During their repeated visits to New Hampshire, the 2016 presidential hopefuls have heard a lot — and probably far more than they expected — about America’s painful drug-addiction crisis. In the first decade and a half of the 21st century, the nationwide rate of deaths from drug overdoses has absolutely exploded, rising by 137 percent between 2000 and 2014, according to the Centers for Disease Control and Prevention (CDC). That increase was driven by a 200 percent rise in the rate of overdose deaths from opioids such as heroin and prescription pain killers. In New Hampshire specifically, the rate of overdose deaths soared from 8.7 per 100,000 in 2002 to 26.2 per 100,000 in 2014. Between 2013 and 2014 alone, it increased by 74 percent.
“Deaths from drug overdoses have jumped in nearly every county across the United States,” the New York Times notes. “The number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day.”
To put the surge in perspective: “The death rate from drug overdoses is climbing at a much faster pace than other causes of death,” so much so that “the trend is now similar to that of the human immunodeficiency virus, or HIV, epidemic in the late 1980s and early 1990s, said Robert Anderson, the CDC’s chief of mortality statistics.”
What’s the solution? Among both liberal and conservative policymakers, there’s a growing push to deal with nonviolent drug users outside the criminal-justice system. No question, if we’re trying to help an addict get clean, it makes more sense to put him in a treatment center rather than a prison cell. And yet, as addiction psychiatrist and AEI scholar Sally Satel recently explained, “We know from experience that referral to treatment alone isn’t enough.” In fact, she writes, “Some of the most promising treatment and rehab models are found within the criminal-justice system” (emphasis added). The reason is that, when addicts face real consequences for not getting or staying clean, they are less likely to need or drop out of treatment.
To illustrate how the carrot-and-stick approach can work, Satel describes the success of Hawaii’s Opportunity Probation with Enforcement program, also known as Project HOPE:
“It offers treatment only to those addicts who don’t quit using after either being threatened with penalties or offered incentives to quit using, or both. The savings from not having to pay for treating all comers means that those who need the intense intervention get more supervision and high-quality care.
“A randomized study conducted by Angela Hawken of Pepperdine University and Mark Kleiman, then of UCLA, found that after one year the Hawaii program’s clients were 55 percent less likely to be arrested for a new crime compared with those on traditional probation, and 72 percent less likely to use drugs. They were also 61 percent less likely to skip appointments with their supervisory officer, and 53 percent less likely to have their probation revoked.
“This and forthcoming data show that progress can be achieved with sanctions and threats alone for the vast majority of participants. Hawken and Kleiman call this ‘behavioral triage.’
“Models marked by rapid responses to someone’s behavior, with and without accompanying formal therapy, should provide important guidance in the years ahead, as the pendulum swings further in favor of treatment of all drug users. Programs modeled on the Hawaii experiment are already having success in Washington State, Alaska, Texas, South Dakota and other places.
“Building on the promise of the ‘swift, certain and fair’ approach to dealing with drug offenders is the realistic, most promising path to follow.”