“Let justice roll down like waters.”Amos 5:24 Dear Friends and Colleagues, In the world of addiction treatment the is ubiquitous. Maia Szalavitz noted in a column this week for the New York Times that 90% of residential addiction treatment centers in the United States are centered in 12-Step methodology. She acknowledges that many people, including herself for a time, found critical help and support in the program. But far too often, this explicitly spiritual approach, one deemed religious by the courts, is the only option. She highlights a few problems including lack of options for non-religious folks (or people who just don’t like A.A.), resistance to medically assisted treatment and exclusion of other evidence based approaches. A.A. represents a specific belief system about the nature of addiction and what the process of recovery looks like. Some aspects of A.A. I agree with, others I do not. But far too often those in treatment or pushed to accept the entire system or risk being told that they are the problem. I am deeply grateful for what A.A. has done in the lives of many people I know and love. Many of those folks are open to harm reduction, a variety of pathways to better health and aren’t dogmatic about abstinence. As a person of faith I also need to say, it is unjust and a violation of fundamental constitutional rights for the government to mandate participation in a religious (or spiritual) program. As a person of faith I also need to say, it is immoral to withhold other forms of help to those in a vulnerable position and coerce participation in a religious (or spiritual) program. There is a world of difference between being motivated by your faith to help others and requiring others to participate in your religion (or spiritual) program in order to receive help, support and assistance. A.A. is a path not the path. When it comes to cancer, there was a time when researchers were looking for a universal cause of the malady and a universal solution. The field leaped forward when scientists focused on trying to discover a multitude of therapies for a wide range of different kinds of cancer. Reducing addiction treatment to participation in A.A. would be like limiting cancer treatment to surgically removing tumors. I celebrate those who have found life and freedom through the 12-Steps. At the same time, coerced participation in a religious program needs to end. Keep the faith, Timothy McMahan King Senior Fellow, CNDP Research and roundup compiled by Cassidy Willard, Research Associate Can a court, prison, or probation officer sentence me to attend A.A., a religious program? The answer is more controversial than it should be. The Establishment Clause in the First Amendment prohibits the government from coercing an individual to participate in any religion. This is especially important when looking at vulnerable populations. Many Federal Circuit Courts have agreed that A.A. (and N.A.) is a religious body for purposes of 1st Amendment Analysis and forcing prisoners or probationers to attend A.A. meetings under the threat of withholding a benefit is a violation of the Establishment Clause. However, New York Governor Kathy Hochul recently vetoed a bill requiring judges to inform drug court participants of their right to choose nonreligious rehabilitation. Additionally, courts still regularly sentence people to attend A.A. While the law may offer a remedy for persons sentenced to A.A. (in some Federal Circuit Courts), many, if not most people being sentenced to A.A. do not know that non-religious addiction treatment is an option. In fact, in many rural areas, non-religious addiction treatment is not an option. The Origins of the Minnesota Model of Addiction Treatment–A First-Person Account By the 1950s the “Minnesota” abstinence model of addiction treatment had developed based on the principles of A.A.. The program included “an individualized treatment plan with active family involvement in a 28-day inpatient setting and participation in Alcoholics Anonymous both during and after treatment.” Although developed 60 years ago, this model remains at the “heart of modern addiction treatment.”. LSD could help alcoholics stop drinking, AA founder believed Even A.A. co-founder Bill Wilson did not think A.A. should be the only treatment option. Instead, Mr. Wilson believed LSD was a promising treatment and credited his own use of the drug with helping his depression. Therapies Offered at Residential Addiction Treatment Programs in the United States Out of 613 residential treatment programs for opioid use disorder surveyed, 92% offered some form of a 12-step program. Why is religion so pervasive in addiction treatment? Many experts attribute this link to A.A. and later the “Minnesota Model” of addiction treatment. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD A 2018 study found that Women for Sobriety (WFS), LifeRing, and SMART are just as effective as A.A. for those with Alcohol Use Disorders. People Have a Right to Nonreligious Rehab Even A.A. co-founder Bill Wilson did not think A.A. should be the only treatment option. Instead, Mr. Wilson believed LSD was a promising treatment and credited his own use of the drug with helping his depression.
Do Democrats Care About The Overdose Crisis?
