The Sentencing Project released a report Wednesday assailing the grievous lack of medical treatment for addiction in prisons and jails, hours before the newly appointed Bureau of Prisons director was scheduled to testify before the House of Representatives.
A national advocacy group released a report Wednesday assailing the grievous lack of medical treatment for addiction in prisons and jails, hours before the newly appointed Bureau of Prisons director was scheduled to testify before the House of Representatives.
Table courtesy of The Sentencing Project
While expanded use of drug courts helps divert people from the criminal justice system, authors of the Sentencing Project report excoriated policies that they said limit treatment within the correctional environment, arguing that lawmakers need to get on board with evidence-based methods in the war on opioids.
The report calls on the federal Bureau of Prisons, state prisons and local jails to follow recommendations of the President’s Commission on Combating Drug Addiction and the Opioid Crisis to increase access to medication-assisted treatment, particularly the use of substitutions such as methadone or buprenorphine.
This treatment is also backed by the Centers for Disease Control, the National Institute on Drug Abuse, and the World Health Organization.
A majority of the roughly 2.2 million people incarcerated in the U.S. report having a drug addiction, according to the most recent data from the Bureau of Justice Statistics; from 58 percent of people in state prisons, to 63 percent of those serving time in jail.
Talk therapy, support groups, and “drug education” are not enough to combat an epidemic that kills at least 91 Americans every day, according to researchers at the National Center on Addiction and Substance Abuse at Columbia University.
Decades of empirical research and the “reflections of police chiefs” show that last century’s punitive War on Drugs model was not effective in reducing either drug use or crime, according to the report.
Authors note that the Mental Health Parity and Addiction Equity Act gives us legislative tools to help close the treatment gap, but are widely under-enforced. The report emphasizes for the population at large, cutbacks to health care coverage provided by the Affordable Care Act are creating the larges barrier to treatment.
This summary was prepared by Victoria Mckenzie, Deputy Editor of The Crime Report. Click here to view the full report, Opioids: Treating an Illness, Ending a War by Ghandnoosh and Casey Anderson, Program Associate at The Sentencing Project.
A U.S. Sentencing Commission hearing was told Tuesday that customs and border patrol agents had seen a “dramatic increase in seizures” of fentanyl and its analogues, from one kilogram in fiscal year 2013, to 208 kilograms in 2016, to 550 kilograms in 2017—a 160 percent increase over the previous year.
Medical and law enforcement experts gathered before the United States Sentencing Commission (USSC) on Thursday to testify on the nation’s growing fentanyl epidemic, in what was the third hearing on synthetic drugs held by the Commission this year.
Over the course of the morning, a group of nine doctors, chemists, emergency medical staff and law enforcement agents discussed the chemical structure, trafficking patterns, and impact of fentanyl and fentanyl analogues, widely believed to be responsible for the sudden acceleration of fatal drug overdoses in recent years.
The latest round of expert testimony still shows this class of drug to be a mercurial and proliferating enemy, due to fentanyl’s extreme potency and the ease with which it can be chemically modified and moved across global markets.
According to CDC data, 33,000 U.S. citizens died of opioid-related deaths in 2015, a number which has quadrupled since 1999; when the The New York times crunched state-level data, it estimated that fentanyl and its analogues caused 20,000 deaths that same year.
But according to statements by Washington D.C.’s chief medical examiner Roger Mitchell Thursday, national data doesn’t provide the full picture.
“Many medical examiners and coroners are not listing each drug on their death certificate,” Marshall told the Commission during the hearing, which was broadcast live over the internet.
He said they fill out their reports “using terms like ‘mixed drug toxicity’ accident,” so there is no way to know which combination of drugs caused the death. For better detail, Marshall added, you have to turn to local jurisdictions.
According to Mitchell, Washington, DC saw a 178 percent increase in fatal opioid overdoses between 2014 and 2016, with 62 percent of cases involving fentanyl or fentanyl analogues in 2016. Some 84 percent of all overdoses were among adults between 40-69 years of age, while fatalities hit those between ages 50-59.
