Can We Help Opioid Abusers Without Jailing Them?

As the nation continue to suffer from the opioid epidemic, programs that can divert substance abusers away from the criminal justice system are critical. One increasingly popular approach called “deflection” partners police and public health workers.

Out of the tremendous heartbreak and suffering of our nation’s opioid epidemic, something new and hopeful is happening in communities across the country.

Police officers and drug treatment providers, previously unaccustomed and sometimes even reluctant to partner with one another, now can be found working side by side to reverse overdoses and connect people to drug treatment.

And while these emerging public safety-public health partnerships are not limited to combatting opioids—they also can address drug use in general, housing, mental health, and social services—it is the overwhelming number of people overdosing and dying from opioids that has accelerated the growth of these collaborations, and catalyzed their value in both saving lives and fighting crime.

The new approach is called ‘deflection.”

In deflection, law enforcement plays the critical role of connecting people to community-based treatment partners. This interaction may occur right on the street at the point of encounter, in the police or fire station, at the person’s home, or wherever the initial encounter occurs, all without fear of arrest.

On the receiving end of this “warm hand-off” are treatment providers and/or peer recovery partners who follow through to ensure the individual’s access to services. The operational specifics of each deflection program depend on the design of the local initiative, but the core idea is consistent: Instead of being a doorway into the justice system, law enforcement instead deflects people with substance use disorders to treatment.

Taken together, these new relationships signify the growing importance of “deflection,” which operates squarely at the intersection of law enforcement and treatment.

Sometimes referred to by other terms such as pre-arrest diversion, deflection is growing rapidly from its infancy. A few such programs came about in the 1990s and then faded, but the opioid epidemic has prompted new urgency for these efforts, birthing, or rebirthing, a wide variety of deflection efforts.

The most visible entry to this new stage was Seattle’s Law Enforcement Assisted Diversion (LEAD) program in 2011. Others soon followed, from the 2014 Civil Citation Network in Alachua and Leon County (FL) and the 2014 Drug Abuse Resistance Team (DART) in Lucas County, Ohio; to the 2015 “Angel” and “Arlington Outreach” programs in Massachusetts and the 2015 Quick Response Teams (QRT) developing in communities in Ohio and elsewhere around the country.

Combined with its longer-serving counterparts on the mental health side—such as Crisis Intervention Teams, co-responders, and triage centers—deflection is changing the narrative about fighting crime from “We can’t arrest our way out of this” to “We have better options than arrest.”

Deflection as a term is differentiated from its cousin in the justice system: diversion. In deflection, it is the presence of a behavioral health issue that is driving the contact with police that in turn triggers the deflection (movement) away from the justice system and to community-based behavioral health.

In the vast majority of these cases there are no criminal charges present, responding to the reality that 81 percent of police encounters are, in the final analysis, social service calls. (There are a smaller number of deflection efforts that allow for criminal charges to be placed in abeyance by the police or a citation with mandatory treatment is issued but still in these cases, no traditional justice involvement is required.)

To be sure, some ongoing contact between law enforcement and treatment is helpful beyond that deflection handoff. In some cases, ongoing communication between partners can serve to de-conflict ongoing encounters, share status updates, and support the person who’s been deflected to treatment.

Still, the intent is not meant to add to the already unrealistic expectations placed upon law enforcement to solve chronic social problems, but instead to lighten the burden from where it does not belong – law enforcement – and instead place it with community treatment, housing, healthcare, and social services.

Deflection does increase the demand for treatment capacity and, as such, strategies and action are needed to assure quick and sufficient treatment availability wherever deflection initiatives exist.

In looking at the variety of existing deflection programs, five “pathways” broadly summarize different ways that law enforcement is connecting people to treatment:

  • Self-referral
  • Active Outreach
  • Naloxone Plus
  • Officer Prevention
  • Officer Intervention

Each of these pathways describes the linkage point between police and treatment. While jurisdictions will usually start by facilitating a single pathway, in time as they get experience in deflection and see first-hand the power of their collaborative work, they will begin to add in additional pathways.

Currently, out of 18,000 law enforcement agencies in the United States, it is estimated that slightly over 600 departments are doing some type of deflection.

In the face of a national opioid epidemic, the growth of the field has occurred almost entirely in the last three years. As such, programs continue to be developed and implemented across the county—responding not just to opioids, but to any drug crises that communities face—collectively they can actually reduce the flow of people into the criminal justice system, while also offering necessary referrals to community-based treatment, housing, and services.

Annually, our nation’s 800,000 law enforcement officers encounter 68 million people, some 12 million of whom will end up churning through our jails. Police also encounter millions of people each year for whom there are no criminal charges present, but who have health, housing, and social service needs.

Jac Charlier

Jac A. Charlier

And, given that the majority of people who currently enter the justice system have a substance use disorder, a mental health condition, or both, deflection provides the opportunity to redirect people to treatment before they reach the justice system, emergency rooms, or homeless shelters.

In a country where over 72,000 people died from overdose in 2017 alone, the expansion of these deflection efforts by law enforcement, and the parallel expansion of treatment capacity, cannot happen soon enough.

Jac A. Charlier is executive director of the TASC Center for Health and Justice, and co-founder of the Police, Treatment, and Community Collaborative (PTACC). He welcomes readers’comments. NOTE: Jac is among the speakers scheduled for this year’s John Jay/HF Guggenheim Symposium on Crime in America. Please watch our site for upcoming information on how to register.

from https://thecrimereport.org

Can $1 Fentanyl Test Strip Reduce Deaths Among Opioid Users?

Sales of a test strip to detect fentanyl, similar to the technique used for pregnancy tests, are soaring in the U.S., but some critics say it provides a “false sense of security” to opioid users.

A test strip to help battle the opioid epidemic works like a pregnancy test to detect fentanyl, the potent substance behind the escalating number of deaths around the U.S., the Wall Street Journal reports.

The strip, designed for the medical profession to test urine, can be used off-label by heroin and cocaine users who fear their drugs have been adulterated with the synthetic opioid fentanyl. The strips are dipped in water containing a minute amount of a drug and generally provide a result within a minute—with one line indicating positive for fentanyl, and two lines negative.

