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Tag: 2020 presidential candidates

  • Addressing the Opioid Epidemic: What the Research Says

    Addressing the Opioid Epidemic: What the Research Says

    Rehab? Safe injection sites? Sue Big Pharma? Find out how each of the Democratic presidential candidates plan to address and treat opioid use disorder, and which of these approaches are supported by evidence.

    In the lead-up to the 2020 elections, the Journalist’s Resource team is combing through the Democratic presidential candidates’ platforms and reporting what the research says about their policy proposals. We want to encourage deep coverage of these proposals — and to do our part to help deter horse race journalism, which research suggests can lead to inaccurate reporting and an uninformed electorate. Our criteria for the proposals we’re covering is simple: We’re focusing on proposals that have a reasonable chance of becoming policy, and for us that means at least 3 of the 5 top-polling candidates say they intend to tackle the issue. Here we look at candidates’ proposals to address the opioid epidemic. Candidates are divided in their approaches; while nearly all favor increasing funding for and access to treatment for opioid use disorder, fewer candidates support harm reduction policy interventions, such as safe injection sites and needle exchanges. A few candidates incorporate broader criminal justice-level changes or physician-level interventions into their policy proposals.

    Candidates favoring increased funding for and access to treatment

    Michael Bennet, Joe Biden, Cory Booker*, Pete Buttigieg, John Delaney, Amy Klobuchar, Bernie Sanders, Tom Steyer, Elizabeth Warren, Marianne Williamson*, Andrew Yang

    Candidates favoring harm reduction interventions

    Michael Bennet, Cory Booker, Pete Buttigieg, Amy Klobuchar, Bernie Sanders, Elizabeth Warren

    Candidates favoring action against pharmaceutical companies

    Michael Bennet, Cory Booker, Pete Buttigieg, John Delaney, Tulsi Gabbard,  Amy Klobuchar, Bernie Sanders, Elizabeth Warren, Andrew Yang

    Candidates favoring interventions that target physician prescribing behavior

    John Delaney, Amy Klobuchar, Andrew Yang

    Candidates favoring decriminalization of possession of opioids

    Pete Buttigieg, Andrew Yang

    What the research says

    Access to treatment: Medication-assisted treatment is an evidence-based treatment for opioid use disorder; it has been shown to reduce the risk of overdose death for people who use opioids. Methadone, buprenorphine and naltrexone are types of medication-assisted therapy for opioid use disorder. These medications reduce symptoms of craving and withdrawal. A systematic review and meta-analysis of medication-assisted treatment find that people receiving such treatment were less likely to die of an overdose or other causes than their peers with opioid use disorder who did not receive medication-assisted treatment.

    Harm reduction: Harm reduction initiatives attempt to reduce the risks associated with using drugs. Such initiatives include needle exchange programs, widespread distribution of the opioid overdose antidote naloxone and supervised injection facilities. Supervised injection facilities, also known as safe injection sites or supervised consumption facilities, are not legal in the U.S. They exist legally in other countries, such as Canada and Australia, however.

    Several studies have demonstrated a positive link between safe injection site use and entry into treatment. Safe injection sites also provide benefits to people who use drugs in the form of sterilized equipment and supervision to mitigate the dangers of overdose.

    Over a dozen studies have linked needle exchanges with lower rates of hepatitis C and HIV infection among people who inject drugs.

    A systematic review of research on take-home naloxone programs, which provide people at risk of opioid overdose with kits including the antidote, concludes that “there is overwhelming support of take-home naloxone programs being effective in preventing fatal opioid overdoses.”

    The pharmaceutical industry: Big Pharma’s role in marketing opioids spurred physicians to prescribe more opioids, research shows. This, in turn, fueled the opioid epidemic the country faces today. Policies targeted toward Big Pharma include proposals to hold industry players liable for their role in the opioid epidemic with criminal penalties and fines.

    Decriminalization: The rationale behind decriminalization of the personal use of narcotics is that criminal penalties essentially criminalize substance use disorder. Proponents of decriminalization argue that such drug use should, instead, be met with evidence-based treatment. There is not much research on the effects of decriminalization because it’s rare. However, in 2001, Portugal decriminalized personal acquisition, possession and use of illicit drugs. Research indicates that drug-related deaths have fallen since the southwestern European country decriminalized illicit drugs.

    Physician-level interventions: These interventions target prescriber behavior. Examples include physician education programs, guidelines or restrictions on the quantity of opioids physicians can prescribe, and prescription monitoring programs that allow physicians to view patients’ prescription history to avoid overprescribing or illegitimate prescribing. While education and prescribing policies have curtailed prescribing habits, prescription monitoring programs have been less successful, studies indicate.

    Key context

    In late 2017, the U.S. Department of Health and Human Services declared the nation’s opioid crisis a “public health emergency.” The problem has been building for over a decade, spurred by sharp increases in prescriptions for opioids, commonly used to treat both short-term and chronic pain.