And contrary to the epidemic’s characterization as a disease killing white Americans, 81 percent of opioid deaths in DC between January 2014 and August 2017 were among African Americans.
Major Juan Colon, commanding officer of the New Jersey State Police Drug Monitoring Initiative, reported an illicit drug market that has come full circle since a flood of prescription opioids first created a reservoir of addicted and dependent customers in the 1990s.
Many of these people later moved on to use street drugs, as greater restrictions were placed on narcotic pain medications. Now, fentanyl and fentanyl analogues are being used to make counterfeit prescription drugs.
New Jersey has seen an increase of naloxone use by EMS and law enforcement, from around 5,000 administrations a year in 2010, to over 12,200 so far in 2017, reported Colon. While naloxone use alone isn’t a sufficient measure of fentanyl overdose rates, Dr. Brian Brown, chair of the University of Maryland Medical School, says first responders were among the first to notice a change.
“Without clinically knowing that [the patient took] fentanyl, we find that suddenly now the paramedics are realizing that they give some and it’s not working, because of the intensity and the strength of the fentanyl and the analogues,” he told the Commission.
“They have to give more of it, and it isn’t lasting as long.”
So although emergency responders are not testing for it, he added, “the clinical circumstances are indicating—this is not the usual opioid overdose.”
According to the United States Customs and Border Patrol (CBP), the agency charged with identifying and responding to global narcotics trafficking trends, the majority of illicit fentanyl sold in the U.S. is manufactured overseas in China and Mexico, and smuggled into the country over the southern border.
CBP Commissioner Robert Perez testified that his agency has overseen a “dramatic increase in seizures”of fentanyl and its analogues, from one kilogram in fiscal year 2013, to 208 kilograms in 2016, to 550 kilograms in 2017–a 160 percent increase over the previous year. CBP expects this number to keep climbing in 2018.
Perez said that the relatively low purity of fentanyl trafficked through southern points of entry makes it more difficult to detect in the field, a fact that has led the agency to introduce a number of pilot programs that make use of handheld tools, reagent test kits, and the development of more “signature odor profiles” for training canine units.
But in terms of potential harm, an even greater threat is posed by the increased availability of high-potency fentanyl sold on the internet and shipped into the country by mail or carrier service. Small amounts of pure fentanyl are more maneuverable and don’t require the coordinated efforts of cartels and gangs, opening the market to individual entrepreneurs and small-scale retailers.
Joe Schleigh, the Acting Chief of Synthetic Drugs and Chemicals for the Diversion Control Division of the Drug Enforcement Administration (DEA), added that manufacturing tools such as pill presses are also easy to order online from China, Mexico and Germany.
Witnesses reported different prices for one kilo of Chinese fentanyl (ranging from $200 to $5,200), but agreed that a single kilo can yield over $6 million in profits if cut into pills in doses of 1.5mg or less.
Schliegh said the DEA ““has become increasingly alarmed” by the proliferation of fentanyl and its synthetic analogues. Street chemists and retailers are constantly altering their products to stay ahead of law enforcement, often introducing new unregulated compounds as soon as the DEA takes action to classify a particular substance as controlled.
Perez also noted that the types of fentanyl and fentanyl-class compounds seen by U.S. Border Patrol laboratories grew from three in 2008 to 120 in 2016; and so far this year, CPB labs have analyzed 333 different kinds of fentanyl (broken down into 5 different class compounds and 2 starting materials).
It is enormously difficult for the DEA to trace the movement of Chinese drug compounds, said Schliegh, since traffickers use multiple freight forwarding services, making sure packages go through numerous chains of custody between the original supplier and border customs.
While CPB inspects mail arriving from over 140 different countries, Perez said agents are stymied by a lack of standardized cargo information, as well as the “sheer volume” of mail that needs to be manually inspected.
The Sentencing Commission also heard testimony from Dr. Howard Taft of the Maryland Department of Health and Mental Hygiene; Barry K. Logan, chief of Forensic Toxicology at NMS Labs; and Dr. Srihari Tella, Drug and Chemical Control Unit chief at the U.S. Drug Enforcement Agency.