Overdose-prevention organizations started handing out fentanyl test strips about two years ago, and they caught on quickly. Now, states like California and Rhode Island and cities such as Baltimore, Philadelphia and Columbus, Oh., are distributing them, or plan to soon.

“This is an effective way to have people thinking about risks,” said Louise Vincent,  the advocacy group Urban Survivors Union in Greensboro, N.C., which has been distributing strips since last year. “It’s so important to give people as many tools as we can.”

Elinore McCance-Katz of the federal government’s Substance Abuse and Mental Health Services Administration, said the approach relies on the flawed premise that drug users make rational choices. She said the strips aren’t guaranteed to be accurate.

“We can’t afford to create a false sense of security” for users, says McCance-Katz. “Let’s not rationalize putting tools in place to help them continue their lifestyle more ‘safely.’ ”

Studies published this year suggest test strips could alter drug users’ behavior. Many advocacy organizations use fentanyl test strips made by Canadian biotechnology company BTNX Inc., whose sales have soared in the U.S., reaching 766,000 strips this year, compared with 117,000 in 2017. The cost: $1 each.

from https://thecrimereport.org

Apparent Drug Overdose Fells Popular and Talented Los Angeles KTLA-TV News Anchor.

Chris Burrous, 43

Glendale, CA—Yesterday afternoon fire and police officials responded to the Days Inn Motel here after being called.  Reportedly KTLA-TV newsman, Chris Burrous, 43 was found un-responsive in a room there.  He was present in the room with a currently unidentified man that supposedly had unsuccessfully performed CPR on Burrous. 


Glendale Police and the LA County Medical Examiner are investigating this death as a potential accidental overdose.  It will take perhaps several weeks to obtain the results of toxicological tests that will identify any drugs involved.  

This death has shattered KTLA-TV, their workers and viewers to the very core. All are mourning the loss of a very unique and bright TV personality of this or any market.

Is this yet another tragic example of the Opioid Crisis?  Who supplied the drugs and how will this shake out in the Criminal Justice System?  

Will we learn the name and history of Burrous’ afternoon rendezvous and motel male roommate?  

Burrous leaves behind a beautiful wife and pre-teen daughter. They will have to deal with the shame involved with the apparent illicit conduct of a husband and father.  Los Angeles society has managed to somehow legitimize Gay sex and drug abuse so that stigma will be reduced.

Undoubtedly his family may also suffer financially over their loss.  I, for one want to morn the loss of his very likable public persona rather than his failings.  

The lesson here is, that his family, co-workers and television viewers really loved this fellow.  He let them all down and lost his charmed life apparently due to bad choices.  

Using drugs properly prescribed by physician caries a genuine risk. Ingesting or injecting drugs from criminal sources always invites poverty, pain and death. 

Recreational drug abuse now kills more people that both automobile accidents and gun related deaths combined. 

There are over 3500 stories on this blog
go to the main page at www.crimefilenews.com
Chris Burrous, 43
Glendale, CA—Yesterday afternoon fire and police officials responded to the Days Inn Motel here after being called.  Reportedly KTLA-TV newsman, Chris Burrous, 43 was found un-responsive in a room there.  He was present in the room with a currently unidentified man that supposedly had unsuccessfully performed CPR on Burrous. 

Glendale Police and the LA County Medical Examiner are investigating this death as a potential accidental overdose.  It will take perhaps several weeks to obtain the results of toxicological tests that will identify any drugs involved.  

This death has shattered KTLA-TV, their workers and viewers to the very core. All are mourning the loss of a very unique and bright TV personality of this or any market.

Is this yet another tragic example of the Opioid Crisis?  Who supplied the drugs and how will this shake out in the Criminal Justice System?  

Will we learn the name and history of Burrous’ afternoon rendezvous and motel male roommate?  

Burrous leaves behind a beautiful wife and pre-teen daughter. They will have to deal with the shame involved with the apparent illicit conduct of a husband and father.  Los Angeles society has managed to somehow legitimize Gay sex and drug abuse so that stigma will be reduced.

Undoubtedly his family may also suffer financially over their loss.  I, for one want to morn the loss of his very likable public persona rather than his failings.  

The lesson here is, that his family, co-workers and television viewers really loved this fellow.  He let them all down and lost his charmed life apparently due to bad choices.  

Using drugs properly prescribed by physician caries a genuine risk. Ingesting or injecting drugs from criminal sources always invites poverty, pain and death. 

Recreational drug abuse now kills more people that both automobile accidents and gun related deaths combined. 

from http://www.crimefilenews.com/

Crackdown on Opioid Prescriptions Called Another War-on-Drugs ‘Failure’

An Arizona doctor argues that the government should have learned from previous federal anti-drug strategies that blanket prohibition doesn’t work. He calls for scrapping attempts to curtail opioids and replacing it with “harm reduction” policies.

The federal crackdown on opioid prescriptions has led to needless deaths and threatens to exacerbate an epidemic that continues to kill thousands of Americans, warns an Arizona physician.

Comparing government efforts to limit the supply of opioids or opioid prescriptions to what he calls the “failure” of the war on drugs, Dr. Jeffrey A. Singer says the policy “only serves to drive non-medical users to heroin, with increasing numbers of non-medical users initiating their opioid abuse with that substance.”

Singer, in a policy analysis written for the right-of-center Cato Institute, calls instead for policies that emphasize “harm reduction” rather than prohibition.

“Drug prohibition has proved a failure,” he wrote. “People are dying largely because of drug prohibition.”

Jeffrey Singer

Dr. Jeffrey A. Singer

He called for policymakers to implement public health options aimed at helping substance-abusers wean themselves from dependence on drugs.

The options include medication-assisted treatment, needle-exchange programs, safe injection sites, heroin-assisted treatment, deregulation of naloxone, and even the decriminalization of marijuana—all of which he said have produced positive outcomes for substance-abusers.

“Though critics have dismissed these strategies as surrendering to addiction, jurisdictions that have attempted them have found they significantly reduce overdose deaths, the spread of infectious diseases, and even the non-medical use of dangerous drugs,” wrote Dr. Singer.