“Let justice roll down like waters.”Amos 5:24 Dear Friends and Colleagues, A recent Axios-Ipsos poll asked what Americans thought was the #1 threat to public health. Opioids/fentanyl came in at number one with 26% of respondents naming it the top issue. What is striking, however, is the dramatic partisan divide. Only 17% of Democrats answered opioids/fentanyl while 37% of Republicans answered the same. What does this mean? Probably a lot of different things. (Feel free to email us with your thoughts.) To quote my old boss, Jim Wallis of Sojourners, it seems to be a classic case of when “the Right gets it wrong and the Left doesn’t get it.” But this is also an area where those partisan categories don’t quite fit. There are two issues that rise to the surface for me in the old Left vs Right framework: proximity and moral narrative. First, let’s look at proximity. Or, why the Left doesn’t get it. While it is notable how widespread the overdose crisis is, not every community is hit equally. When looking at racial demographics, Indigenous and Black communities have been hit the hardest. When looking at a county level, Republican counties have higher death rates than Democratic counties. It isn’t surprising that the poll also found, “People with a high school education or less are, by a three-to-one margin, more concerned with opioids over obesity compared to those with a college degree, who see obesity as the bigger issue.” This means college-educated, middle-class, white professionals living in Democratic counties are some of the least connected to the overdose crisis. They also happen to be a core constituency for Democrats and (probably) over represented in media and government. It’s a pretty good case for saying “the Left” just doesn’t get it. Second, is moral narrative. Or, why the Right gets it wrong. In Crack in America: Demon Drugs and Social Justice, Craig Reinarman and Harry Levine demonstrated that public concern about crime and crack cocaine didn’t track trends in drug use or crime. Instead, public concern followed media coverage and media coverage went in waves tied to election cycles. In the 80’s and 90’s, politicians created a narrative of moral decay that could only be stopped with a campaign for “law and order.” During the 2022 midterm elections, Republican leadership created a new narrative of the “fentanyl border crisis.” Instead of moral decay from within, it was a message of threat from the without. This establishes a moral narrative of Americans as the innocent victims of an evil invading force that must be stopped. And this is a good case for why the Right gets it wrong. The good news is that while some of the Right gets it wrong and some of the Left doesn’t get it, the exceptions are growing. Christina Dent, a conservative Christian, leads End it For Good, a non-profit in Mississippi committed to increasing public health and safety by ending the “War on Drugs.” Rev. Erica Poellet is a progressive faith leader who runs Faith in Harm Reduction committed to engaging all people of faith in working together with people who use drugs to create a more just world. It can be frustrating to see those who still don’t understand the scope and severity of the crisis. It is concerning when there are those who do understand but support policies that will only make the situation worse. But there is hope. And awareness is growing. In the past month, this newsletter has grown by over 25%. We are glad you are here and keep spreading the word! Timothy McMahan KingSenior Fellow, CNDP Research and roundup compiled by Cassidy Willard, Research Associate Australia Moves Forward On Psychedelic Access Australia’s Therapeutic Goods Administration recently approved a request to reschedule psilocybin and MDMA under that country’s drug-classification scheme, making Australia the first country in the world to recognize the psychedelic drugs as medicines. Effective July 1, 2023, the TGA will add psilocybin and MDMA to Schedule 8 of Australia’s list of Controlled Drugs, permitting qualified psychiatrists to prescribe MDMA to treat post-traumatic stress disorder and psilocybin for treatment-resistant depression. The decision was largely based on the research and data being produced under current FDA trials in the United States. Hopefully, these steps will continue to put pressure on policy makers in the United States to acknowledge that the Schedule 1 classification in the United States has always been based on a lie. Highlighting the Work of Overdose Prevention Centers Australia’s Therapeutic Goods Administration recently approved a request to reschedule psilocybin and MDMA under that country’s drug-classification scheme, making Australia the first country in the world to recognize the psychedelic drugs as medicines. Effective July 1, 2023, the TGA will add psilocybin and MDMA to Schedule 8 of Australia’s list of Controlled Drugs, permitting qualified psychiatrists to prescribe MDMA to treat post-traumatic stress disorder and psilocybin for treatment-resistant depression. The decision was largely based on the research and data being produced under current FDA trials in the United States. Hopefully, these steps will continue to put pressure on policy makers in the United States to acknowledge that the Schedule 1 classification in the United States has always been based on a lie. National Push to Legalize Fentanyl Test Strips Rev. Sharp was interviewed by the Epoch Times on the rising focus on harm reduction. Rev. Alexander Sharp, founder of Clergy for New Drug Policy, said he was “heartened by the depth of the response” that is currently happening with regard to this crisis. “So often what you get is the reaction that you can’t do anything because it falls under the category of harm reduction,” Sharp told The Epoch Times, saying that “while it appears to be enabling” the use of drugs, “that concept is horribly misguided.” God and Pot Timothy McMahan King was interviewed for an article at Religion Unplugged on the upcoming vote in Oklahoma on adult-use cannabis: Timothy McMahan King…echoed Tilley’s perspective on criminal justice reform. “You can be concerned about the effects of drugs in society,” said King, an evangelical-turned-Episcopalian who wrote the book “Addiction Nation” and a Christianity Today cover story on his battle with opioid addiction. “But if you pursue a punitive path, you might actually be … creating more harm from drugs,” he added, “than if we go this path that focuses on regulation, education and treating drug use as a public health issue, not a criminal one.”