Following the fentanyl panels, the Commission heard further testimony on the topic of synthetic cannabiniods.
Victoria Mckenzie is Deputy Editor of The Crime Report. She welcomes comments from readers.
A federal report released Wednesday examines FBI crime data in big cities, considering two possible explanations for the “sudden and unforeseen” spike in homicides nationwide.
A federal report released Wednesday examines FBI crime data in big cities, considering two possible explanations for the “sudden and unforeseen” spike in homicides nationwide.
According to the National Institute of Justice (NIJ) study, which focuses on cities with a population of 250,000 or more, preliminary evidence suggests that expansions in illegal drug markets have driven the considerable increase of homicide rates among whites. In 2015 and 2016, drug-related homicides increased to a greater extent than other types of homicide.
The second hypothesis authors consider is the so-called Furguson effect, which resulted in “de-policing, compromised police legitimacy, or both.”
NIJ stipulates that “current evidence that links de-policing to the homicide rise is mixed, at best,” and that it remains an “open research question”– since arrests-offense ratios and arrest clearance rates had been declining for years, as were homicide rates, before the recent spike.
Neither explanation is meant to stand alone; in particular, growing tensions between African Americans and police do not account for the abrupt increase in homicides among whites beginning in 2013.
A look at the numbers
Nationally, 2014-2015 saw the largest percentage rise in the homicide rate since 1968, according FBI data; an increase of 11.4% over the previous year, or from 4.4 to 4.9 homicides per 100,000 people.
National homicide rates continued to increase by 8.2% in 2015-2016, and 10.8% in big cities. In 2015, Cleveland and Nashville saw the biggest absolute homicide increases, while Austin and Chicago topped the chart in 2016.
Only two cities bucked this upward trend: Miami and Tuscon both experienced a decline in homicides over the two-year period.
Despite the recent incline, the homicide rate in 2016 was still 35.4% lower than it was in 1995. “Even at the elevated rates of increase in 2015 and 2016,” note the authors, “it would take about five more years for the U.S. national and big city homicide rates to return to the levels of the early 1990s.”
‘Sudden and unforeseen’
In the search for external ‘shocks’ that could explain the rapid and unexpected nature of the recent homicide increase, NIJ finds two plausible candidates, both of which have parallels in contemporary U.S. history: the opioid epidemic, echoing the crack-driven homicide escalation of the 1980s–and anger over police brutality and fatal use-of-force, such as precipitated the civil unrest of the 1960s (and corresponding “crisis of institutional legitimacy,” according to some analysts).
Researchers need better data to measure the affects of the opioid crisis, according to the report. Drug arrests are not a reliable indicator, since they are “a product of both police
enforcement and criminal conduct,” and since “policymakers and law enforcement officials alike have viewed the heroin and synthetic opioid epidemic as more of a public health than a criminal justice problem.”
There is some data to suggest a link between heroin and increased homicides: arrests for heroin or cocaine were falling between 2010 and 2013, but heroin use was on the rise. Arrests then rose in 2014 and 2015, coinciding with the accelerating homicide rate.
Data also needs to be disaggregated by race, in order to “determine whether, as expected, whites have entered local drug markets in greater numbers over time as both buyers and sellers.”
Police activity and community “reservoir of discontent”
When considering the influence on homicide rates of police enforcement, legitimacy, and community alienation, reliable indicators are also hard to chase down.
Arrest rates not only measure crime, but police activity, as noted above. “Arrests fell in Baltimore in 2015 after the Freddie Gray incident, and in Chicago in 2016 after the delayed release of a video of a controversial police shooting there.” The reduction in arrests was then followed by an increase of homicide in both cities.
However, researchers say that it “remains to be seen whether comparable decreases in arrests preceded increases in homicide elsewhere.” The link between homicide and arrests/de-policing needs to be further examined at the neighborhood level, since homicide rates vary substantially across neighborhoods.