The alternative approach, largely spearheaded by the federal Drug Enforcement Administration (DEA), not only undermines the legitimate use of opioid analgesics but leads “many physicians to practice in fear,” he wrote.

“Worse, it may be driving desperate pain patients to the illegal market, with all the risks that entails.”

See also: “Are Pain Doctors Wrongly Taking the Blame for the Opioid Crisis?”

Although there have been indications that the opioid epidemic has begun to wane, Dr. Singer noted that preliminary figures released in August show the opioid overdose rate increasing in 2017—mainly as a result of a 37 percent increase in deaths involving fentanyl.

Overdoses in 2017 from prescription drugs actually dropped 2 percent and overdoses from heroin dropped 4 percent over that period. But the reduced availability of common prescription drugs like hydrocodone and oxycodone has been driving up the use of heroin.

In 2015, more than 33 percent of heroin addicts entering treatment initiated their non-medical opioid use with heroin, up from 8.7 percent in 2005, according to figures cited by Dr. Singer.

Dr. Singer, a Cato Institute research fellow, is the principal and founder of Valley Surgical Clinics, Ltd., the largest and oldest group private surgical practice in Arizona. According to his biography, he served as treasurer of the US Health Freedom Coalition, which lobbies against what it calls “restrictive health practices.”

To read the complete essay, please click here

Most attention on the opioid crisis has focused on its impact on Americans in the U.S. heartland.  But a Washington Post investigation says opioid overdoses have been responsible for a wave of deaths among African-Americans in the nation’s capital, in a development it says is largely ignored by local DC officials.

from https://thecrimereport.org

Are Pain Doctors Wrongly Taking the Blame for the Opioid Crisis?

A California doctor now serving a 25-year term for operating a “pill mill” says pain management specialists like himself are scapegoats for the government’s failure to address the opioid epidemic. Many experts and pain advocates contacted by The Crime Report suggest he has raised a valid point.  

Dr. Masoud Bamdad and his wife, Shabnam Datalchian, emigrated from Iran to California in 1987, in pursuit of a better life for themselves and their two then-young children.

Four decades later, Dr. Bamdad is serving a 25-year sentence on a federal charge of distributing and dispensing Oxycodone, an opiate pain reliever, in Federal Medical Center (FMC) Fort Worth, a Texas prison.

Dr. Bamdad, believing he was innocent, had refused to take the plea deal he was offered, or to admit guilt, which is why the judge gave him such a high sentence.

The journey he took from clinic to jail is one of hundreds of similar, but little-known, footnotes to America’s struggle with the opioid epidemic.

clinic

Dr. Masoud’ Bamdad’s clinic in San Fernando, Ca., was raided by DEA agents in 2008.

Dr. Bamdad is a certified pain management specialist and a physician licensed to practice family medicine. After completing a four-year pathology residency at Rutgers University Medical School, a two-year fellowship at the University of California-Los Angeles Medical Center, and qualifying for a certificate in pain management at USC Holy Cross, he and his wife, a dentist, opened the “Americare Medical and Dental Clinic” in San Fernando, Ca., in 1999.

They did well, following the classic path of immigrants starting from nothing in a new land. Their clinic provided pain reliever medication, including Oxcycodone, and advice to patients suffering acute or chronic pain. The government argues that the clinic was in fact a “pill mill,” dispensing massive amounts of opiates to patients without bothering to check whether they needed them.

But as far as Dr. Bamdad was concerned, he never broke the law.

He believes, in fact, that he is a “scapegoat”–along with other convicted pain doctors like himself–for the nation’s failure to address the opioid crisis.

In an interview via email from prison, he told The Crime Report:

At the time that I was practicing medicine, there was no concern and information about the opioid epidemic, and we were all in [the] dark. The government had not prosecuted all doctors who were prescribing opioids, they just selected some doctors and used them as scapegoats to teach a lesson to others.

Patient advocates and medical experts interviewed by The Crime Report suggest he has a point.

Although they didn’t comment on the specifics of the Bamdad case, they argued that federal efforts to combat the opioid epidemic by cracking down on pain medication prescriptions are an example of government overreach that has unfairly targeted some of the most vulnerable providers.

Worse, they add, the practice has caused grievous harm to many Americans who depend on pain relievers for their chronic illnesses.

”Without access to legal prescriptions, they are forced to go to street dealers for their pills,” said Dr. Nancy Nielsen, the Senior Associate Dean for Health Policy at The University of Buffalo Jacobs School of Medicine and Biomedical Sciences.

“As we reduced the number of opioids out there, chronic pain patients become medical refugees,” she added. “People are dying.”

In the most tragic cases, according to an investigation published earlier this week by FoxNews, it has driven some desperate pain sufferers to suicide.

Leo Beletsky

Leo Beletsky

Leo Beletsky, an associate professor of law and health at Northeastern University, called the government crackdown on prescribers an example of picking on “the lowest hanging fruit.”

Noting that most measurements of DEA success are based on the numbers of arrests and prosecutions, he argued that federal actions have largely ended up “ensnaring a lot of vulnerable people” who, if anything, represented minor players in a crisis that was fueled in part by the activities of major pharmaceutical firms.

The number of doctors and pain specialists imprisoned for violations of the Controlled Substances Act is still relatively small.

A Crime Report investigation identified 263 registered physicians, convicted and imprisoned on charges brought by the DEA Diversion Unit—the unit that handles controlled substances—between 2003 and 2017.

In nearly all the cases, the charges related to opioid prescriptions..

The total number of doctors affected, however, is probably much larger. While only a few hundred doctors have been incarcerated under the crackdown on over-prescribers, over 3,000 doctors have been forced by the DEA to surrender their licenses between 2011 to 2015 alone, according to figures obtained by the Pittsburgh Post-Gazette under a Freedom of Information Act request.

The “Pill Mill” Argument

Like many of the other physicians hit by the crackdown, Dr. Bamdad might have avoided a jail term by simply admitting his guilt, and giving up his license.