    About 233.7 million opioid prescriptions were filled each year, on average, from 2006 to 2017, according to a March 2019 study in JAMA Network Open that looks at opioid prescriptions filled in retail pharmacies across the U.S.

    Prescription painkillers have a high risk of abuse — across the academic literature, rates of misuse among patients taking opioids for chronic non-cancer pain average between 21% and 29%. Research indicates that as of 2013, more than 2 million people in the U.S. had prescription opioid-related opioid use disorder.

    Prescription opioids can also pave the way for illegal drugs like heroin. Eighty percent of people who have used heroin have previously misused prescription opioids, according to an August 2013 analysis of national survey data collected from 2002 to 2011.

    As opioid use and misuse has increased, deaths linked to the drugs have increased. In 2017, opioids were involved in 47,600 drug overdose deaths, accounting for nearly 70% of all overdose deaths nationwide that year.

    Recent research

    Access to treatment:

    A review of randomized controlled trials comparing medication-assisted treatment of opioid use disorder to placebo or no medication finds that medication-assisted treatment “at least doubles rates of opioid-abstinence outcomes.”

    A study of 151,983 adults in England treated for opioid dependence between 2005 and 2009 finds that the risk of fatal drug overdose more than doubled for individuals who received only psychotherapy compared with those who received medication-assisted treatment.

    Harm Reduction:

    Two reviews — one published in Drug and Alcohol Dependence in 2014, and one published in Current HIV/AIDS Reports in 2017 — indicate that supervised consumption facilities promote help people access treatment. The more recent review looks at 47 studies published between 2003 and 2017 on supervised drug consumption facilities. The authors find a handful of studies that demonstrate a positive link between safe injection site use and starting treatment.

    One of these studies compared enrollment in detoxification programs among those who used Vancouver’s supervised injection facility the year before and after it opened in 2003. Researchers find the facility’s opening was linked to a 30% increase in detox program use, which, in turn, was linked to pursuing long-term treatment and injecting at the facility less often. A later study of the injection facility focused on use of detox services located at the facility. It finds that 11.2% (147 people) used these services at least once over the two years studied. The authors conclude that supervised injection facilities might serve as a “point of access to detoxification services.”

    A 2006 study of 871 people who injected drugs finds no substantial increase in rates of relapse among former users before and after the Vancouver site opened. However, the researchers also find no substantial decrease in the rate of stopping drug use among current users before and after the site opened. Another study of 1,065 people at this facility published in 2007 finds that only one individual performed his or her first injection at the site.

    Though supervised injection sites are illegal in the U.S., one opened underground in 2014. Researchers interviewed those who used the underground site during its first two years of operation and their findings were published in 2017 in the American Journal of Preventive Medicine. The site’s users were asked the same set of questions about their use patterns every time they injected drugs at the site. The authors conclude that the site offered several benefits, including safe disposal of equipment, unrushed injections and immediate medical response to overdoses. The authors add that if the site were sanctioned, it might be able to offer additional benefits, including health care and other services.

    Big Pharma:

    Research suggests that physicians targeted with marketing from pharmaceutical companies prescribe opioids at higher rates than doctors not exposed to their marketing.

    Several studies use data from the Centers for Medicare and Medicaid Services’ Open Payments database, which tracks payments made by drug and medical device companies to physicians. That information is used to analyze how relationships between physicians and drug companies are linked to prescriptions written.

    These studies define opioid-related payments as cash payments — for example, speaking fees associated with promoting a drug — and payments-in-kind — free meals pharmaceutical representatives provide to doctors’ offices, for instance. These studies find that physicians who receive opioid-related payments tend to prescribe more opioids.

    A study in PLoS One from December 2018 looks at physicians who received opioid-related payments, some in 2014 and some in 2015, compared with doctors who never received such payments. The authors find that physicians who received opioid-related payments had a larger increase in the number of daily doses of opioids dispensed, as well as in total opioid expenditures, prescribing pricier opioids per dose.

    Another study looking at the same data offers further detail. The study, published in Addiction in June 2019, focuses on 865,347 physicians across the country who filled prescriptions for Medicare patients from 2014 to 2016. “Prescribers who received opioid-specific payments prescribed 8,784 opioid daily doses per year more than their peers who did not receive any such payments,” the authors write.

    Other research geographically links opioid marketing and opioid-related overdose mortality. The paper, published in JAMA Network Open in January 2019, analyzes county-level prescription opioid overdose deaths and county-level opioid marketing payments.

    The authors find that deaths from prescription opioid overdoses increased with each standard deviation increase in opioid marketing as measured by dollars spent per capita, number of payments to physicians per capita and number of physicians receiving payments per capita. Standard deviation indicates the variation of a given value from the average. “Opioid prescribing rates also increased with marketing,” the authors write. They note that the higher prescription rate might be why overdose deaths increased.