Addiction & Lent
“Let justice roll down like waters.”Amos 5:24 Dear Friends and Colleagues, “How do I get others to care?” is a question I hear all the time. It is a perennial challenge for activists and advocates of all kinds. There is no shortage of important issues and causes to which we can all give our time and attention. But how do we get others to share our passion? While there isn’t an easy answer to this question, there is one practical tip I like to give: Start where people are at, not where you want them to be. Most people aren’t looking around for a new cause. If they were, our job would be easy. We all live with many competing demands on our time and attention. Engaging new people in an important cause often comes through connecting it to other interests and priorities they already have. The Christian season of Lent is coming soon. It is a time we feel the pain of loss and the promise of new life to come. It is a season that calls us to reflect on many of the same themes we see in stories of addiction and recovery. Churches and pastors across the country have found Lent a valuable time to engage their congregations and communities in reflection on the challenges of addiction in our society and the hope the Church can bring for healing by ending our culture of violence and punishment. I’m partnering with the Center of Addiction and Faith to host a Zoom meeting next week about engaging churches around addiction, overdoses, and the War on Drugs this Lenten season. While the conversation will center around the Christian tradition, all people are welcome to attend to see how they might apply these lessons in their context. While there are lots of ways to connect Lent to these issues, I’ll focus on some of the themes of my book Addiction Nation: What the Opioid Crisis Reveals About Us. And provide resources and strategies for using the book as a conversation starter in your community. This will be a Zoom meeting to allow for discussion and questions. During the meeting, you will: If you’ve been looking for a way to start a conversation in your community, we hope you’ll join us. Starting these kinds of conversations can be challenging, and we hope to support you on that Keep the Faith, Timothy McMahan King Senior Fellow, Clergy for a New Drug Policy
How the D.E.A. Causes Overdoses
THE CLERGY FOR NEW DRUG POLICY WEEKLY NEWS ROUND-UP “Let justice roll down like waters.”Amos 5:24 Dear Friends and Colleagues, Pain resists words. We use stories, songs and poems to express great love but great pain finds its deepest expression in the screams and groans that aren’t words at all. “To have great pain is to have certainty; to hear that another person has pain is to have doubt,” writes philosopher Elaine Scarry. The difficulty of expressing pain in words, as well as the often hidden nature of physical, emotional and spiritual pain can make it difficult to address. Many people, especially chronic pain patients, understand what it is like to have pain dominate their lives while feeling that those around them are constantly questioning if the pain is real, and if it needs to be treated. As I wrote in Addiction Nation, I had no problem managing the pain that came from putting a chainsaw into my leg, but acute necrotizing pancreatitis was different. It was the opioid-based pain medication that gave me even a slight breath of relief. I wrote: The only moment that I remembered I was still a person—that pain was an experience I was having and not my entire existence—was the moment every fifteen minutes when I pressed a small button. That button sent a pump whirring and boosted the slow trickle of that blessed, blessed, blessed analgesic. While I did develop an opioid use disorder, I might not have survived the pain of that condition without the drugs I was given. While I was lucky that my pain resolved after nine months, there are many others that deal with chronic pain for years. Tragically, some of these chronic pain patients are dying by suicide after losing access to pain medicine that had been working for them. Dana Farber, one of the country’s leading cancer research institutes, is warning that even terminal patients are having difficulty accessing end-of-life pain management. In the last newsletter, we covered a new report from the Cato institute about the dangers of politicians and law enforcement taking over the practice of medicine. This week, we want to highlight some additional stories of how that goes wrong. The primary media narrative about the overdose crisis begins with the deceptive marketing of Purdue Pharma and overprescribing doctors. This led to a wave of addiction and then finally, overdoses. But the real story is much more complicated. Purdue Pharma was criminally deceitful and many doctors subsequently underestimated the likelihood of addiction, especially among young people. But, roughly 75% of those who develop an opioid use disorder didn’t start with a doctor’s prescription but diverted drugs typically obtained through a friend, family member or dealer. While there was some early correlation between the rise in opioid prescribing and opioid related