But when agents of the Drug Enforcement Administration (DEA) raided his clinic, he was confident that the government would discover its error. The amount of Oxycodone he prescribed to his patients, he claims, was based on guidelines set by the Medical Board of California.

The government charges, however, that he was running a “pill mill,” dispensing large amounts of opioids to his patients without thoroughly examining them.

After declining the plea deal, Dr. Bamdad was convicted on ten counts of illegally prescribing Oxycodone and three counts of illegally prescribing Oxycodone to persons under 21.

His lengthy sentence, according to U.S. District Court Judge George Wu, was justified by the scope of Masoud Bamdad’s “pill mill,” the seriousness of his illicit prescribing, and his apparent lack of remorse.

According to media reports at the time, Wu cited the prosecution’s report that for three years running — including 2008, the year of his arrest —Bamdad ranked among the state’s highest prescribers of Oxycodone, a powerful narcotic popularly known as “synthetic heroin.” The volume of his prescriptions exceeded that of many hospitals and pain management clinics, Wu said.

Dr. Bamdad counters that he never prescribed more than he was permitted under his license, and he also denies prescribing to anyone under the age of 18. He also maintains that he operated a relatively small office with three medical assistants, and rebuts government charges that he was among California’s “highest prescribers of Oxycodone.”

He said in his email:

All my prescriptions were for a legitimate quantity of painkillers for a legitimate time span, as even my defective indictment reveals. 2-3 pills per day as my indictment illuminates, only for controlling pain based on the guidelines of Medical Board of California for treating pain with narcotics at the time of my practice.

The key weapon used by the government to prosecute Dr. Bamdad and other alleged “pill mills” is the Controlled Substances Act. Advocates say the Act, which was most typically used to combat activities of drug kingpins by prosecuting them for the “manufacture, importation, possession, use, and distribution of certain substances,” is being wrongly used against many legitimate medical professionals.

Dr. Linda Cheek, a pain specialist who was incarcerated herself for over-prescribing painkillers and now leads a nonprofit, Doctors of Courage, which champions “innocent doctors” caught up in the opioid crackdown, charges the DEA has based its actions against doctors on a misinterpretation of a key section of the Controlled Substances Act.

Section 802 (56) of the Act allows the individual practitioner to determine what is “legitimate medical purpose for the issuance of [a] prescriptions;” but, Dr. Cheek argues, U.S. Attorneys and DEA agents with little or no medical training have taken it upon themselves to determine what is a “legitimate” medical purpose.

The DEA disputes such arguments, maintaining that there is nothing ambiguous about a “pill mill,” even if it calls itself a pain management clinic.

“In a typical pill mill case, you’d see hundreds of patients in a small amount of time frequenting that facility,” said Melvin Patterson, a special agent who is an official spokesperson for the DEA. “Just like you would see pills in a pill mill— they go in and out. That’s how we came up with the term.”

The charges and countercharges in Dr. Bamdad’s case reflect a much larger and more troubling issue, according to critics of the government’s anti-opioid policies.

While there have been well-publicized examples of profiteering doctors who have operated clinics as a kind of assembly-line where pain medications are dispensed freely with few questions asked, experts say the government is using the blunt weapon of prosecution to hold pain-management physicians responsible for an epidemic that had little to do with their activities.

That begs the question: Are the wrong people taking the fall for the opioid epidemic?

Who’s to Blame for the Opioid Epidemic?

The opioid crisis continues to shake America.

According to figures released by the National Institutes of Health, as of March 2018, more than 115 Americans die every day from overdosing on opiates, including prescription pain relievers, heroin, and synthetic opioids such as fentanyl.

Many critics have singled out the activities of pharmaceutical firms for blame.

So-called Big Pharma is now the target of multiple lawsuits brought by state attorneys general around the country, as well as by native Americans who contend that tribal populations were especially victimized by the opiates that flooded Indian Country.

The lawsuits contend that the production and distribution of massive amounts of pain medications over the past decades were fueled, in the words of one filing, by “a massive deceptive marketing campaign [aimed at] convincing doctors and the public that their drugs are effective for treating chronic pain and have a low risk of addiction, contrary to overwhelming evidence.”

“It’s the…pharmaceutical executives who should be in jail,” said Dr. Nielsen. “They cost lives and terrible, terrible misery.”

Joe Rannazzisi

Joe Rannazzisi

Joe Rannazzisi, former head of the Office of Diversion Control for the Drug Enforcement Administration, agrees.

“Should some of these companies have been more heavily fined or criminally prosecuted?” he told The Crime Report. “Yes.”

Rannazzisi, who leaked details of what he said were the federal government’s efforts to deflect prosecutions against pharmaceutical companies to The Washington Post and CBS 60 Minutes in a celebrated “whistleblowing” expose, has charged that the opioid crisis was allowed to spread by “Congress, lobbyists, and the drug distribution industry that shipped almost unchecked, hundreds of millions of pills to rogue pharmacies and pain clinics—providing the rocket fuel for the opioid crisis.”

Advocates say government crackdowns on prescription providers don’t address the real roots of the epidemic, including the question of how opiates like Oxycodone came to be seen as a solution for many symptoms aside from chronic pain.

“We were told that the drugs prescribed for pain were safe, and that it was extremely rare that people became addicted,” said Dr. Nielsen. “And [we now know] that is simply not true.”

But senior management at the companies has received little more than slaps on the wrist. In 2007, three executives at Purdue Pharma pleaded guilty to misdemeanor charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.

Opiates and Bias

One other aspect of the DEA crackdown on physicians raises additional concerns.

Dr. Cheek, who spent 24 months in prison for prescribing painkillers, believes that racial bias is a factor in many of the cases that resulted in doctors’ imprisonment. She noted that many of her fellow medical incarcerees were minorities, and were therefore considered vulnerable by authorities.

“Once the government sees these people won’t have much support…they think ‘we’ll get a plea out of them, take their money, and on to the next target,’ ” she said.

While such claims are difficult to prove, The Crime Report investigation found that of the 263 doctors incarcerated from 2003 to 2017, 26 percent were persons of color. A majority of them were immigrants to the U.S. from the Middle East or Iran. The research included checking each doctor on the DEA’s list and looking at their home countries and medical schools.

