A Prophetic Voice in Maryland
Image via http://www.freeimages.com/photo/maryland-flag-1187240
A Promising Alternative to the War on Drugs: Delegate Morhaim’s Harm-Reduction Proposals
On October 5th, Rev. Marvin Silver and I (Rev. Alex Vishio), Associate and Assistant Conference Ministers, respectively, of the Central Atlantic Conference of the United Church of Christ (CAC-UCC), met with Delegate Dr. Dan Morhaim, who represents Baltimore County's 11th legislative district in the Maryland General Assembly. Rev. Silver and I asked for this meeting because we were very much intrigued by a package of harm-reduction bills that Dr. Morhaim had recently proposed, legislation that treats drug addiction as a serious public health crisis rather than a criminal offense. Dr. Morhaim firmly believes that the so-called War on Drugs has been deeply problematic and even counterproductive. We agree. Indeed, the CAC-UCC was so instructed and inspired by Prof. Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness that as a conference it crafted and adopted a resolution entitled “Dismantling the New Jim Crow” that identified the War on Drugs as the primary reason for mass incarceration and thus as the main cause of the creation of a permanent caste of second-class citizens in this country. That resolution (slightly amended) was overwhelmingly adopted by the 2015 national gathering of the UCC, and we are now in the process of helping to implement its recommendations throughout the Conference. What follows is a summary of Dr. Morhaim’s legislative proposals and some instructive insights gleaned from our conversation with him.
During the 2016 legislative session of the Maryland General Assembly, Delegate Dr. Dan Morhaim introduced a package of harm-reduction drug legislation designed to “awake and alert” legislators and the public. Having witnessed firsthand the deleterious consequences of the War on Drugs as a seasoned emergency medicine physician, Dr. Morhaim had been pondering for years an alternative approach to resolving the drug crisis in this country. Encouraged by the promising public advocacy of organizations such as LEAP (Law Enforcement Against Prohibition), instructed by the stellar investigative research of works such as Chasing the Scream: The First and Last Days of the War on Drugs, and inspired by the successful implementation of harm reduction policies and practices in countries such as Portugal, Dr. Morhaim helped put together the 2015 Harm Reduction Meeting at the Johns Hopkins Bloomberg School of Public Health (where he serves on the faculty) to flesh out such an alternative approach. “The full-day meeting brought together 75 high-level Maryland research, policy, and practice leaders from the law enforcement, substance use disorder treatment community, and violence prevention fields with the goal of developing policy recommendations that could be turned into legislation.”[i]
From that meeting emerged the substance of the bills in which Dr. Morhaim would subsequently invest his political capital by introducing them to his colleagues in the Maryland legislature. The war on drugs had been a complete failure, and it was time to offer politicians and the public realistic and effective alternatives. This bold attempt at consciousness-raising had the desired effect, insofar as his legislative initiatives piqued the interest (if not support) of many of his colleagues and gained the attention of several news organizations. The Huffington Post, for instance, published an article on February 4, 2016, entitled “A Maryland Lawmaker Offers A Radical New Solution To The Heroin Crisis” that laid out the basic substance of each of Dr. Morhaim’s four legislative salvos.
The first of these concerns the institutionalization of round-the-clock addiction counseling at hospital emergency rooms. In our conversation, Dr. Morhaim noted that referrals to counseling centers and clinicians by emergency room staff fail to take the direct action required to meet the urgent and specific treatment needs of those who are substance abusers. Moreover, the easy accessibility to such proposed counseling provides a more certain means to begin to create a community network of care and support for addicts.
Indeed, the concern to fashion such a supportive environment also provides much of the motivation for the second legislative proposal: the establishment of safe-consumption programs. The availability of medical care and access to social services afforded by such programs are the specific means incorporated in this legislation that serve to achieve that goal. In addition, by providing medical oversight and sterile equipment in secure locations for users to self-administer their own self-supplied drugs, such programs aim to reduce the communication of infectious diseases, the occurrence of overdoses and injection-related illnesses, and even the misuse of public facilities (e.g., bathrooms and libraries). Furthermore, the overdose death rate in facilities that host these programs (such as Insite in Vancouver, Canada) is zero, because professionals are on-site to rescue the user who overdoses. Given the epidemic death rate in the U.S. from drug overdose, this would be a major step in combatting that on-going tragedy.