Calculating police legitimacy and community alienation is “onerous,” and largely measured through opinion surveys– “for the time being,” say the authors, “it appears that strategic case studies and one- or two-time snapshot surveys will have to suffice.”
There are two empirical indicators that can be measured, however, if police departments are willing to release the data: calls for police service, and complaints against the police.
“If the community alienation hypothesis is correct, investigators should expect to observe a reduction in calls for service and an increase in complaints in cities where controversial use-of-force incidents and outbreaks of community unrest have occurred, particularly in African-American communities. Increases in homicide…should be greater in those cities and communities than in others.”
The dark figure of homicide
Finally, and critically, “it is important not to overstate the precision of these figures,”say researchers. “Like all UCR crime data, they are based on the classification of homicide events by local law enforcement agencies, and crime classification criteria and procedures can differ across agencies or within the same agency over time.”
Homicides with unknown circumstances are omitted from the FBI’s Supplemental Homicide Report– and “the circumstances of fully 39.9 percent of homicides were unknown to law enforcement officials in 2015.”
To locate many of the indicators that researchers have identified, researchers will have to go beyond FBI data and work directly with public health and police sources, say authors of the report.
Alaska has the highest rate of femicide by men, followed by Nevada, Louisiana, and Tennessee, according to the annual report of the Violence Policy Center (VPI) . Black women are more than twice as likely to be killed by men than their white counterparts.
The latest analysis of state-level homicide data shows a sharp increase in the rate at which women were slain by single men between 2014 and 2015 despite an overall 20-year decline, according to an annual report released by the Violence Policy Center (VPC) in September.
The 20th annual publication of When Men Murder Women analyzed the most recent Supplementary Homicide Report (SHR) data submitted to the FBI, which covers the year 2015, and offers a breakdown of cases in the ten states with the highest rates of female homicides committed by men. Alaska had the highest femicide rate, followed by Louisiana, Tennessee, South Carolina, Arkansas, Kansas, Kentucky, Texas, New Mexico, and Missouri. VPC notes that data from Florida and Alabama are missing, and data received from Illinois is incomplete.
The study, which only examined instances involving one female victim and one male offender, found that 1,686 females were murdered by males in the U.S. in 2015.
“This is the exact scenario—the lone male attacker and the vulnerable woman—that is often used to promote gun ownership among women,” write the authors, zooming in on VPC’s main target: gun laws. For 2015, firearms, and especially handguns, were the weapon most commonly used by men to murder women.
The report also notes the findings of a 2003 study from California which showed that while two-thirds of women who get a handgun do so for for protection, “purchasing a handgun provides no protection against homicide among women and is associated with an increase in their risk for intimate partner homicide.”
Editor’s note: According to the Gun Violence Archive, out of 46,597 incidents of gun violence so far this year, only 1,518 incidents were “defensive use” of a firearm– roughly equal to the number of accidental shootings, which numbered 1,511.
Here are highlights from VPC’s analysis of 2015 data on women slain by men:
For homicides in which the victim to offender relationship could be identified, 93 percent of female victims (1,450 out of 1,551) were murdered by a male they knew.
Fourteen times as many females were murdered by a male they knew (1,450 victims) than were killed
by male strangers (101 victims).
For victims who knew their offenders, 64 percent (928) of female homicide victims were wives or
intimate acquaintances of their killers.12
There were 266 women shot and killed by either their husband or intimate acquaintance during the
course of an argument.
Nationwide, for homicides in which the weapon could be determined (1,522), more female homicides were committed with firearms (55 percent) than with any other weapon. Knives and other cutting instruments accounted for 20 percent of all female murders, bodily force 11 percent, and murder by blunt object six percent. Of the homicides committed with firearms, 69 percent were committed with handguns.
In 84 percent of all incidents where the circumstances could be determined, homicides were not related
to the commission of any other felony, such as rape or robbery.
The Violence Against Women Act (VAWA) turned 23 this year.
Victoria Mckenzie is deputy editor of The Crime Report. Readers’ comments are welcome.