According to statistics, more than one-quarter (247,000) of the doctors licensed to practice in the U.S. have foreign medical degrees.

But while the proportion of convicted foreign-born medics matches the general proportion of foreign-born doctors in the U.S., some argue that the pain management field attracts large numbers of immigrant physicians because there are fewer barriers to entry, and is often considered to have less status by U.S. doctors.

That makes them especially vulnerable, said Leo Beletsky.

“They’ve stepped into those opportunities—some of them probably because they were discriminated against in other areas of medicine,” he said. “Not unlike men of color who don’t have other job opportunities.”

Which is why Beletsky believes that economics as well as racial bias plays a part in the prosecutions.

“Minorities are probably less likely to have the right lawyers, institutional support or someone who can address the charges brought against them,” he said.

“So they bear the brunt of these criminal investigations (while) other doctors who have the resources might be able to get out.”

Shabnam Datalchian believes her husband faces the prospect of spending the rest of his life behind bars because of their naivety about the U.S. justice system.

“It’s much easier for [the government] to go after [immigrants] because they think we don’t have the proper knowledge of the legal system… Which we honestly don’t.” she said.

DEA agents contacted by The Crime Report strongly dispute charges of bias.

“[These are] people who have violated the Controlled Substances Act,” said Melvin Patterson, a special agent and an official spokesperson for the DEA. “We go where the evidence leads us. We could care less what the person looks like or where they are from.”

Patterson said undercover DEA agents make their cases when they go into a suspected clinic and receive opioids without a medical examination.

Dr. Bamdad described the same scenario, but in a different light.

DEA agents came to his office in 2008, posing as patients, and complaining of pain.

Since pain is subjective and there is no real way to prove just how much pain a patient is experiencing, doctors are left with limited options.

They usually chose to believe their patients and prescribe them medication, Dr. Bamdad said.

The Pain Dilemma

Richard A Lawhern, director of research at the Alliance for the Treatment of Intractable Pain, who leads a nationwide effort to end the targeting of prescription opioids, argues that the prosecution of individual doctors has no medical justification.

Lawhern has contended, in a series of columns for The Crime Report, that most opioid overdose deaths are not the results of opioids prescribed for chronic pain users.

Richard Lawhern

Richard A. Lawhern

The U.S. is now chasing the “wrong epidemic” in its efforts to reduce the death toll from narcotic drugs, he wrote.

According to Lawhern, the demographic analysis that supposedly connects chronic pain to addiction doesn’t bear up under careful scrutiny.

“The typical new addict is an adolescent or early-20s male with a history of family trauma, mental-health issues and prolonged unemployment,” he said. “Young men from economically depressed areas are rarely treated long-term for pain severe enough to justify use of opioids.”

In contrast, a majority of chronic pain patients (by a ratio of 60/40 or higher) are women in their 40s or older with a history of accident trauma, failed back surgery, fibromyalgia, or facial neuropathy, he said.

“And women of this age whose lives are stable enough to allow them to see a doctor don’t often become addicts.”

Other research supports Lawhern’s claim.

A recent study published in Addiction, the official journal of the Society for Addiction Studies, found that reducing opioid prescriptions has had little effect on reducing overall opioid deaths,

The study, entitled A Crisis of Opioids and the Limits of Prescription Control: United States, argues that the amount of opioids prescribed is not the sole factor leading to the rise in opioid deaths, nor even necessarily the most prominent one.

“No data supports forced opioid reductions as safe or effective,” wrote the study’s authors, Stefan Kertesz of the Birmingham School of Medicine at the University of Alabama; and Adam Gordon, of the University of Utah School of Medicine and Informatics.

The amount of overdose deaths involving prescribed opioids has remained constant since 2010, despite a reduction in the amount of opioids being prescribed. This “lack of return” is grounds for developing a new approach to the crisis, according to the study.

But so far there is little evidence that such an approach is on the drawing boards in Washington.

As the public continues to clamor for action against the opioid epidemic, the government appears to continue using the playbook from the much-criticized “War on Drugs” of the 1980s.

Hardball Tactics

One hardball tactic frequently used in cases against physicians resembles the “flip” tactics used to get suspected co-conspirators to testify against their former comrades in order to receive lighter sentences or get away with no jail time at all. Similar tactics are being used this month in the prosecution of the notorious reputed Mexican narco-boss El Chapo in his trial in Brooklyn, N.Y.

In an opioid prescription case, prosecutors may warn a doctor’s personal assistants or nurses that they will be co-defendants unless they testify against him or her.

That’s what happened to Dr. Bamdad.

He came to the DEA’s attention when a patient overdosed and died from drugs he prescribed. Members of his staff, including secretaries and nurses, were pressured into giving misleading testimony about his activities to avoid prosecution themselves, he claimed.

Dr. Bamdad believes that if the prosecutors had not introduced the evidence of his patient’s death (his patient committed suicide), no rational jury would have convicted him for prescribing what was a legal quantity of Oxycodone for controlling pain.

Shabnam Datalchian, his wife, told The Crime Report that during the trial, one woman admitted the government threatened her with prosecution unless she testified. After Dr. Bamdad’s attorney told the prosecutor, she was released and never testified.

“It’s insane [that he was given a long sentence for helping patients, for prescribing patients with chronic pain,” Shabnam said.

“The doctors don’t know what to do. If they don’t prescribe pills they get in trouble for not treating a patient’s pain problem. But if they do…they might end up like my husband.”

Advocates suggest that a key problem is DEA investigators’ lack of training which would enable them to distinguish a doctor who is overprescribing or diverting drugs from one who has just taken on a lot of patients who take opioids.

“The DEA assumes any patient who is prescribed more than 90 milligrams of morphine daily has been over-prescribed,” Lawhern said. “[But] if you ever have the chance to talk to pain management doctors in practice, you might learn the normal range of a daily dose for pain patients is between 50 and 1,000 milligrams.”

The DEA counters that the law is clear in distinguishing legitimate doctors from those who operate the so-called “pill mills.”

