Erika Neldner, managing editor of the Cherokee Ledger-News in Cherokee County Georgia, recently published an editorial that was critical of Georgia’s medical amnesty (also known as 911 Good Samaritan) law and overdose prevention efforts. She relies on outdated and inaccurate myths that have been disproven and to which only the most reactionary politicians and pundits still cling.
Georgia’s overdose prevention laws passed in 2014 with broad bipartisan support and the backing of Gov. Deal and police departments across the state. That the article comes from Cherokee County is important. The Holly Springs Police Department was the first in the state to equip officers with naloxone. In Holly Springs alone 9 overdoses have been reversed since April 2014. When Woodstock and Canton are added, Cherokee County has had at least 19 overdose reversals. I’m sure the loved ones of those whose of those who were saved are grateful that Police Chief Ken Ball didn’t adopt such a rigid “tough love” approach toward drug users.
I’ve had my share of experience with drugs and overdose deaths. I used heroin for 11 years. I didn’t fit the common stereotype of a teenager who start on some gateway drug and works their way up. I started using heroin — the first drug I ever tried — in my mid-20s. In fact, that’s when a lot of heroin users get started. The recent national spike in heroin use is a result of tighter restrictions on prescription pain medications like hydrocodone and oxycodone. When patients become dependent on these drugs and have their supply cut off, usually by doctors scared to write them another prescription, heroin and other potent opiates become a reasonable alternative.
The traditional “tough love” model, still pushed by many 12-step programs and inpatient rehab centers, calls for an abstinence-only approach to drug treatment. These programs have a reported 5-10% success rate and almost always result in users relapsing. They do work for some people, but today we have alternatives which have proven to be more successful.
Drug courts, 12-step programs, and some rehabs shun medication-assisted treatments like methadone and suboxone programs. Despite a proven record of success (studies show these programs have a 40-60% long-term success rate), those with a stake in the rehab industry or the judicial system view them as “substituting one drug for another.” Methadone and suboxone can be powerful drugs, but when used correctly (and regulations on both are strict) they do not cause euphoria and they allow patients to lead normal, productive lives — something many heroin users are unable to do. It is difficult to overdose on methadone to anyone who has a tolerance for opiates and nearly impossible to overdose on suboxone.
Neldner brings up the spread of HIV and Hepatitis C, but fails to mention one of the most effective methods for stopping it: clean needle exchanges. The Atlanta Harm Reduction Coalition (AHRC) runs the only needle exchange program in Georgia. AHRC and its sister-group Georgia Overdose Prevention distribute naloxone kits to at-risk communities. As of June 1st, 2015 these kits have reversed at least 266 overdoses. If people like Neldner had their way, most of those people would be dead. Instead, they’ve been given a second chance, an opportunity to stop using street drugs and resume a normal life. It’s difficult to see how anyone with just a drop of compassion in their soul could oppose that.
I’ve been to rehab and 12-step programs and, like many drug users, found them ineffective. Eventually I found my way to SMART Recovery, a program that uses cognitive-behavioral therapy (CBT) and evidence-based treatment. SMART accepts methadone and suboxone assisted treatment, preferring to leave medical decisions up to doctors and their patients. It changed my way of thinking about my drug use. Instead of viewing slips and relapses as a failure, after which I had to start all over at the beginning, carrying a fresh supply of guilt and shame along the way, it suddenly wasn’t a big deal as long as I keep working toward my goal of stopping illicit drugs. It saved my life.
Drug courts in Georgia still push an abstinence-from-all-drugs line on recovering drug users. I had a close friend who spent over a year in court-ordered rehab, got a job, and managed to save up money for an apartment and a car. He went out and had a drink one night which got him kicked out of the rehab. A drug court judge sent him back to jail while they figured out what to do with him. Eventually we managed to convince the rehab to take him back. He left jail but never made it to the rehab. Along the way he picked up some heroin and overdosed. Whoever he was with that night left him in his mom’s yard rather than find help. This was before the 911 medical amnesty law and before naloxone was widely available in Georgia. If either of those had been an option my friend might still be alive. If he’d been on methadone or suboxone he might still be alive. Instead, the “tough love” approach led to him dying. That’s why me, and all the people at Georgia Overdose Prevention who have lost loved ones, keep up the fight and put in so many hours to educating people and distributing naloxone. My friend won’t come back, but maybe we can spare someone else the pain of losing a friend, child, parent, or neighbor.
Neldner tries to convince us that naloxone access makes drug users carelessly take more drugs, relying on EMTs and first responders to “save them” from an overdose. In reality, drug users who are educated about drugs and practice harm reduction techniques like using clean needles and carrying naloxone use no more drugs than other drug users. In fact, harm reduction programs provide an entry for drug users to adopt a more healthy lifestyle, get much-needed medical care, and find their way into effective treatment. Like so much other Drug War propaganda, the facts don’t fit the hard-line narrative pushed by some politicians and pundits. Their attitudes are dangerous. While we could be saving lives, people like Neldner seem content destroying them.
Naloxone in the hands of first responders saves lives. Naloxone in the hands of drug users saves lives. The 911 medical amnesty law saves lives. It defies logic that anyone with the most rudimentary knowledge about modern drug use and addiction would oppose them. The point of these laws is to encourage people to report an overdose. Adding the threat of legal action or forcing users into rehab would unravel those efforts. People in our communities are needlessly dying and, if we place any value on human life, we should do all we can to stop it. If we let drug users die because we’re set on a failed “tough love” approach, we’ll never give them a chance to find effective treatment, to stop using, to lead healthy lives. We will never know their true potential. To quote one of the mom’s from Georgia Overdose Prevention, who lost a son to heroin overdose 3 years ago: “If they’re still alive, there’s hope.” If we truly care about people who use drugs, we have an obligation to offer them that hope. Naloxone and medical amnesty laws do just that. Opposing them or adding strings is not only ineffective, it’s a certain recipe for more overdose deaths.
- Georgia’s 911 medical amnesty (“Good Samaritan”) and naloxone access laws: http://media.wix.com/ugd/8dac26_efb9f8de9f0f463e89cb3bdc1bf5793e.pdf
- Atlanta Harm Reduction Coalition: http://atlantaharmreduction.org
- Georgia Overdose Prevention: http://georgiaoverdoseprevention.org
- Failure of 12-step programs: http://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/
- Success of medication-assisted treatment: http://www.addictionpro.com/article/medication-assisted-treatment-working
- What is harm reduction? http://www.ihra.net/what-is-harm-reduction
- SMART Recovery: http://smartrecovery.org
- Overdose Reversal Tracker: http://www.nchrc.org/law-enforcement/southern-law-enforcement-overdose-reversal-data-tracker/
- TIP 40 – SAMHSA guide to buprenorphine (suboxone) treatment: http://buprenorphine.samhsa.gov/Bup_Guidelines.pdf
- TIP 43 – SAMHSA guide to medication assisted treatment in general: http://buprenorphine.samhsa.gov/tip43_curriculum.pdf
- SAMHSA facts and statistics about methadone assisted treatment: http://www.dpt.samhsa.gov/medications/methadone.aspx