With global cocaine production estimated to be at historic levels, the flow of drugs, money and weapons through the Dominican Republic and its Caribbean neighbors looks poised to grow, reports InSight Crime. Homegrown criminal cells are also becoming stronger in a country that has traditionally come under the influence of Colombian and Mexican crime syndicates.
The man who was once considered the most powerful drug kingpin in the Dominican Republic and Puerto Rico has been convicted and sentenced to decades in a U.S. prison, raising questions as to who will step up to take control over the growing drug trade in this small but important trafficking corridor.
José David Figueroa Agosto, a Puerto Rican known by the alias “Junior Cápsula,” was sentenced to 30 years in prison on drug trafficking charges, local media reported on August 8. The sentence was handed down by a U.S. federal judge in May as part of a plea agreement, but relevant court documents had been sealed until recently.
A 2010 indictment charged Figueroa Agosto with shipping approximately 3 metric tons of Colombian cocaine between 2000 and 2001. His organization is thought to have controlled up to 90 percent of narcotics trafficking through the Dominican Republic and Puerto Rico at the height of his power. This led the Puerto Rican–who enjoyed a luxurious lifestyle, using various false identities and even resorting to plastic surgery to evade capture–to eventually be dubbed the “Pablo Escobar of the Caribbean.”
According to the indictment, Figueroa Agosto would acquire Colombian cocaine and ship it either straight from Colombia or through neighboring Venezuela to Puerto Rico. A U.S. Justice Department press release indicates that his group also dealt with heroin, and at times used private yachts to ship millions in cash earned from drug sales back to the Dominican Republic.
Earlier in his career in the drug business, Figueroa Agosto murdered an individual he believed had stolen cocaine, a crime for which he was sentenced to more than 200 years in prison in 1995. But four years later, the Puerto Rican national walked out of prison through the front door with a forged release permit, most likely with help from colluding guards.
Figueroa Agosto twice more secured his release in the Dominican Republic, supposedly by bribing officials, before his final arrest in Puerto Rico in 2010. Rumours swirled that he may even have bribed a presidential candidate. And in 2015, Figueroa Agosto’s defense attorney was sentenced to nearly six years in prison on money laundering charges. The Justice Department asserts the attorney bribed Puerto Rican officials with drug money, in the hope of obtaining the nullification of the original murder sentence.
Beyond his colorful story, Figueroa Agosto is one of the rare examples of a homegrown Caribbean kingpin. As the region’s importance as a drug transit point has grown, his demise raises questions about the future of the criminal landscape in the Dominican Republic and Puerto Rico, two of the Caribbean’s main drug trafficking hubs.
The volume of narcotics transiting through the region reportedly tripled between 2009 and 2014, while a series of multi-ton seizures in 2017 support official estimates that this upward trend has continued. Today, the Dominican Republic sees an estimated 120 metric tons of cocaine transiting through the country each year. Furthermore, the Caribbean’s role in the US market also appears to have grown over the past few years. In 2012, only 5 percent of drugs reaching the United States reportedly passed through the Caribbean; by 2015 this figure reached 13 percent.
No single major criminal figure has publicly emerged in the Dominican Republic since the days of Figueroa. But during recent field research to the country InSight Crime learned that local groups were assuming greater control of drug routes. This would represent an empowerment of homegrown criminal cells in a country that has traditionally come under the influence of Colombian and Mexican crime syndicates. It could also represent a potential impetus for conflict, if these local groups resort to violence in attempting to maintain or expand their operations.
Furthermore, analysts have suggested that corrupt government elements–particularly the military and police–have gradually stepped up their role in the drug trade from acting as facilitators to becoming traffickers in their own right. In 2015, top officials of the Dominican anti-narcotics police were accused of stealing over a ton of seized cocaine, and authorities suggested that up to 90 percent of organized crime related cases could involve collusion by security forces.
With global cocaine production estimated to be at historic levels, the flow of drugs, money and weapons through the Dominican Republic and its Caribbean neighbors looks poised to grow. The DEA’s Caribbean Division has also confirmed to InSight Crime that laboratories producing the powerful opioid fentanyl have been discovered on the island, potentially representing a new phenomenon in this traditional transit hub.