    Physician-level interventions:

    An August 2018 study published in Science highlights the role physician education might play in addressing the nation’s opioid crisis. The intervention was simple: When a patient died of an opioid overdose, the county medical examiner sent the prescribing physicians a letter notifying them. The authors conducted a randomized trial of 861 physicians whose patients overdosed. The intervention group received the letter, which included a safe prescribing warning consisting of these recommendations:

    • Avoid co-prescribing an opioid and a benzodiazepine.
    • Minimize opioid prescribing for acute pain.
    • Taper long-term users off opioids.
    • Avoid prescriptions lasting for three consecutive months or longer and prescribe naloxone, an opioid overdose antidote.

    The control group received no communication.

    Physicians in the intervention group cut their opioid prescribing by 9.7% — as measured by milligram morphine equivalents in prescriptions filled — in the three months after the letter was sent. These physicians also started fewer patients on opioids and wrote fewer high-dose prescriptions than the control group.

    Prescribing policies and guidelines also have successfully curbed physicians’ distribution of opioids.

    In October 2017, the Michigan Opioid Prescribing Engagement Network released opioid prescribing guidelines for nine surgical procedures to clinicians participating in the Michigan Surgical Quality Collaborative, a statewide initiative to improve surgical care.

    Researchers compared opioid prescribing before and after these guidelines were released, analyzing data from 11,716 patients across 43 hospitals collected from February 2017 to May 2018. They find that prescriptions declined, on average, from 26 pills to 18 pills per month after the guidelines were released.

    Patients also took fewer of the pills they were prescribed. As measured by patient-reported survey data, opioid consumption following surgery dropped from 12 pills to nine, “possibly as a result of patients anchoring and adjusting their expectations for opioid use to smaller prescriptions,” explain the authors of the August 2019 New England Journal of Medicine study. Although patients received smaller prescriptions and used fewer pills after the guidelines were published, there were no substantial changes in the patients’ satisfaction and pain scores.

    Similar to the study of Michigan’s opioid prescribing guidelines is a February 2018 study in the American Journal of Emergency Medicine that tracks the effects of an emergency department opioid prescribing policy. The policy resulted in declines in opioid prescriptions. Compared with the control emergency department, the two intervention hospitals had a more pronounced decline in opioid prescribing. The authors conclude that emergency department-based policies might help reduce opioid prescribing.

    Prescription drug monitoring programs, which allow physicians to view patients’ prescription history to avoid overprescribing or prescribing opioids to people who don’t actually need them, have been shown to be less effective. A January 2018 study of national data published in Addictive Behaviors finds that there were not statistically significant differences in the likelihood that physicians would prescribe opioids for chronic pain when comparing states with prescription drug monitoring programs with those without.

    Further reading

    General overview

    Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic

    Allison L. Pitt, Keith Humphreys and Margaret L. Brandeau. American Journal of Public Health, October 2019.

    The gist: “Policies focused on services for addicted people improve population health without harming any groups. Policies that reduce the prescription opioid supply may increase heroin use and reduce quality of life in the short term, but in the long term could generate positive health benefits. A portfolio of interventions will be needed for eventual mitigation.”

    Safe injection sites

    Attendance at Supervised Injecting Facilities and Use of Detoxification Services

    Evan Wood, Mark W. Tyndall, Ruth Zhang, Jo-Anne Stoltz, Calvin Lai, Julio S.G. Montaner and Thomas Kerr. New England Journal of Medicine, June 2006.

    The gist: A study of Vancouver’s supervised injection facility finds “an average of at least weekly use of the supervised injecting facility and any contact with the facility’s addictions counselor were both independently associated with more rapid entry into a detoxification program.”

    Injection Drug Use Cessation and Use of North America’s First Medically Supervised Safer Injecting Facility

    Kora DeBeck, Thomas Kerr, Lorna Bird, Ruth Zhang, David Marsh, Mark Tyndall, Julio Montaner and Evan Wood. Drug and Alcohol Dependence, January 2011.

    The gist: “These data indicate a potential role of SIF [supervised injecting facilities] in promoting increased uptake of addiction treatment and subsequent injection cessation.”

    “A Little Heaven in Hell”: The Role of a Supervised Injection Facility in Transforming Place

    Ehsan Jozaghi. Urban Geography, May 2013.

    The gist: “Participants’ narratives indicate that attending InSite [Vancouver’s supervised injection facility] has had numerous positive effects in their lives, including changes in sharing behavior, improving health, establishing social support and saving their lives.”

    Process and Predictors of Drug Treatment Referral and Referral Uptake at the Sydney Medically Supervised Injecting Centre

    Jo Kimber, Richard P. Mattick, John Kaldor, Ingrid Van Beek, Stuart Gilmour and Jake A. Rance. Drug and Alcohol Review, May 2009.