“You can prescribe large amounts of opioids, but the question is, are (you) doing it within the law?” said former DEA agent Jeffrey Higgins.

“There are certain requirements when you’re licensed by DEA to prescribe drugs and part of that is seeing the patient and evaluating the needs of the patient.”

“If you are prescribing without examining patients, that is a violation of the license.”

The legal requirements, he noted, include being seen by a doctor, and being evaluated on their need for pain medication.

What is ‘Legitimate Medical Purpose’?

The difficulty lies in defining the phrase legitimate medical purpose, used under the Controlled Substance Act according to Dr. Cheek.

She gave the example of the trial of Dr. John Patrick Couch in Mobile, Ala., a doctor who was sentenced to 240 months in prison for running a “massive pill mill.”

When the DEA agent was asked during the trial to define “legitimate medical purpose” in pain management, he said he couldn’t answer that question because “he wasn’t a doctor,” Dr Cheek said in an interview.

That captures the principal problem connected with prosecution of pain doctors, she explained, arguing the government is trying to define “legitimate medical purpose” without any expertise.

Similarly, under questioning during Dr. Bamdad’s trial, the lead DEA investigator admitted she only had one hour of training on painkillers and medications.

“That was all her and her associates’ knowledge of medicine! Isn’t it interesting?!” Dr. Bamdad wrote in his email.

In fact, for most pain management doctors, prescribing large amounts of opioids to chronic pain patients is a legitimate medical practice Dr. Nielsen said. Sometimes, the dosages are high, depending upon the amount of patients each doctor sees, she added.

Today, at 64, Dr. Bamdad remains confused and angry, hoping his case will eventually come before the Supreme Court. His lawyer has petitioned for a review on the grounds that his constitutional rights were violated by the DEA sting.

He argued in his petition that a physician who “was practicing legitimate pain management based on his licensing agency guidelines” could not be held liable for a violation of the Controlled Substances Act that involved the distribution of controlled substances.

Appeals of his case in California have so far been unsuccessful.

Megan Hadley

Megan Hadley

Dr. Bamdad’s lawyers hold out slim hope that his petition will get anywhere. Nevertheless, he believes that the country he came to as an ambitious young man will live up to the ideals that drew him here.

“You were damned if you did and damned if you didn’t,” Dr. Bamdad wrote in his email.

“I wish I knew about the Department of Justice and DEA criminalizing treating patients with pain; if so, I never would have done it.”

Megan Hadley is senior staff writer and associate editor of The Crime Report. She welcomes comments from readers.

from https://thecrimereport.org

Survey Finds Opioid Epidemic is Biggest Concern Among Rural Americans

Almost a quarter of rural Americans consider drug addiction or abuse as the most urgent health problem facing their communities, and more than half reported they knew someone struggling with addiction, according to a Harvard survey released this month.

Almost a quarter of rural Americans consider drug addiction or abuse as the most urgent health problem facing their communities, and the opioid crisis alone now edges past the economy as their major preoccupation, according to a survey released this month.

The survey, conducted by the Harvard T.H. Chan School of Public Health in partnership with with National Public Radio and the Robert Wood Johnson Foundation, and released as part of the Harvard Shorenstein Center continuing series of “Resources for Journalists,” polled a sample of 1,300 adults living in rural America between June 6, 2018 and Aug. 4, 2018.

Nearly half of those polled reported they knew someone struggling with addiction.

Asked what they felt was the “biggest problem” facing their community, 25 percent said drug addiction or abuse, and 21 percent named economic concerns.

Poll organizers said the survey results represented a new window into the thinking of Americans living outside mainstream population areas.

“For over a decade, the discussions about rural America have been about serious economic concerns,” according to Robert J. Blendon, a professor of public health and health policy at the Harvard T.H. Chan School of Public Health, and a co-director of the poll.

“When we asked people in their own words, it turned out that drug abuse was essentially the same [level of concern as economic issues]. This has never been reported before.”

Blendon’s comments came in an interview with Chloe Reichl for Harvard’s Shorenstein Center on Media, Politics and Public Policy at the Kennedy School.

Some 49 percent of those surveyed said they personally knew someone who struggled with opioid addiction, and 48 percent said that the problem had worsened in the past five years.

One surprising result of the survey, according to Blendon, was that a majority felt that government had a major role to play in solving the addiction crisis and other problems. Most of the respondents believed effective help could come from state or local governments, but 18 per cent felt the federal government had a major role

Blendon said this contradicted the common assumptions that rural Americans were resistant to governmental intervention.

He said rural Americans in some cases seemed more optimistic than experts in their beliefs that short-term solutions were possible.

There’s “a gap where people do believe you can make some really short-term progress in treatment and education (while) a lot of experts say this could be turned around, but it could take decades.”

Respondents to the phone survey were 78 percent white, 8 percent black, and 8 percent Latino. Most of the respondents (80 percent) were not college graduates.

A related briefing paper produced by Journalists Resources noted two recent studies which showed that patients in the rural South are more likely to receive opioid prescriptions for their pain than patients in the urban North.

The complete survey on “Life in Rural America” can be downloaded here.

from https://thecrimereport.org

As States Emphasize Addiction Treatment, Prison Populations Will Drop: Study

At least five states have reclassified simple drug possession from a felony to misdemeanor since 2014 in an effort to reduce prison populations—and it seems to be working, according to a new report released by the Urban Institute. The study says the results support a growing body of evidence that shows treatment, not incarceration, is the most effective way to address drug addiction, as the country continues to grapple with the opioid crisis.

At least five states have reclassified all simple drug possession from a felony to misdemeanor since 2014 in an effort to reduce prison populations—and it seems to be working—according to a new report released by the Justice Policy Center at the Urban Institute. 

As the country continues to grapple with the opioid crisis, a growing body of evidence shows treatment, not incarceration, is the most effective way to address drug addiction, say report c0-authors Julia Durnan, a policy analyst at the Justice Policy Institute, and Brian Elderboom, an affiliated scholar.

Currently, there are more than 20 million people in the U.S. with a current or prior felony conviction, about four times more than in 1980.

