Opioid Crisis, Part 2: The New War on Drugs: Treatment Rather Than Prison

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New Hampshire, U.S.A., a Northeastern idyll, lakes, woods and small cities and towns practically leaping out of Norman Rockwell paintings.

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The reality is darker. The pristine surface covers a raging opioid and heroin addiction epidemic.

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The State’s motto is “Live free or die.” The crisis has given a whole new and literal dimension to this expression. We traveled to New Hampshire to examine the tragedy of the New Hampshire epidemic, as well as the State’s progressive ‘Drug Court’ program. Our segment on the subject aired on 3sat Nano on June 6, 2016 and can be seen here, starting at minute 15 of the program.

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The addicts are not the “other people.” They are your best friends and next-door neighbors. This is Noah. He worked in the financial industry and had a wife and family. He lost it all to the drugs and found himself in the legal system when he  turned to shoplifting to support his habit. He, like most opioid addicts, couldn’t quit because he would feel ill without the drugs, not because he wanted to get high.

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Opioid addiction is not a crime, in and of itself. But users often turn to crime to support their habits. Small time drug dealing is common. Prison, in many instances for years on end, is society’s long-standing response to drug-related offenses.

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An innovative program called ‘Drug Court’ implements a treatment-based therapeutic approach, rather than a punitive one. Participants successfully completing a drug court program will not have to go to prison. Here we are in Drug Court in Nashua, New Hampshire, Judge Jacalyn Colburn presiding.

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Noah sits in Drug Court, waiting for his case to be called. The stories of the participants are strikingly similar. Many get hooked on prescription pain killers after an injury (see Part 1 of our Opioid Segments), and later switch to heroin because it is cheaper – in fact, cheaper than beer. Others, like Noah, get hooked earlier in life, when they use the pills as a party drug, only to find that they can’t break their addiction.

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Judge Colburn says she could lock the users up all day, but that wouldn’t do any good because they would just resume their addictions and commit more crimes. The addicts want desperately to quit, but can’t because of changes to their brain chemistry.

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Judge Colburn has adopted a psycho-social approach, designed to return Drug Court defendants to normal life. Participants are praised and given rewards for performing their assigned tasks. Here, Judge Colburn hands Noah a certificate for graduating to the program’s next level.

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Drug Court utilizes an interdisciplinary team of social workers, therapists, law enforcement personnel and attorneys. Here, Noah explains to a social worker how he feels when he gets cravings, and is counseled on the tools of how to avoid relapsing.

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Drug Court is unusual in that professionals who are ordinarily forced by their roles to be adversarial, now all work together to help the program participants. Here, Lt. Kevin Rourke of the Nashua Police Department is pictured with a prosecutor and defense attorney. They are all on the same side.

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We drove around with Lt. Rourke. He knows the Drug Court participants better than anyone in the program, from arresting them! But he also knows their hopes, dreams and struggles – how they have tried to quit their addictions, but couldn’t. His bond with the defendants is genuine and inspiring. The cop has become a big brother figure.

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Frequently, the support provided by caring professionals like Judge Colburn and Lt. Rourke is not enough for users to quit.  Addiction is a neurological disease and not a question of “bad character.” Substitute drugs such as Methadone and Buprenorphin are therapeutic substitutes for heroin and other opiates. Without the substitute drugs, many users will suffer from an endorphin deficiency and feel horribly sick, to the point of debilitation.

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Addiction specialist Dr. Richard Rosenthal explains that the substitute drugs provide the platform for addiction patients to feel well enough to be able to receive and benefit from psychosocial treatment. Yet, the substitutes remain controversial, as there is a widespread belief – including among many judges and users – that getting “clean” means living without the substitute drugs also. Yet, as we explained in our prior segment, relapse rates without substitute drugs exceed 90% Judge Colburn’s Drug Court allows for the use of substitutes as an important aspect of the recovery program.

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This is Hugh and Jamie. They are a couple, and have both struggled for years with opioid addiction. The future is uncertain and perilous for both of them, but they are on opposite trajectories.

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Jamie is in Drug Court, takes medication for her addiction, has been clean for many months, and has her children back. Although she has attended many funerals recently of friends who have overdosed, she is convinced that she is going to be one of those who make it.

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Hugh is about to go for a urine test. He will fail because he has been using opioids again, and will immediately be returned to prison. He loves Jamie, but doesn’t want to bring her down.

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He would give anything just to be able to stay out of prison, and be with Jamie, out in the sun. But he can’t beat his addiction. He has never been admitted into a drug court program. He is not a bad person, he has much goodness and love in his heart, but he is also opioid agony personified.

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A last hug, at least for the foreseeable future, as Jamie and Hugh go on their separate journeys.