The ability to predict crimes before they happen has long been a topic of fascination for science fiction writers and filmmakers. But in real life, the data feeding predictive algorithms is riddled with problems, according to a researcher at the UC Davis School of Law.
The ability to predict crimes before they happen has long been a topic of fascination for science fiction writers and filmmakers. In real life, predictive policing is getting a similar buzz, as dozens of police departments experiment with algorithm-driven programs to help them deploy resources more effectively.
But more attention should be focused on problems with the data that feed predictive algorithms, argues one researcher from the UC Davis School of Law.
“Predictive policing programs can’t be fully understood without an acknowledgment of the role police have in creating its inputs,” writes Elizabeth E. Joh, in a paper forthcoming in the William & Mary Bill of Rights Journal. Police aren’t just passive end-users of these data-driven programs– they generate the information that feeds them.
The difference between crime, and crime data
“A closer look at the “raw data” fed to these algorithms reveals some familiar problems,” the study maintains.
Even under the best of circumstances, crime data only partially captures the actual crime that occurs in any given place. To become fact, a crime must first be discovered, investigated, and recorded by police.
Racial bias is only one factor that can influence the way police record crime, as well as the rate at which they record it, writes Joh. Other factors include workplace pressures, contract disputes, funding crises, the seriousness of the offense, “wishes of the complainant, the social distance between the suspect and the complainant, and the respect shown to the police.”
Changes in policy, such as the ‘broken windows’ campaign of the early 90s, also leave an indelible footprint on crime data.
There is also a concern that the algorithms produce self-fulfilling prophecies; send police to an area where crimes occurred in the past, and chances are that they’ll see something, reinforcing the the prediction.
As crime forecasting programs become more and more commonplace in police departments across the country, the consequences of data gaps will also grow in scale.
“Many of these issues will become even more difficult to isolate and identify as algorithmic decisionmaking becomes integrated into larger data management systems used by the police.”
The legitimacy of the “black box” algorithms themselves, which remain hidden behind proprietary information laws, is also uncertain. Last year, ProPublica investigated an algorithm created by Northpointe, Inc, and after comparing risk scores to actual recidivism rates, found the program to be only “somewhat more accurate than a coin flip.”
Ultimately, Joh cautions against “the assumption that algorithmic models don’t have subjectivity baked into them because they involve math.”
The same goes for law enforcement’s role in generating crime data:
“As long as policing is fundamentally a set of decisions by people about other people, the data fed to the machine will remain a concern.”
This summary was prepared by Deputy Content Editor Victoria Mckenzie. A full copy of the report can be obtained here. Readers’ comments are welcome.
Children are more deeply affected by crime, both directly and indirectly, than previously realized, a sobering new research paper from University of Pennsylvania Law School has found. And while most states provide services for children affected by crime, a world-class bureaucratic labyrinth makes it extremely difficult for anyone, particularly parents who are not highly educated, to access these programs. Yet not providing counseling and other help for these children is a step almost certain to cause more lasting damage both […]
Children are more deeply affected by crime, both directly and indirectly, than previously realized, a sobering new research paper from University of Pennsylvania Law School has found.
And while most states provide services for children affected by crime, a world-class bureaucratic labyrinth makes it extremely difficult for anyone, particularly parents who are not highly educated, to access these programs.
Yet not providing counseling and other help for these children is a step almost certain to cause more lasting damage both to the helpless minors and to society in the long term.
The study, conducted by Michal Gilad, looked at five categories of impact across 50 states: children’s being directly victimized by crime, witnessing crime in the family, witnessing crime in the community, parents being hurt by crime, and parents being incarcerated. While no one thinks that a crime committed against a child won’t cause psychological harm, the report found that even indirect exposure, such as witnessing violence in the community, damages children because of the plasticity of their developing brains and lack of emotional maturity.
“The documented harm ranges from physical and mental health problems to increased risk for learning disabilities, behavioral problems, repeat victimization, juvenile delinquency, adult criminality, and substance abuse,” writes Gilad.