The third piece of legislation involves the creation of a poly-morphone-assisted treatment pilot program. Perhaps the most controversial of the harm reduction initiatives, this program would be reserved only for the most hard-core drug addicts. So far as I have been able to discern, the enactment of this bill might produce a program closely resembling the one described above – with the exception that a heroin substitute would be medically supplied and administered to the user.
To be sure, Dr. Morhaim is under no illusion that even radical harm reduction programs, such as one based upon a heroin substitute, will generate a cure for every single difficult-to-treat addict. In our conversation, he made it clear that his extensive medical experience has taught him that there are certain hard-core addicts who, either through nurture or nature, are incapable of changing or unwilling to reform. But the point is that some are able and willing, and for these such programs may be the decisive difference between life and death. Moreover, the anticipated community savings – both financial and otherwise – such programs promise to engender makes them worthy candidates for implementation.
Indeed, when one considers the devastating impact on individuals, families, and communities of thousands of hard-core users in major metropolitan areas, innovative policies are needed. There are about 20,000 such users in Baltimore City alone seeking any and all means to satisfy a habit that requires an average of $50/day. This translates to annual costs of almost $400 million per year for their drug purchases. That does not count the costs (both monetary and otherwise) of their substance abuse to their families and communities, as well as to the criminal justice and health care systems. Addiction treatment is cost-effective. Benefits will accrue from the removal of even a small percentage of such users from the illicit drug economy.
The decriminalization of the possession of small amounts of all drugs is the fourth legislative proposal. Dr. Morhaim’s bill would provide for civil rather than criminal penalties for conviction of use or possession of small quantities of illicit drugs. Those convicted would be required to pay a small fine on a first offense. Subsequent convictions would lead to heavier fines, eventually resulting in criminal penalties upon repeated convictions.
Of these four legislative proposals focused upon harm reduction, only the first gained any traction in its first year of introduction in the Maryland General Assembly. By a vote of 133-0, the House adopted the bill establishing round-the-clock addiction counseling at hospital emergency rooms, but the legislative session ended before the Senate could consider it. The second and third bills received unfavorable reports from their hearings before House committees and were withdrawn. The fourth received an unfavorable report before the House Judiciary Committee.
“What was missing that would have been helpful to you in making the case for harm-reduction legislation?” my colleague inquired of Dr. Morhaim. After all, Dr. Morhaim had had the benefit of expert testimony from public health experts, law enforcement representatives, physicians and nurses, and addiction counselors. Many of the experts and most of the facts had been on his side.
What was missing? “You,” came the reply. By this response, I think Dr. Morhaim intended not only to encourage Rev. Silver and me to participate in next year’s hearings on these proposals but also to draw attention to that fact that religious leadership in general has been reluctant to be out in front on an issue that has arisen in no small measure from a “deep spiritual void in our culture.” Indeed, Dr. Morhaim believes such a void has contributed significantly to the current drug crisis because he thinks that people naturally will seek ways to alter or elevate their consciousness – and narcotics especially are a popular and relatively accessible means of so doing. And insofar as there is a dearth of enticing, edifying alternatives in our communities that can fill that void and thereby serve as effective countervailing or moderating influences, in many cases drug use will continue to yield abuse.
In this regard, Dr. Morhaim believes the iconic rat study of Bruce Alexander becomes instructive. Through the results of several experiments, Prof. Alexander appeared to show that addiction to opiate drugs in rats is primarily a consequence of socially isolating and alienating living conditions and not of any addictive property of the drugs themselves. These studies support the conclusion of Fr. David Kelly’s Catholic Statement on the Drug Policy of the U.S.: “The most important part of combating the drug problem in the US is to build and fortify a strong, inclusive community. Drug prevention and rehabilitation is a public health issue that requires a treatment/supportive, holistic approach.”[ii] If this assertion is sound, then it is clear that our responsibility as clergy to provide leadership in advocating for and cultivating such communities and approaches must include a call to end the War on Drugs and a summons to champion new ways of addressing the problem, such as those for which Dr. Morhaim is advocating.
References
[i] http://www.jhsph.edu/research/centers-and-institutes/institute-for-health-and-social-policy/awards-and-fellowships/lipitz-public-health-policy-faculty-awards/awardees/2015-harm-reduction-meeting.html (accessed 10 October 2016)
[ii] http://49b.cfd.myftpupload.com/2016/10/statement-drug-policy-us/ (accessed 13 October 2016)