proposals can be implemented independently, although they strongly support each other. Some suggested reforms are very controversial, at least for now. Here are the more easily implemented reforms:

Decriminalization or De-Penalization. A State could establish a Dissuasion Commission to govern, control and work with addicts under its supervision. Being a civil not criminal process, a Dissuasion Commission might have authority to commit or confine addicts in the name of public health or send them to drug-free workplaces or other institutions, but not jail or prison. One State might de-penalize recreational possession of a drug, while preserving draconian punishment for drug traffickers. Singapore sends addicts to Singapore’s drug treatment centers, just so long as the quantity held by the addict is below their legal limits, above which the defendant is heavily presumed guilty of drug trafficking and faces the death penalty.

The States are already legislatively experimenting with marijuana legalization. Other States can move in the opposite direction to punish marijuana with renewed vigor, reduce illegal drug use with civil legal actions (those not involving charging people with crimes) or legalize older punishments. We should watch what foreign nations are doing, because there is an infinite variety of drugs and ways to handle legal consequences. We should get used to the idea of States trying different solutions, some opposed to each other, because we need legislative experimentation. Nobody has all the solutions, experience or knowledge. Those in authority are beginning to admit their helplessness.

Eliminate Bias Against Medicines & Educate. Medication-assisted treatment (“MAT”) refers to substitute drugs prescribed to overcome opioid addiction. Methadone, buprenorphine and naltrexone are the most common medicines and are opioids themselves. Many oppose these drugs due to expense, diversion concerns, uneven results and the difficulties of administering them. A common prejudice holds that MAT simply substitutes one addictive drug for another. MAT medicines are the gold standard for treatment of opioid addiction, even though half of addicts on these medicines, under current procedures, relapse within six months.[2] They allow addicts to work productively and live fairly normal lives. On the flip-side, most non-MAT drug treatments lasting just 30 or 60 days and not followed with substantial aftercare and family or other support are ineffective except as temporary incapacitation. The public needs to know how ineffectual nearly all drug treatments can be, so that we do not continue to pour money into vessels that leak badly and so we can bolster all treatments.

Medication-Assisted Drug Treatment in Prison. Very few prisons provide MAT for their prisoners. We should increase medication-assisted drug abuse treatment (MAT) in prisons, especially in the 30 to 60 days before release. If on parole, opioid addicts should be required to take their methadone or buprenorphine dose regularly, without using recreational drugs.

Provide Standard Texts & Workbooks to Help Addicts and Their Supporters. Parents, grandparents, professionals and many others need education, because their drug-addicted children, grandchildren, clients and patients do not even think they have a problem. The confusing blizzard of debatable treatments, facilities, methods, websites, acronyms, brochures, theories and groups ought to be simplified for those who need a convenient and authoritative reference concerning each of the main drug addictions. From the perspective of the addict, there are enough shared principles, facts and local reference information for the addict and supporters to begin the process of recovery. Each State could authorize or issue such authoritative texts, revise them after input from interested parties, advance knowledge of drug addiction, drug laws and commence psychosocial and behavioral therapy in a rudimentary manner. The major theories and approaches could all be consolidated into factual guidelines, the best websites provided, computer-assisted treatment started, and the subjects of relapse, insurance, costs, resources, benefits, statistics and addiction-related diseases provided, without sugar-coating, bias, financial or hidden agendas. Recovery is not rocket science, despite an alphabet soup of acronyms, it is just extremely difficult to escape what addicts desire. Texts could list services for addicts and the homeless. Parents and families are entitled to know how high the relapse rates are before they spend retirement savings on expensive ineffective drug treatments.

The reforms stated above are already underway, easily accomplished or could be implemented in a year or less. Major or significant legislation will be required for the following proposals, because they change the rights, responsibilities, opportunities and options for offenders, prisoners, addicts, civil defendants and those who treat, employ, prosecute and sentence them:

New Legal Status. We should create the legal status of “addict,” attainable at various junctures such as overdose admissions to hospitals, conviction on drug-related charges or dangerous overt acts, admissions by addicts or parental designation. A new legal status will expedite and improve civil legal proceedings and mandatory drug treatment without prosecutions for crimes.

New Duty for Addicts. We should create a civil legal duty on the part of the addict to make reasonable progress toward abstinence. Methadone and buprenorphine maintenance participants could initiate this procedure, since those medications take away craving for opioids. Alcoholics convicted of their first or second DUI or alcohol-related offense have a drug to take away their craving for alcohol. Cocaine and methamphetamine addicts likewise should have a legal duty to recover, although different duties and sanctions might apply for separate recreational drugs depending upon the availability of medication-assisted treatments and other factors. Complete abstinence is a great goal, but most cannot achieve it without social, family, legal and financial support and accountability.