    The gist: Researchers conducted 1.5-year study at a supervised injection site in Sydney. They find that 16% of clients at the site referred to treatment by health and social welfare professionals went on to receive it, leading the authors to conclude that the center “engaged injecting drug users successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services.”

    Inability to Access Addiction Treatment and Risk of HIV Infection Among Injection Drug Users Recruited from a Supervised Injection Facility

    M.-J.S. Milloy, Thomas Kerr, Ruth Zhang, Mark Tyndall, Julio Montaner and Evan Wood. Journal of Public Health, September 2012.

    The gist: Many who use supervised injection facilities have the desire to access treatment. This study surveyed 889 people who were randomly selected to be surveyed at Vancouver’s supervised injection facility. “At each interview, ∼20 percent of respondents reported trying but being unable to access any type of drug or alcohol treatment in the previous 6 months,” the authors write. The main barrier to access, respondents said, was waiting lists for treatment.

    Big Pharma

    The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

    Art Van Zee. American Journal of Public Health, February 2009.

    The gist: In the first six years it was on the market, Purdue Pharma spent about six to 12 times more to promote OxyContin than it had to promote another long-lasting opioid. The paper describes various marketing strategies including promotional giveaways and Pharma-funded medical education programs.

    Industry Payments to Physicians for Opioid Products, 2013-2015

    Scott E. Hadland, Maxwell S. Krieger and Brandon D. L. Marshall. American Journal of Public Health, September 2017.

    The gist: This study examines payments pharmaceutical companies make to physicians to market opioid products. The authors find that 375,266 opioid-related payments that weren’t related to research work were made to 68,177 physicians over the study period. The authors estimate that about 1 in 12 physicians in the U.S. received a payment from a pharmaceutical company to promote their opioid medications during the 29-month study period. The bulk of the money went toward speaking fees or honoraria, but the most common expense was food and beverages – 352,298 payments totaling $7,872,581.

    Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians with Subsequent Opioid Prescribing

    Scott E. Hadland, Magdalena Cerdá, Yu Li, Maxwell S. Krieger and Brandon D. L. Marshall. JAMA Internal Medicine, June 2018.

    The gist: “Whereas physicians receiving no opioid-related payments had fewer opioid claims in 2015 than in 2014, physicians receiving such payments had more opioid claims,” the authors write.

    Physician-level interventions

    Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada

    David W. Grant, Hollie A. Power, Linh N. Vuong, Colin W. McInnes, Katherine B. Santosa, Jennifer F. Waljee and Susan E. Mackinnon. Plastic and Reconstructive Surgery, July 2019.

    The gist: Plastic surgery trainees were asked about their opioid prescribing education, factors contributing to their prescribing practices and what they would prescribe for eight different procedures. The authors find that, of the 162 respondents, 25% of U.S. plastic surgery trainees received opioid-prescriber education, compared with 53% of Canadian trainees. For all but one of the eight procedures, U.S. physicians prescribed significantly more morphine milligram equivalents than their Canadian counterparts.

    Source list

    Caleb Alexander, professor and co-director of the Center for Drug Safety and Effectiveness. Johns Hopkins University.

    Michael L. Barnett, assistant professor. Harvard T.H. Chan School of Public Health.

    Chinazo Cunningham, professor. Albert Einstein College of Medicine.

    Scott Hadland, assistant professor. Boston University School of Medicine.

    David N. Juurlink, scientist. Sunnybrook Research Institute.

    Thomas Kerr, associate professor. The University of British Columbia.

     

    For more, check out JR’s long read on the opioid prescribing problem, our summary of research on where opioids are prescribed the most and our tip sheet for reporting on fentanyl and synthetic opioids.

    This piece adheres to suggestions offered by the National Institute on Drug Abuse’s media guide, which recommends language that avoids the potentially stigmatizing term “addict” in the context of substance use. It states: “In the past, people who used drugs were called ‘addicts.’ Current appropriate terms are people who use drugs and drug users.”

    *Dropped out of race since publication date.

    This article first appeared on Journalist’s Resource on December 9, 2019 and is republished here under a Creative Commons license.

  • Kamala Harris Unveils Mental Health Plan With Charlamagne Tha God

    Kamala Harris Unveils Mental Health Plan With Charlamagne Tha God

    Harris calls for more treatment beds, an end to solitary confinement, and increased access to mental health treatment in her newly released plan.

    Senator Kamala Harris unveiled her new mental health plan in South Carolina this week during an event featuring radio personality/author Charlamagne tha God. Harris sat down with The Breakfast Club host to discuss the state of mental health in America.  

    A Public Policy Failure

    “Probably one of the biggest public policy failures of America is the failure to address mental health and put the resources into it as a priority. The result of that is that people are silently suffering who should never suffer. We have so many children who are experiencing undiagnosed, untreated trauma, whether it is because they’re growing up in a home where there’s violence, which crosses socioeconomic lines, or a community where there’s violence, or growing up in poverty because — let’s be clear — poverty is trauma-inducing,” Harris explained, according to Post and Courier. “All of the behaviors that result from that undiagnosed, untreated trauma are predictable. We’re failing to address it and then where we do address it is in the criminal justice system. We have basically turned jails and prisons into these gigantic mental health facilities without any mental health treatment.”