overdoses, that has not been true for more than a decade (possibly two). In fact, overdoses skyrocketed after crackdowns on opioid prescribing as those who were addicted moved to more dangerous street drugs. Drug policy and trends in the United States often bounce between extremes. From the false belief in a “non-addictive” opioid that made billions for those peddling a lie to draconian enforcement by the DEA that leaves doctors in fear of law enforcement and pain patients suffering. The people who end up bearing the burden are the ones who are most vulnerable. Reducing the story of the overdose crisis to the actions of Big Pharma (as bad as they may have been) distracts from the ongoing driver of overdose deaths today, failed federal drug policy. Keep the faith, Timothy McMahan King Senior Fellow, Clergy for a New Drug Policy Research and roundup compiled by Cassidy Willard, Research Associate Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder Most nonmedical opioid users are not yesterday’s patients. High-dose opioid prescriptions (90 MME or greater) fell by 58% from 2008 to 2017, deaths involving opioids rose by 500% between 1999 and 2018. Since 2010, deaths involving heroin and fentanyl have risen much more dramatically than those involving prescription opioids. In fact, “based on likely understated CDC data, fentanyl or heroin was involved in 75% of opioid-related deaths in 2017, up from 28% in 2010. Just 30% of opioid-related deaths involved prescription analgesics such as hydrocodone and oxycodone in 2017, down from 52% in 2010, and roughly 40% of those 2017 cases also involved heroin or fentanyl. In other words, approximately 18% of total opioid-related deaths in 2017 involved prescription analgesics without heroin or fentanyl.” Sadly, the catastrophic nature of the current policies have been on full display in the last three months. This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor On November 1, 2022, the DEA suspended Dr. David Bockoff, a chronic pain specialist, license to prescribe controlled substances such as opioids. The DEA has said that Bockoff received an “Immediate Suspension Order” which is warranted in cases where the agency believes the prescriber poses “an imminent danger to public health or safety.” One of Bockoff’s patients was Danny Elliot, a 61-year-old chronic pain patient that was nearly electrocuted to death in 1991. Elliot struggled to keep a doctor, telling Vice that Bockoff was his third doctor to be shut down by the DEA since 2018. Elliott described “each transition meant weeks or months of desperate scrambling to find a replacement, plus excruciating withdrawals due to his physical dependence on opioids, followed by the return of that burning eyeball pit of despair.” On November 8, 2022, after frantically trying to find another doctor to help him manage his chronic pain, Elliot and his wife died in a “dual suicide.” Elliot left behind a note that reads in part: “I just can’t live with this severe pain anymore, and I don’t have any options left. There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares. I haven’t lived without some sort of pain and pain relief meds since 1998, and I considered suicide back then. My wife called 17 doctors this past week looking for some kind of help. The only doctor who agreed to see me refused to help in any way. What am I supposed to do?” The DEA Shut Down a Pain Doctor. Now 3 People Are Dead Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems. In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs. However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.” Judge Won’t Stop DEA Despite Patient Deaths Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems. In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs. However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.” ‘Entire Body Is Shaking’: Why Americans with Chronic Pain Are Dying These stories of chronic pain sufferers who have killed themselves after losing access to opioid medication are not unique. So, what happens now? How can we help chronic pain patients? Maia Szalavitz, addiction expert and journalist, has some ideas. First, the surgeon general needs to make a strong national call for healthcare professionals to pay attention to the 2022 updated C.D.C guidelines for opioid prescribing. Doctors need to be warned that involuntary dose cuts for existing patients puts them at high overdose risk. Second, the U.S. attorney general needs to tell the D.E.A. to stop perusing doctors solely because they prescribe high doses of opioids. Without other reason to believe there is criminal intent, it should not be an issue for law enforcement. If doctors are not providing a high level of care, it should be an issue for medical boards or an issue of civil malpractice. Third, if the D.E.A. does discover criminal diversion of prescription opioids, great care should be taken to ensure that existing patients are not suddenly abandoned. Cutting off these prescriptions without support for those using them will only lead to more overdoses. We cannot let more pain patients become the latest victims of the War on Drugs.