Much of the growth in felony convictions can be attributed to our nation’s drug laws, the study noted.

“Changing drug convictions is an important policy change that states can adopt to reduce incarceration for drug possession cases, and invest in more effective treatment interventions,” the authors said.

California was the first state in 2014 to reclassify drug possession, as part of voter-approved Proposition 47 in 2014, and similar reforms have been signed into law by governors in Utah (2015), Connecticut (2015), and Alaska (2016) and reclassification was approved at the ballot in Oklahoma in 2016.

Early indicators on the impact of this reclassification show promise, the report said.

  • The Utah prison population has declined nine percent since Gov. Gary Herbert signed House Bill (H.B.) 348, fueled in part by a 74 percent decline in new court commitments for drug possession. The legislation also directs the state to invest more than $10 million in behavioral health programs and training for treatment staff.
  • In Connecticut, as of December 2017, the population in prison for drug possession had declined 74 percent to only 134 people, including an 80 percent decline in the pretrial population. Budget experts estimate that reclassification of drug possession will save the Department of Corrections $5.3 million in FY 2016 and $9.8 million in FY 2017.
  • In California, reclassifying drug possession has helped lead to a decline in both state prison and local jail populations.  As a result, California awarded more than $100 million in grants to local governments for mental health treatment, victims’ services, and crime prevention programs.

A full copy of the report can be found here.

This summary was prepared by senior TCR staff writer Megan Hadley.

from https://thecrimereport.org

Prosecuting Dealers for Opioid Deaths Called ‘Bad Justice Policy’

Since the start of the opioid crisis, courts across the country have stepped up prosecutions of individuals found to have given drugs to someone who later died of an overdose. But such “drug-induced homicide” cases will only worsen the crisis, according to a health policy expert.

Prosecutors across the country have been expanding the use of stiff penalties targeted at drug dealers whose clients have died as a result of using their product, in efforts to combat the opioid crisis. Heavier sentences that in some cases are equated with a murder charge not only “send a message” to dealers but will prevent further drug-related deaths, supporters claim.

But a new study says such prosecutions for “drug-induced homicides” have the opposite effect.

They are not only “bad law and bad criminal justice policy,” but have exacerbated a public health crisis that has taken thousands of Americans lives, according to Leo Beletsky, Associate Professor of Law and Health Sciences of the Northeastern University School of Law.

The legal strategy actually dates to 1986, following the death of NBA player Len Bias of an overdose from cocaine provided by a friend. But since the opioid addiction emerged as what Beletsky describes as the “worst drug crisis in U.S. history” in 2000, more than half of the states now have specific statues facilitating enhanced sentences given for drug-induced homicides in the case of opioid deaths. Others are considering broadening them to include Fentanyl.

In a study posted online, Beletsky said such prosecutions amount to little more than “policy theater” and are only the most recent examples of the punitive approach that has long characterized America’s War on Drugs—an approach that he noted has largely failed to stem the trafficking of narcotics into the U.S. or address addiction problems.

drug policy

Leo Beletsky

“Aside from crowding out evidence-based interventions and investments, these prosecutions run at complete cross-purposes to efforts that encourage witnesses to summon lifesaving help during overdose events,” Beletsky wrote.

In what he said was the first study of its kind, Beletsky examined data from 263 drug-induced homicide prosecutions between 2000 and 2016.

He found that although such prosecutions were ostensibly targeted at drug dealers, at least half of those charged were family members and partners.

“In many jurisdictions, it is enough to have simply shared a small amount of your drugs with the deceased to be prosecuted for homicide,” he wrote.

Applying his dataset to what he said were “existing racially disparate patterns of drug law and felony murder enforcement,” he also found evidence indicating selective enforcement of the penalties that resulted “in gaping sentencing disparities between whites and people of color.”

Beletsky wrote that his findings only underlined the futility of punishment-oriented strategies as a tool for combating the opioid crisis.

Although there are now widely known and widely used antidotes such as naloxone which can resuscitate someone suffering an overdose if given in time, many family members or even bystanders are reluctant to call 911 for emergency help because they fear legal repercussions, even if they had no role in providing the drugs, according to Beletsky.

“Police involvement at overdose scenes may result in arrests on drug, parole violation,weapons, and other charges,” wrote Beletsky. “It may also lead to loss of child custody, violation of community supervision conditions, and other legal consequences rooted in pervasive stigmatization of substance use, but not directly linked to criminal law.

“Research suggests that fear of police contact and legal detriment is actually the single most important reason why people who witnessed overdoses do not seek timely emergency medical help.”

And, he pointed out, the addition of drug-induced homicide prosecutions to the tools used by law enforcement can have tragic effects on those who were unwittingly responsible for a drug overdose death. He cited the case of Caleb Smith, a Williamsport, Pa., man who was charged in 2016 after giving his girlfriend what he thought was a stimulant but turned out to be fentanyl.

Facing a 20-year mandatory-minimum sentence, Smith committed suicide in 2017.

Beletsky argued that the “surge” in drug-induced homicide prosecutions only underlined the urgency of re-examining punishment-oriented drug policies with the aim of developing what he called a “population-based” health policy that emphasized addiction treatment and diversion.

“A system that relies on the instrument of punishment to regulate the behavior of people affected by severe SUD (Substance Use Disorder) fundamentally misconstrues the nature of addiction,” Beletsky wrote. “The established scientific consensus predicts that individuals affected by addiction will substantially discount—or totally disregard—legal risks and threats of punishment as a matter of course.

“This scientific construct has yet to be translated into U.S. jurisprudence, however.”

While similar punitive strategies such as curbs on prescriptions and suits against pharmaceutical companies for failure to monitor how their products are distributed have a role in reducing supply, they have nevertheless crowded out public health strategies that have been shown to work in limiting the impact of widespread opioid use, he wrote.

“The bottom line,” he wrote, “is that, when it comes to policies that hold the most empirical promise for addressing the overdose crisis, we know what to do; we just are not doing it.”

See also TCR Op Ed by Leo Beletsky and Elizabeth Ryan: The Wrong Path: Involuntary Treatment and the Opioid Crisis.