    Charlamagne then touched on the issue of trauma and how he had to unlearn stigmatizing beliefs regarding who is affected by mental illness.

    “They call it a correctional facility, but what are you really correcting? You’re taking these kids who are already dealing with so much trauma and throwing them in a situation that’s just putting trauma on top of trauma, and then you’re letting them out in the world — if they are blessed enough to come home — and they haven’t dealt with anything,” he said. “I think one of the reasons they don’t get the help they need is because we don’t look at mental health services as something that should be part of a larger healthcare initiative. I didn’t even realize anxiety and depression was considered a mental health issue until I started going to therapy. When you think mental health, you think schizophrenia, you think somebody in a straitjacket, but no, it’s people dealing with these issues every single day and they just don’t have the proper tools and resources to go deal with it.”

    Harris added, “And then we deal with it when it reaches a crisis level. You would never say that we should have a health care system that only deals with stage four cancer.”

    In her new plan, Harris calls for an amendment to the Health Insurance Portability and Accountability Act (HIPAA) that would protect healthcare providers who give out patients’ private information if they are acting out of “good faith.”

    Disabled healthcare advocate Kendally Brown tweeted Harris in response to her proposed HIPAA amendments. “I adore you, but eliminating the IMD exclusion would remove the ONE protection mentally ill people have from the state locking them up in institutions long-term. I love that you’re focussing on mental health, but any solution MUST be community based, not institutional.”

    Brown’s stance is a common one among recovery and mental health advocates who fight for patients with addiction and/or mental health issues to make their own healthcare decisions.

    Kamala’s Mental Health Plan

    Here is Harris’s multi-pronged plan to address mental health, according to her campaign website:

    Focus Federal Funding on Needed Mental Health Research

    Kamala will direct federal funds to seek better treatment for mental illness and research on mental health issues more broadly, including research on adults with serious mental illness (SMI) and the use of interventions that reduce homelessness, arrest, incarceration, and unnecessary hospitalization.

    Expand Coverage of and Access to Mental Health Services

    Through her Medicare for All plan, Kamala will deliver mental health on demand via telemedicine, providing care by phone or video to all Americans whenever and wherever they need it—all without deductibles or copays.

    A shortage of mental health professionals harms American families and communities. It also drives provider stress and burnout. Kamala will authorize an educational loan forgiveness program for mental health professionals that agree to practice in areas with a shortage of providers.

    Increase Access to Hospitals, Housing, and Other Care Facilities

    Kamala will double the number of treatment beds nationwide, prioritizing states with shortages, including Iowa, Nevada, South Carolina, and Michigan, so persons with mental illness can receive the high levels of care they need.

    She’ll repeal the Institutions of Mental Disease (IMD) exclusion, which precludes Medicaid funding for adults receiving care in psychiatric facilities with more than 16 beds and has exacerbated a severe shortage of acute psychiatric care beds nationwide.

    Focus on Vulnerable Populations

    Double US Departments of Defense and Veterans Affairs (VA) research dollars to address and treat PTSD, military sexual trauma, and traumatic brain injury.

    Invest in evidence-based screenings for childhood trauma—including the fact that poverty is trauma-inducing—to diagnose and treat mental illness as early as possible.

    End the Mental-Illness-to-Jail Pipeline

    Kamala will expand Crisis Intervention Team training, which integrates specialized police, mental health professionals, EMS, 911 systems, and hospital emergency rooms in response to mental health crisis calls.

    You can read more about Harris’s plan here.

    View the original article at thefix.com

  • Beto O’Rourke: Ex-Marijuana Offenders Deserve “Drug War Justice Grants”

    Beto O’Rourke: Ex-Marijuana Offenders Deserve “Drug War Justice Grants”

    The Democratic presidential candidate believes we need to give back to those who were incarcerated under defunct marijuana laws.

    Democratic presidential candidate Beto O’Rourke says that the federal government owes Drug War Justice Grants to those who have been jailed for non-violent marijuana offenses to help them get their lives back.

    The proposed policy is part of O’Rourke’s larger platform that includes the legalization of marijuana. He promises that if he were elected President of the United States, he would grant clemency to all persons in the criminal justice system for possession of marijuana as well as expunge their criminal records related to those charges. Going one step further, he also wants to cross marijuana charges off the list of reasons someone could be deported or denied citizenship.

    While it might be easy to assume that O’Rourke is simply trying to gain a foothold in the Democratic presidential primaries by jumping on the legalization bandwagon—nearly all the Democratic challengers have advocated legalizing marijuana—the drug war has actually been an issue he’s long held dear.