Drugs & Crime in Oregon
The Clergy for New Drug Policy Weekly News Round-up “Let justice roll down like waters.” Amos 5:24 Dear Friends and Colleagues, In 2020, voters in Oregon overwhelmingly supported ballot measure 110. This groundbreaking measure made Oregon the first state to decriminalize possession of small amounts of drugs and expand addiction services through cannabis tax revenue. In addition, the state is establishing regulated access to psychedelic-assisted therapy and retreats. Kassandra Frederique, Executive Director of the Drug Policy Alliance called the passing of Measure 110, “the biggest blow to the war on drugs to date.” While the measure reduced the violence of the war on drugs, it would be a mistake to call it true peace. As Nelson Mandela reminded us: Peace is not just the absence of conflict; peace is the creation of an environment where all can flourish, regardless of race, color, creed, religion, gender, class, caste, or any other social markers of difference. Ending the “war on drugs” isn’t just about stopping the violence and trauma of arrests and incarceration, it’s about ensuring access to harm reduction, recovery services, health care, housing, and quality jobs. One of the major criticisms of Measure 110 has been that few people who have accessed services have entered into treatment. This is true but ignores that there are still huge gaps in treatment access and capacity throughout the state. And, additional funding for these services was held up until September 2022. We don’t have any reason to believe that Measure 110 has increased drug use. Overdoses in Oregon were on a rapid rise before the changes in the law due to illicit fentanyl contaminating the drug supply. And, we have no reason to believe that crime trends are any different than in other comparable cities. While critics have already proclaimed that Measure 110 is a “failed experiment,” the reality is that it has yet to be tried. War can provide a false sense of moral clarity. You know who the “enemy” is and you “win” by defeating them. The work of peace is much more difficult and slow going. It requires breaking down barriers and building opportunity. Arresting and caging a person today may make some voters feel better in the moment but it fails to take into account the generational trauma, devastated communities, and stifling of opportunity for years to come. In Oregon, the fighting has slowed. But, that doesn’t mean that true peace has been achieved. A lot more investment is needed in high-quality harm reduction and attractive treatment services to create an environment where everyone can flourish. We’ve provided a breakdown of more of what you need to know about Measure 110 below. Keep the Faith, Timothy McMahan King Oregon Voters Want Measure 110 to Remain in Place While two gubernatorial candidates actively campaign for repealing Measure 110, the public still believes in the project. A recent Data for Progress study of 1,051 Oregon voters found that Measure 110 retains strong majority support. Specifically, a majority of Oregon voters believe drug use and addiction is a public health issue and that Measure 110 should remain in place. Additionally, voters overwhelmingly support individual provisions of the law and understand that Measure 110 is not contributing to crime and homelessness in Oregon. Building the Evidence: Understanding the Impacts of Drug Decriminalization in Oregon Although politicians are falsely pushing the idea that Measure 110 is causing an increase in crime and overdoses, this claim is directly contradicted by another recent study. The study states: Additionally, drug possession arrests significantly decreased after Measure 110 took effect on February 1, 2021, according to data from the Oregon Criminal Justice Commission. Once Measure 110 took effect, the monthly average fell by 65%, and it held steady for the first half of 2022. New study finds large gaps in services for substance use disorder treatment in Oregon There is still a lot more work to be done on ensuring the presence of opportunities where all can flourish. A study published in September found a nearly 50% gap in services for substance use disorder treatment, prevention, recovery, and harm reduction in Oregon. The study’s lead author, Katie Lenahan, a research project manager at the OHSU-PSU School of Public Health stated “We definitely see gaps in harm reduction access. Syringe exchange programs, we have less than half of the number that is necessary to really meet the need. Naloxone distribution, we see a 28% gap, so the need for much more access to naloxone And then fentanyl test strips so people can test and make sure their drugs are safe, we saw about a 35% gap in facilities that offer that resource.” Without funding, groups doing harm reduction and recovery work can only be partially successful.