Expand Civil Remedies & Mandatory Treatment. In the name of public health, we should expand civil proceedings to bring more addicts involuntarily into outpatient or residential drug abuse treatment, therapeutic communities, recovery residences, employment or other controlled environments and keep them committed to recovery. We could hopefully develop drug-free employment, home or school environments through civil commitment in the name of public health, and can provide basic drug treatment or therapy in these drug-free environments. Civil commitment can expand to include multiple destinations, treatments and handling. We could confine addicts as a civil commitment in the interests of public health and force them to initiate methadone or buprenorphine maintenance therapy if they are addicted to opioids. In jail or detention initially for purposes of public health, a physician could establish their correct methadone or buprenorphine maintenance therapy doses to be administered in confinement. We could put Frequent Flyers[3] into mandatory treatment directly from the hospital, and could use jail cells for their civil commitment, all under existing U.S. Supreme Court rulings. “Patients who are opioid dependent and...commence methadone maintenance treatment do not require withdrawal maintenance; they can be commenced on methadone immediately.”[4]

After initial confinement, addicts could be referred to treatment, homes, facilities, Drug Courts, recovery residences and outpatient therapy while contact with addiction-related people and environments could be prohibited.

Addicts if below the age of 28 might be sent to the homes of their empowered responsible parents, grandparents, relatives or friends by raising on a very selected basis the age of majority for these addicts.

In view of the addicted population, the costs of residential drug treatments, and the greater number of months in residential treatment required for effectiveness, addicts might labor productively in drug-free work environments for multiple years in exchange for treatment, in something like indentured servitude, adding years to their lives.

Expand & Strengthen Drug Courts. Drug Courts have expanded into many jurisdictions but are selective in the offenders they accept. They act under criminal legal principles without effective sanctions or civil powers. We could strengthen Drug Courts with civil judicial powers by allowing them to order, control and supervise civil commitments to drug treatment, lengthy aftercare following treatment and application of more effective sanctions without incarceration. With civil legal actions, the Courts could coerce addicts to overcome their addictions.

Some proposed reforms will cost significant sums of money, major reworking of existing legislation or will generate enormous controversy while we in society debate. A very few geographically smaller States have already instituted a program to bring MAT to rural populations, and those programs would be more expensive in larger States.

Expand Hub & Spoke Program. States could adopt the Hub & Spoke program, as some smaller States already do. Mobile drug treatment vans could distribute methadone, buprenorphine and other medications in rural areas. Switzerland, Portugal and Singapore provide such services in their smaller nations. We should significantly improve mandatory and voluntary drug treatment availability, participation and results, over the objections of addicts, including expanded methadone and buprenorphine use and longer treatments. I think Drug Courts should punish the consumption of recreational drugs outside the prescription of the addicts’ physicians and generally enforce contracts or laws establishing abstinence goals.

Here is a reform I’ve been pushing along with many other persons interested in prison reform. I wrote a little-noticed law review article entitled How to Create American Manufacturing Jobs. This major reform will require substantial legislation at the U.S. and State levels. The interests previously blocking this reform can more easily assent to it now that much manufacturing has moved to low-wage countries like China and Vietnam:

Revitalize prison industries and create jobs for addicts. We could revitalize prison industries and labor under a laissez-faire model paying negotiated wages without the application of most employment related laws.[5] We must shield employers from the numerous lawsuits prisoners or addicts would file under laws regulating wages, hours, conditions of employment, discrimination of all types, and breach of contract, while preserving OSHA safety regulations, a form of workers’ compensation and other laws protecting people. Employers and prisoners would each have the right to terminate employment at will, sending the inmate back to the general prison population, subject to any written employment contracts. The American economy would receive a huge boost if we manufactured consumer and other goods now made exclusively overseas. This would include a surprising number of All-American brands now made in China and other countries,[6] including baseballs, blue jeans and Christmas lights.[7] Similar businesses are contemplated to employ drug addicts, although initially the work groups should be separated.

The Truth, the Ugly Truth. Our still-abstinent young people should see the whole truth regarding the fate of drug-addicted people. We should relax and modify privacy, confidentiality, police and paramedic policies, secrecy, medical record policies and non-disclosure laws enough to facilitate youth deterrence and prevention, help law enforcement and mandate compulsory treatment. We should subject addicts’ overdoses, faces, photographs, deaths, syringes, corpses, punishments and problems to much more photographic and video disclosure on the internet, in other media and in public. These awful things are the truth and families naturally want them concealed. Their full disclosure will surpass in effectiveness the multiple unsuccessful, expensive and counter-productive attempts to deter youth from initiating drug use. Emergency doctors should be able to talk to primary care physicians, and in other ways we need to enhance communication on drug topics.