    Back in 2009 as an El Paso city council member, he pushed for a resolution to advocate that the federal government undertake “open, honest, national dialogue on ending the prohibition of narcotics,” believing that marijuana legalization could help alleviate the stresses from drug trafficking at the border. In 2011, he co-wrote a book called Dealing Death and Drugs: The Big Business of Dope in the U.S. and Mexico.

    The proposed Drug War Justice Grant would be funded entirely by taxes taken on legal marijuana, according to O’Rourke’s campaign. The grants would be doled out based on how much time each individual convicted person has spent in prison.

    Going a step further, the candidate would also spend the taxes on treatment and re-entry programs as well as social programs for communities that have been disproportionately affected by marijuana arrests. Additionally, he proposes using federal criminal justice funds to allow state and local governments to waive licensing fees for marijuana businesses for low-income people who were formerly convicted of marijuana crimes.

    “We need to not only end the prohibition on marijuana, but also repair the damage done to the communities of color disproportionately locked up in our criminal justice system or locked out of opportunity because of the War on Drugs,” said O’Rourke in a prepared statement.

    “These inequalities have compounded for decades, as predominantly white communities have been given the vast majority of lucrative business opportunities, while communities of color still face over-policing and criminalization. It’s our responsibility to begin to remedy the injustices of the past and help the people and communities most impacted by this misguided war.”

    View the original article at thefix.com

  • Elizabeth Warren, Bernie Sanders Endorse Supervised Injection Facilities

    Elizabeth Warren, Bernie Sanders Endorse Supervised Injection Facilities

    Warren, Sanders and de Blasio are the only 2020 presidential candidates who have voiced support for SIFs. 

    US Sens. Elizabeth Warren and Bernie Sanders endorsed safer consumption spaces in late August, a position lauded by harm reduction advocates.

    Safer consumption spaces, also known as supervised injection facilities (SIFs) or overdose prevention sites, “are clinical but community-oriented spaces” where people may use under medical supervision and have a place to access information about treatment for substance use disorder.

    Those in favor of SIFs say “the facilities keep people alive during the drug-using phases of their lives, while also offering them a hand up to a new and better life.” 

    Their Endorsements

    Both Warren and Sanders, who are running for president, said they would support SIFs, if elected.

    As reported by The Hill, Sanders would “legalize safe injection sites and needle exchanges around the country, and support pilot programs for supervised injection sites, which have been shown to substantially reduce drug overdose deaths.”

    Warren would “support evidence-based safe injection sites and needle exchanges and expand the availability” of naloxone.

    Lindsay LaSalle, director of public health law and policy with the Drug Policy Alliance, said the candidates’ endorsement is “significant.” “It shows that there are candidates who, in the context of the opioid crisis… that they’re willing to think outside of the box and look at interventions that have proven successful in other countries.”

    SIFs Around The World

    There are approximately 120 safer consumption spaces currently operating in 12 countries, according to the Drug Policy Alliance. 

    A visit to Vancouver’s Insite was able to convince Philadelphia Police Commissioner Richard Ross that his city needed to follow suit. He said the experience changed him from being “adamantly against [the sites] to having an open mind.”

    Safehouse, the organization trying to open the nation’s first safer consumption spaces in Philadelphia, will fight the good fight in court against the federal government, which has sued the organization for violating federal law.

    “Either way it’s decided, it will set the first legal precedent in the country,” said LaSalle.

    Harm reduction and recovery advocate, Ryan Hampton, told Truthout that he would have attempted recovery sooner had he had access to safer consumption spaces.

    “I would have found my way into recovery much sooner, because I would have established trust with a clinician, a qualified health care provider, instead of some shady treatment center that was just trying to rip off my insurance company, or my mother,” Hampton said.

    View the original article at thefix.com

  • 2020 Presidential Candidates Detail How They'd "Turn The Tide" On Addiction Crisis

    2020 Presidential Candidates Detail How They'd "Turn The Tide" On Addiction Crisis

    All of the candidates approached the drug crisis as a public health issue, emphasizing the need for comprehensive treatment options.

    The 2020 presidential election is just over a year away.

    Ahead of the much-anticipated event, the Mental Health for U.S. coalition posed 11 questions about mental health and substance use disorder to the presidential hopefuls.

    Not every candidate answered, including former Vice President Joe Biden, former Massachusetts governor Bill Weld (a Republican) and President Donald Trump.

    But among the six who did, we focused on question number 2: “Every hour, eight people in America die of drug overdose, from opioids and increasingly from other drugs as well. What would your administration do to turn the tide on the addiction crisis?”

    Holding Big Pharma Accountable

    U.S. Senators Cory Booker, Kamala Harris and Bernie Sanders said they would hold drug manufacturers and distributors accountable for their role in exacerbating the drug crisis.

    “This epidemic, caused by the greed of pharmaceutical companies, is ravaging communities across America,” said Sanders.

