In this year’s race for mayor and Boston City Council, two candidates who are in recovery from alcohol and drug addiction – Marty Walsh and myself — made it into our respective finals. Not too long ago, alcoholics were viewed as morally weak and unreliable, and the thought of electing anyone who had used or abused hard drugs was completely unthinkable. In addition, City Councilor and mayoral candidate John Connolly has even stated his desire to create an “Office of Recovery” if elected — clear acknowledgment of progress in lifting the stigma around addiction.
It’s a positive testament to our society that people who are drug addicted are not simply given up on. At the same time, there is something frightening about the reality that the number of people in recovery is so large that they can be identified as a distinct community, and that there is scarcely a family in Boston or in America that hasn’t been touched by addiction of some sort.
Drugs occupy a unique place at the intersection of public safety and public health. When law enforcement officials warn about the violence that stems from and surrounds the drug culture, it is not an exaggeration or a scare tactic. Similarly, when public health advocates argue that addiction is a disease and needs to be treated as such, they have mountains of medical evidence to support their claim.
It’s not surprising that the public temperament when it comes to drug policy is so mercurial and that our drug policies seem so contradictory. We complain that the war on drugs has failed, but I am living proof that even the most strictly regulated prescription drugs are easily accessed and abused. We complain that the cost of incarceration for drug offenses is too high, but even in places like South Boston, Roxbury, Dorchester or Charlestown, where there is a deep well of sympathy for those who struggle with addiction, there is also a high level of anger and exasperation with the thefts, break-ins, armed robberies, and even worse violence rooted in drugs and addiction.
The criminal justice system has become the largest referrer for treatment services for low-level and non-violent offenders, reserving jail cells almost entirely for the violent and the incorrigible. And while no one — including law enforcement officials I’ve spoken with — believes we can jail our way out of the problem, we also need to recognize that treatment carries a high rate of relapse, which the public can only tolerate for so long. There are a number of steps that I think Boston can take to protect public safety, preserve limited resources, and improve outcomes for addicts.
First, we need to approach treatment in a manner that is evidence based and fiscally prudent. It’s common sense, for example, that a middle age man suffering from addiction to cocaine will have different treatment needs than someone struggling with heroin; and that a young mother will face an entirely different set of dangers and pressures and triggers than a young man.
And yet there is a shockingly small amount of research or evidence available to point us toward treatment models or options with the highest likelihood of success for certain individuals with certain addictions. While some treatment centers are willing to disclose their success rates, most will not. As a result, while some complain that we aren’t spending enough to treat addiction, and I agree, it could also be argued that we often have very little idea what we’re spending for. This is not simply unwise financially, but on a human level, cruel. Families with loved ones struggling with addiction are desperate for help and for hope.
Here in Boston, we are surrounded with some of the greatest research hospitals, colleges and universities, and a broad spectrum of public leadership in public health and in public safety willing to collaborate and cooperate to achieve the best results. This brainpower and leadership should be applied to more careful study of which treatment programs work best for what substances and for which addicts. Limited public resources should follow the evidence.
At the same time, we should be working with law enforcement and the medical community to shut down the prescription drug pipeline that has become a major gateway to addiction for young people. Without a doubt, drugs like Oxycontin can find their way onto the streets by young people stealing from their grandparents, but that can’t possibly account from its incredible overabundance and accessibility. Whether it’s unscrupulous physicians who are acting as prescription mills or pharmaceutical companies producing more of the drug than legitimate medical need can justify are fair questions that should be explored and answered.
Finally, it seems so obvious, but we need to remember that drugs are a demand-side business. You can go after dealers and traffickers all you want, but unless and until we reduce demand, there will be an endless supply of greedy people willing to take the risk to turn drug profits from other people’s addiction. This is not an argument for tougher laws, but an argument for a comprehensive, consistent and sustained public health and education campaign — similar to highly successful efforts around tobacco and drunk driving —aimed at changing cultural attitudes and norms. Tobacco isn’t less addictive than before; it’s just not considered cool to smoke anymore so the numbers of people who do so have dropped steadily. We need a similar effort around drugs.
A wise man whose name I can’t recall once said that he had no interest in fighting wars against anything. Instead, he wanted to know what he was fighting for. As a recovering drug addict, I am fighting for evidence-based policies to promote safer, healthier neighborhoods, for people like me who deserve a second chance at life, and to give them and their families real hope.