Control Without Incarceration. We need to dramatically expand electronic GPS monitoring of offenders, beyond ankle bracelets, continue to develop advanced monitoring technology and develop a variety of new software, monitors, systems and devices to keep track of offenders and addicts. Remotely monitoring alcohol intake is highly advanced, but the same cannot be said of other drugs. Ankle bracelets are valuable tools, and in addition, we ought to have sturdier, more visible devices.

In lieu of designated periods of incarceration, re-incarceration, juvenile detention, continued addiction or expulsion from high school, we might allow defendants unable to make bail, juvenile delinquents, offenders, parolees, probationers, guilty criminal defendants and addicts to wear color-coded yokes or collars, with or without various electronic enhancements, adjusted in weight or removed according to the conduct, addiction or status of the offender.[8] States could adopt policies and punishments should a yoked or collared individual be found guilty of an offense or be out at night, in a proscribed place or with prohibited people. Cell phones and GPS technology would make enforcement of yoke control exponentially easier, since any bystander might call 911 to report an errant yoke-wearer. Removal of the yoke or collar could generally follow employment, sobriety, drug treatment or compliant school participation.

Most Controversial. The most controversial reforms I propose did not arise out of thin air, but instead were used throughout the world for centuries and millennia in the past. As a student of history, I found them in many places and discovered clear and powerful support in the scientific literature for their use. Great opposition to these controversial proposals arises from (1) lack of knowledge of their effectiveness, cost-efficiency, speed, publicity, portability, responsiveness and repeatability when administered in public with due process, judicial observation and two pre-determined limits, (2) the unknown and unsuspected preference of offenders for these punishments over incarceration, (3) their cessation in Western civilization for about the last four or five generations, (4) abuse in other cultures, circumstances and times, (5) their use to enforce values we condemn in Western civilization, (6) the isolating government-driven centralization of hidden punishment found in our current American incarceration regimes, (7) inaccurate and biased Hollywood and televised portrayal, (8) our freewheeling and relatively wealthy consumer culture, (9) Eurocentric bias and ignorance of Singapore’s triumphant success in defeating their opioid crises and achieving the lowest crime and addiction rates in the world, (10) unfamiliarity with or indifference to the twin disasters of massive incarceration and drug addiction, (11) the anomaly that the punishments are legal and sometimes harmfully administered to children but not legally to adults, (12) identification with abolished slavery without considering the worse modern slaveries of drug addiction and massive incarceration, (13) dealing with overdoses and addiction as a disease rather than as a behavior, to the exclusion of handling overdoses primarily as the reckless, senseless, suicidal overconsumption of illegal drugs, and (14) misperception as to which procedures are backed by science and which are not so supported.

In addition to the proven scientific principles of behavior modification, these controversial punishments came from or are sanctioned by the Old and New Testaments of the Bible together with American and world history. Ridding Singapore of opioids, addicts and drugs better than any other nation in the world ought to prove effectiveness scientifically, but Americans are still trying to get a grip on the situation without any reference to Singapore.

Knee-jerk opposition and a refusal to even discuss direct behavior modification in the Bible Belt show how much public opinion must change before some of the suggested reforms are adopted. Immediate opposition to new techniques represents a lack of urgency, ignorance or apathy concerning the sorry state of American addictions and massive incarceration. Confidence in persuading people now arises from skyrocketing drug overdose mortality, declining life expectancy in the U.S. for the last three years, monumental failures of drug treatments and punishments, Frequent Flyers, fentanyl, the power of criminal gangs and cartels, declining prices and increasing purity of illegal drugs, the continued invention and distribution of new illegal drugs, corruption produced in foreign countries and at home, and most of all our spectacular inability to deter and prevent young people from initiating drug use.

Selections & Reference: Get Tough & Smart: How to Start Winning the War on Drug Addiction (advocates more civil handling of drug problems, expanded Drug Courts, legal duty on addict to recover, mandatory treatments, work for addicts & prisoners, more MAT, punishments other than incarceration, less enabling, denormalizing recreational pharmacology, denial destruction, abstinence reinforcement, more publicity of worst aspects of addiction, less emphasis on NIDA brain disease paradigm, relaxation of some HIPPA requirements, etc.).