    “Our response to the addiction crisis must start by tackling the very thing that fueled it in the first place: reckless pharmaceutical companies that marketed dangerous drugs they knew could be highly addictive in order to profit,” said Harris.

    “In the Senate, I called for bringing pharmaceutical CEOs to Capitol Hill to testify about their role in the opioid crisis,” said Booker.

    Investing In A Solution

    Booker and Harris referred to their co-sponsorship of the Comprehensive Addiction Resources Emergency (CARE) Act. The legislation would “authorize $100 billion over 10 years to combat drug addiction and funnel money to cities, counties and states… to boost spending on addiction treatment, harm reduction services and prevention programs,” as Booker outlined.

    Treat It as a Public Health Crisis

    All of the candidates approached the drug crisis as a public health issue, emphasizing the need for comprehensive treatment options.

    Mayor Pete Buttigieg emphasized expanding access to medication-assisted treatment (MAT), the “gold standard” of treatment for opioid use disorder.

    Sen. Amy Klobuchar, using funding from her opioid tax, would expand prevention and treatment initiatives, including mental health support, “giving Americans a path to sustainable recovery.”

    Sanders would guarantee substance use disorder and mental health services through Medicare-for-all, which emphasizes health care “as a right, not a privilege.”

    Other elements of the candidates’ plans included investing in the research of opioid alternatives for pain management, harm reduction programs like syringe exchange, and ensuring the availability of mental health and substance use disorder services for incarcerated individuals, a demographic of people mired by these issues.

    Addressing Trauma 

    Sen. Elizabeth Warren’s response stood out from the rest. She focused her strategy on addressing the root causes of substance use disorder and mental illness: trauma.

    “To start, we need to support our very youngest,” she said. “We know that adverse childhood experiences, like poverty, homelessness, violence in the community or in the home, family separation, or a caretaker with a substance use disorder, can affect brain development and have an impact on mental health in the teen years and beyond. My plans on gun safety, housing, immigration and the opioid crisis confront many of the conditions that can cause childhood trauma.”

    View the original article at thefix.com

  • Joe Biden Applauds Son For Speaking Out About Addiction Struggles

    Joe Biden Applauds Son For Speaking Out About Addiction Struggles

    In a recent New Yorker profile, Hunter Biden went on the record about his long-time addiction struggles.  

    Presidential hopeful Joe Biden and his wife Jill are speaking out about their son Hunter’s experience with addiction after the publication of a New Yorker profile that detailed Hunter’s decades-long struggle with substance misuse. 

    “Hunter’s been through some tough times, but he’s fighting, he’s never given up. He’s the most honorable, decent person I know,” Joe Biden said in a CNN interview, according to The Hill. 

    Biden added that Hunter’s participation in the New Yorker profile “took enormous courage.”

    In the profile, Hunter spoke out about his drug and alcohol abuse. 

    “Look, everybody faces pain,” Hunter told the magazine. “Everybody has trauma. There’s addiction in every family. I was in that darkness. I was in that tunnel—it’s a never-ending tunnel. You don’t get rid of it. You figure out how to deal with it.”

    Red Flags

    Hunter admits that during college he drank socially and used cocaine. When cocaine was unavailable once, he smoked crack. “It didn’t have much of an effect,” he said.

    However, as his career as a lobbyist and consultant took off, he began drinking more. When he started staying in Washington rather than getting on his commuter train home, it was a red flag. 

    “When I found myself making the decision to have another drink or get on a train, I knew I had a problem,” he said. 

    His wife at the time urged him to try a sober month. “And I wouldn’t drink for 30 days, but, on day 31, I’d be right back to it,” he said. 

    After connecting with AA, Hunter was sober for seven years before relapsing in 2010, and again in 2013. In 2014 he was discharged from the Navy after testing positive for cocaine. 

    In 2015, Hunter enrolled in a treatment program, followed by another in 2016. However, later that year he admits to buying crack, and drug paraphernalia was found in his vehicle.

    Divorce proceedings from 2017 included the claim that Hunter had “created financial concerns for the family by spending extravagantly on his own interests (including drugs, alcohol, prostitutes, strip clubs, and gifts for women with whom he has sexual relations), while leaving the family with no funds to pay legitimate bills.” 

    More recently, Hunter said that his father’s support has helped him endure his addiction. In May he told his father, “Dad, I always had love. And the only thing that allowed me to see it was the fact that you never gave up on me, you always believed in me.”

    Facing Addiction 

    Joe Biden has continued to stand by Hunter.

    “Everybody has to deal with these issues in a way that’s consistent with who they are and what they are,” he said this week. “The idea that we treat mental health and physical health as though somehow they’re distinct—it’s health.”

    Jill Biden, Hunter’s stepmother, said that her family, like many others, has had no choice but to face addiction head-on. 

    “We’ve seen his struggle and we know most American families are dealing with some sort of struggle like we are, and I think they can relate to us as parents who are hopeful and are supportive of our son,” she said. 