Moreover, the problem is much more widespread than most people may think. The study found that “nearly half of the minor children living in the United States today” have been victimized or exposed to crime in their home or community each year.
And yet, “even when identified, only a minuscule minority ever receive services or treatment to facilitate recovery.” While Gilad was surprised and heartened to discover through a newly designed survey that in the majority of the 50 states, services are in place to help children in four of the five crime-impact categories (the exception being children of incarcerated parents), an extremely challenging bureaucratic labyrinth exists.
Even in conducting the survey for his report, Gilad found that contact information for agencies serving children was hard to come by with phone numbers and emails withheld reportedly for security reasons and “phone contact frequently proved to be futile, as the caller seeking information is transferred from one person to another until reaching a dead end, usually a voice mail filled to capacity.”
In a disturbingly large number of cases, once Gilad was able to communicate with an agency worker, there was lack of awareness of statutorily mandated victim-assistance funds for necessary services. Lack of coordination, and stakeholders not speaking the same language, was apparent.
This report poses the chilling scenario: “Imagine a child in desperate need for assistance to overcome trauma in this environment. The child must depend almost solely on a lay parent with no professional skills, and often with only minimal education and resources, to go through the daunting journey through the thorny terrain of the system.”
The difficulty in finding out how to help children victimized by crime raises the possibility that “these persistent and reoccurring system design flaws and administrative roadblocks are not entirely coincidental,” and are saving states money in the short term, the report says.
“Unfortunately, an evidence-based examination of the problem indicates that such short-term savings are likely to result in epic long-term costs borne by tax payers and society,” Gilad writes.
This summary was prepared by TCR Deputy Web Editor Nancy Bilyeau. A full copy of the report can be obtained here. Readers’ comments are welcome.
The use of involuntary commitment for drug addiction is expanding across the country, as desperate families seek help for their loved ones. But it is likely to make things worse.
In May, nine people committed to the Massachusetts Alcohol and Substance Abuse Center in Plymouth briefly walked out from the minimum-security facility. State authorities mounted a manhunt, using helicopters and dogs to apprehend these treatment “patients.”
The episode illustrates a dangerously-blurred line between substance use treatment and prison, based on a statute that allows for involuntary commitment of “alcoholics or substance abusers.”
In this case, the facilities housing criminals and patients were, in fact, one and the same.
The Massachusetts provision—Section 35—allows family members, doctors and police to petition a judge to civilly commit an individual with substance use disorder, where the condition creates a “likelihood of serious harm.”
Across the US, at least 33 states have similar statutes, though their precise parameters and level of deployment vary widely. In Massachusetts, an individual can be ordered to a course of treatment for up to 90 days.
The use of this mechanism has rapidly expanded as the opioid crisis has worsened, used primarily by desperate families seeking to get help for their loved ones.
In some of the over 8,000 Section 35 commitments a year in the state, the mechanism is being invoked by the very individual who is to be committed. This is because many see Section 35 as the only—or the most expedient and cheapest—way to access treatment.
That highlights the perversion of our drug treatment system.
It’s easier to voluntarily submit oneself to “involuntary” treatment, just to receive rapid and free access to assistance. This is despite the fact that the path is through a coercive, criminal justice-based structure, rather than through normal health care navigation channels.
Drug users committed under this provision have committed no crime. Treating them as criminals and depriving them of agency and liberty without adequate justification violates basic constitutional and ethical principles, as recent and previous litigation has posited. To make matters worse, these individuals are now subject to being physically restrained in treatment facilities, raising concerns about possible physical abuse.
The parallel provision in Massachusetts law applying to mental health cases, such as cases of suicide risk, imposes only a three-day commitment and requires authorization from a mental health clinician. In contrast, Section 35 authorizes a person to be held for up to 90 days and considers clinical judgment non-binding.
Further, the rules of evidence do not apply to Section 35 hearings. And, for police and physicians, “committing” individuals through Section 35 recently became easier because a standing order in some courts now allows those petitioners to simply fax the petition rather than appearing in person.