The full study can be downloaded here.

from https://thecrimereport.org

Curbs on Opioid Prescriptions Haven’t Prevented Deaths: Study

The needs of pain sufferers have been “sacrificed” to aggressive policies aimed at curbing the nation’s opioid epidemic, write two medical researchers in a forthcoming study in the Addiction journal. They argue the policies are based on a misreading of experts’ recommendations.

Reducing opioid prescriptions has shown little payoff in reducing overall opioid deaths, according to a forthcoming study in Addiction, the official journal of the Society for Addiction Studies.

The study, entitled A Crisis of Opioids and the Limits of Prescription Control: United States, argues that the amount of opioids prescribed is not the sole factor leading to the rise in opioid deaths, nor even necessarily the most prominent one.

“No data supports forced opioid reductions as safe or effective,” wrote the study’s authors, Stefan Kertesz of the Birmingham School of Medicine at the University of Alabama; and Adam Gordon, of the University of Utah School of Medicine and Informatics.

The amount of overdose deaths involving prescribed opioids has remained constant since 2010, despite a reduction in the amount of opioids being prescribed. This “lack of return” is grounds for developing a new approach to the crisis, the study says.

According to the study, a major roadblock to developing a feasible plan to prevent opioid overdoses is a “policy monopoly” that prevents some voices and ideas from being heard. A 2016 report from the Centers for Disease Control and Prevention (CDC) outlined some of the primary issues and effects of prescribing opioids for chronic pain, but the nuances in the CDC’s findings were glossed over, Kertesz and Gordon wrote.

For example, the CDC report did not directly call for an end to prescribing opioids to pain sufferers, but instead recommended a “cautious reevaluation” in determining larger dosage levels.

Nevertheless, the authors wrote, the CDC’s report was “weaponized,” and the nuances in the recommendations were lost on policymakers.

“Some authorities avowed that patient deaths, if regrettable, were necessary,” the report said. “One said, ‘we knew that this was going to be an issue, that we were going to push addicts in a direction that was going to be more deadly…but you have to start somewhere.’

“The zeitgeist might be phrased: ‘do something, anything, and we’ll discuss the consequences later.’”

Although the authors believe it likely that “some people will be protected if they never touch opioids,” they do not consider prescription control a primary deterrent to opioid-related deaths.

The authors cited a survey from the National Survey on Drug Use and Health states showing that 80 percent of respondents aged 12-49 who reported at least one episode of heroin use in the last year also reported one prior non-medical use of prescription pain relievers.

But people who misuse opioid medication often aren’t the ones obtaining the prescription, the authors wrote.

Even where opioid prescription control has seen some success, heroin usage has been on the rise. The authors cite the U.S. National Survey on Drug Use and Health, saying that there has been a continuous increase in persons with heroin-use disorder from 2008 to 2016.

In order to effectively combat the crisis, the needs of those who use opioids as a pain treatment should be considered more strongly.

“A tide of anecdotes details suicides, health decline, broken health care relationships and — occasionally at least — overdose among abandoned pain patients who have resorted to the illicit market,” the study says.

“We don’t believe anyone would approve sacrificing innocent lives in the service of addressing addiction.”

Marianne Dodson is a TCR news intern. She welcomes comments from readers.

from https://thecrimereport.org

50-State Report Offers ‘Playbook’ on Meeting Public Safety Challenges

The Council of State Governments Justice Center (CSG) has issued what it calls a first-of-its-kind, web-based resource combining data analyses, case studies and recommended strategies for all 50 states to help policymakers address public safety challenges. Among its major points: violent crime rates decreased in 32 states between 2006 and 2016, and the number of drug overdose deaths is now almost four times higher than the number of homicides.

The Council of State Governments (CSG) Justice Center has issued what it calls a first-of-its-kind, web-based resource combining data analyses, case studies and recommended strategies for all 50 states to help policymakers address public safety challenges.

The “50-State Report on Public Safety” includes more than 300 “data visualizations” comparing crime, recidivism and correctional practices across all 50 states.

The report discusses these data along with research on strategies aimed at improving public safety, giving more than 100 examples of public safety innovations drawn from every state.

The center says the report “provides a playbook that policymakers can customize to tackle the issues most relevant to their communities.”

Megan Quattlebaum, director of the center said that, “Data and research are essential to successfully addressing the unique conditions in each state.”

The report was promised at a 50-state summit held in Washington, D.C., last fall, at which officials were given preliminary data compilations from their states. (See coverage in The Crime Report). The summit was sponsored by the CSG and the Association of State Correctional Administrators.

Following up on the summit, the CSG Justice Center is working with more than 15 states to hold statewide forums on public safety with a broad coalition of stakeholders.

“There is no shortage of information to examine and consider when it comes to public safety,” Bryan Collier, Executive Director of the Texas Department of Criminal Justice, told the center. “

As the head of a state corrections agency, digesting all of the available data can be overwhelming. The 50-State Report on Public Safety organizes a wealth of criminal justice information in one place, creating an important resource that is without equal in its size and scope.”

Among the report’s major points:

  • Between 2006 and 2016, violent crime rates decreased in 32 states. Violent crime increased in rural areas in 16 states.
  • The number of drug overdose deaths is almost four times higher than the number of homicides. Two decades ago, the numbers were about the same.
  • In 2015, states spend nearly 10 times as much on prisons as on community supervision of offenders, although there were 4.5 million people on probation and parole and 1.5 million in state prisons.
  • Most states track recidivism of people leaving prison. Thirty-two states use a narrow definition of the term that includes only people who are reincarcerated, not all rearrests and reconvictions.
  • Corrections populations increased in the last decade in 42 states, and 24 states project growth in prison populations.

According to a press release from the center, Alabama state Sen. Cam Ward praised the report, saying that it “gives policymakers a blueprint for achieving results, and the strategies offered here will be useful for years to come.”

Funding for the 50-State Report on Public Safety was provided by the U.S. Justice Department’s Bureau of Justice Assistance.

Ted Gest is president of Criminal Justice Journalists and Washington bureau chief of The Crime Report.

from https://thecrimereport.org