    View the original article at thefix.com

  • "New York Times" Fact-Checks Elizabeth Warren’s Stance on Legalization

    "New York Times" Fact-Checks Elizabeth Warren’s Stance on Legalization

    Warren is now pro-legalization but the record shows that this was not always the case.

    A new article by the New York Times fact-checks Senator Elizabeth Warren’s comments regarding marijuana legalization.

    In April 2019, the senator, who is currently a 2020 Democratic candidate for president, told a CNN town meeting that she “thought it made a lot more sense for Massachusetts to go ahead and legalize marijuana” instead of decriminalizing it, which the state passed in 2008.

    However, the Times found that Warren’s declaration was somewhat exaggerated, and pointed to comments made in 2011 and 2012 that appeared to show reluctance towards embracing full legalization.

    At the town hall meeting in April, Warren was responding to a student’s question about her stance towards legalization by noting that she “supported Massachusetts changing its laws on marijuana,” and believed that legalization was a more effective measure than decriminalization.

    The Times considered her comment an “exaggerated” version of her actual stance at various times in the past.

    During the Senate Democratic primary debate in October 2011, Warren actually opposed legalization. “Medical marijuana is one thing, but [legalization] generally, no,” she said. A year later, she declined to offer an opinion on the issue during an interview with the Associated Press, but later voiced her support for medical marijuana during an interview for Boston radio.

    In 2015, Warren was asked by Boston Globe reporter Joshua Miller about her previous opposition to legalization efforts. She told Miller that she was “open to it” after hearing about legalization measures in other states, and reiterated her willingness to consider legalization a year later when asked about her position on Question 4, a legalization initiative on the November 2016 ballot.

    The Times piece found that Warren’s statements on various subjects were largely true, including the decline of the minimum wage and her wealth tax plan, though it took issue with her description of Democratic support for said plan as “huge.”

    Warren’s current support for legalization puts her on equal footing with the majority of her fellow Democratic candidates, including Senators Cory Booker, Kirsten Gillibrand, Amy Klobuchar, Kamala Harris and Mayor Pete Buttgieg, as well as former Housing and Urban Development Secretary Julian Castro. 

    Former Vice President Joe Biden supports decriminalization efforts, criminal record expungement for marijuana charges and federal research into cannabis, but has stopped short of backing legalization, a position he shares with two other Democratic candidates, former Colorado Governor John Hickenlooper and Senator Sherrod Brown.

    View the original article at thefix.com

  • Presidential Candidate Seth Moulton Wants Mental Health Screening To Be Routine

    Presidential Candidate Seth Moulton Wants Mental Health Screening To Be Routine

    Moulton, who served in Iraq, has been open about his own mental health struggles.

    Presidential candidate Seth Moulton wants to make annual mental health screenings part of routine care, both for active duty military members and American high schoolers as part of his plan to prioritize mental health care. 

    Moulton, who served in Iraq with the United States Marine Corps, has been open about his own mental health struggles.

    “There is still this stigma against mental health care,” he said in March. “Post-traumatic stress is very real. I have had post-traumatic stress and I have a lot of friends who have had it. And I have lost two Marines in my platoon since we have been back.”

    Because of his personal experience, he knows how important proper treatment of mental health is. 

    “Post traumatic stress is a great example of a mental issue that is curable,” said Moulton, who currently represents Massachusetts in the House of Representatives. “I know a lot of vets who have gotten through post-traumatic stress, including myself. So we can fix this, but we need to be investing in it and we are not.”

    This week, Moulton formally released his mental health plan. It calls for making annual mental health screenings standard for military service members and high school students. It would also introduce mindfulness training for both of these groups. 

    “Mindfulness training is preventative medicine as pioneered today by the special operations community and other elite units,” Moulton wrote. 

    In addition, Moulton would establish 511, national mental health hotline. 

    “Mental health is a core component of overall health: it strengthens our economy and country,” Moulton wrote. “Serious mental illness costs America up to $193 billion in lost earnings per year, and touches everyone in America directly or indirectly. We must do everything we can to protect mental health coverage in this country, and that means protecting this coverage from the current administration’s efforts to undermine these essential health benefits.”

    Although his plan focuses heavily on service members and veterans, Moulton said that it’s important to remember that mental health affects all members of society. 

    “We must recognize that mental health matters to everyone. We all have personally dealt with mental health challenges, or have a family member, friend, or co-worker who has dealt with them, whether we know it or not,” he wrote. “High schoolers today are particularly at risk; in addition to the traditional anxieties of being a teenager, they face scrutiny on social media and live in a time of school shootings—all of them should get the support and care they need.”

    That starts with talking openly about mental wellbeing. 

    “We need to make sure that we all can discuss our mental health and get whatever help we may need,” Moulton said. “That is why I am telling my own story, encouraging others to tell theirs.”

    View the original article at thefix.com