In the meantime, police, family support groups, and others are disseminating information and instructions on how to “section” SUD-affected individuals.
As it turns out, coerced and involuntary treatment is actually less effective in terms of long-term substance use outcomes, and more dangerous in terms of overdose risk.
Though further research is needed to confirm these findings, there are several possible reasons for this. One is that recovery is much more likely when it is driven by internal motivation, not by coercion or force (i.e. the person must “want to change”).
Second, the state may actually route individuals to less evidence-driven programs on average (e.g. “detox”) than the kind of treatment accessed voluntarily (i.e. outpatient methadone or buprenorphine treatment).
Finally, those receiving care in outpatient settings may also receive services that help address underlying physical or mental health needs, which are often at the root of problematic substance use.
Another important concern is that mechanisms like Section 35 massively shift financial responsibility for substance use treatment from insurers directly to taxpayers. In Massachusetts, care provided under Section 35 has to be paid for by state public health dollars (or criminal justice dollars, depending on the location of commitment). In contrast, care received voluntarily is paid for by health insurers.
This is in addition to the fact that the gold standard for most people with opioid use disorder is outpatient treatment, which does not require “beds.” In other words, taxpayers are left holding the bag for something that is more costly, less effective, and more traumatizing. Misuse of those resources also raises questions about what alternative evidence-based investments could be made with those resources.
Despite these and other weighty concerns, policymakers in Massachusetts and elsewhere have looked to expand the scope of mechanisms like Section 35, because they seem them as a key tool in addressing the opioid crisis. The recent federal announcement of a public health emergency will likely accelerate this trend.
Across Massachusetts and throughout the U.S., families are desperate for solutions, but increased reliance on Section 35 is not the way to go. Many individuals who are in crisis are unable or unwilling to access help. There are formidable logistical, financial, and other barriers to receiving on-demand treatment and related services.
The way services are currently rendered is also a barrier.
Many users do not want to engage in existing programs because those programs use unproven methods and approach care in ways that traumatizes and denigrates patients. Others may simply not be ready to enter treatment.
Currently, there is no alternative mechanism that would trigger timely assistance and intensive case management of the kind that is necessary to support people in crisis and their families in non-coercive, evidence-driven way.
Any conversation about reducing over-reliance on involuntary commitment provisions like Section 35 must include a discussion of such alternatives.
Leo Beletsky is an Associate Professor of Law and Health Sciences at Northeastern University. He’s on Twitter at @leobeletsky. Elisabeth Ryan is a Legal Fellow at the Center for Health Policy and Law, Northeastern University School of Law. She runs publichealthlawwatch.org, on Twitter at @phlawwatch. They welcome comments from readers.https://twitter.com/phlawwatch
A survey conducted by the John Jay College Center on Terrorism, found that only 38% of all respondents “expressed familiarity with the general idea that climate change could multiply global threats such as political violence or mass migrations, or act as a catalyst for conflict.”
According to a survey conducted by the John Jay College Center on Terrorism, even people who believe climate change is real remain largely unaware of its connection to global security. The study found that only 38% of all respondents “expressed familiarity with the general idea that climate change could multiply global threats such as political violence or mass migrations, or act as a catalyst for conflict.”
That number was only slightly higher among people who believe climate change is real, and caused or contributed to by human actions: 42%.
Only 15% were aware of the role a deadly drought played in sparking the ongoing Syrian conflict.
Participants in the study were more willing to take action and change their behaviors when they perceived U.S. national security, rather than global security, to be at threat, say the researchers.
According to the authors, the results of this study could have significant implications for “climate change communications.”
The connection between global climate change and security is not new among the national security, intelligence and research communities. However, according to the John Jay College Center on Terrorism at the John Jay College of Criminal Justice, public understanding of climate change as a security threat has been under-explored till now.
The study was conducted by Kelly A. Berkell, Research Fellow and principal author,
with Charles B. Strozier, Director of the Center on Terrorism. The original report can be found here.