Why President Donald Trump is Wrong to Increase Prosecution of Drug Offenders; Addition Expert Reacts to President Trump's Opioid Briefing

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Center for Network Therapy Medical Director Dr. Indra Cidambi Says Tougher Law Enforcement Will Hurt Individuals in Recovery and Cost the Country Much More

President Donald Trump this week pledged stronger law enforcement and increased criminal prosecution of drug offenders to combat the opioid epidemic, a move many addiction experts think will hurt people recovering from addiction.

“As an addiction medical doctor and psychiatrist, we are making a big mistake as 80% of drug law violations in 2015 were for possession (not manufacturing or sales) and the people most affected by increased prosecution are those suffering from substance use disorders,” said Dr. Indra Cidambi, Medical Director at the Center for Network Therapy, New Jersey’s first Ambulatory Detoxification facility.

“More prosecution will leave people in recovery with a criminal record while trying to re-integrate into the job market and it will cost us more to prosecute and jail these individuals,” Dr. Cidambi noted. Instead, Dr. Cidambi advocates using the ‘token economy’ model to universally offer individuals a clean record upon successful completion of addiction treatment. “Decriminalization will save us huge sums of money, which can be redirected to treatment and prevention,” she added.

“I have been treating individuals suffering from substance use disorders for over a decade and many times the biggest hurdle for recovering addicts trying to re-integrate into society is their criminal record,” said Dr. Cidambi. “The stigma of a drug law violation that stays on their record for a long time, boredom and continued dependence on family, acts as trigger for relapse.”

According to a Department of Justice report, half the total cost of illicit drug use in 2007 was related to criminal justice and incarceration, while, as per the Federal Bureau of Investigation, 80% of drug law violations in 2015 were for possession (not manufacturing or sales). “With the Center for Network Therapy estimating that the drug epidemic cost the U.S. economy a total of $1 trillion in 2015 (https://www.recoverycnt.com/wp-content/uploads/2017/08/actual-cost-of-drugs.pdf), criminal justice and incarceration costs were likely in the $500 billion range and will rise with policies that promote criminalization,” said Dr. Cidambi.

Drug abuse has wide-reaching consequences for the U.S. economy, so much so that Federal Reserve Chairman Janet Yellen has attributed rampant opioid abuse to the decline in labor force participation among prime-age workers.

Dr. Cidambi explains how “decriminalization” will benefit individuals in recovery, help America’s economy, and free up resources that could then be redirected to treatment and prevention:

  •     Decriminalization Offers Dual Benefits: In 2015, there were roughly 1.5 million arrests for drug law violations and four out of five were for possession. Decriminalization of drug possession related violations may offer the biggest bang for the buck because, according to the U.S. Department of Justice, more than 50% of the costs tied to illicit drug use related to criminal justice and incarceration.

“It is time we utilize the ‘token economy’ modality of treatment that universally offers individuals a clean record upon successful completion of addiction treatment. This would cut criminal justice costs dramatically and also enable those in recovery to more easily re-integrate into the job market more easily,” said Dr. Cidambi. “Currently, I find many individuals in recovery being frustrated by their inability to re-integrate into the economy and it also acts as a trigger for relapse.”

  •     Increased Funding for Newer Modalities of Treatment Should Deliver Better Results: According to the U.S. Department of Justice report, the cost of addiction treatment accounted for only 6% of the total costs associated with illicit drug use. Funding for treatment is essential, with funds allocated wisely to methods proven clinically effective and economically prudent. Newer modalities of treatment such as ambulatory (outpatient) detoxification offer better solutions to this trillion-dollar problem. Compared to traditional inpatient treatment, the outpatient model is less costly and delivers better results because it integrates the home environment into treatment.

“At CNT, we pioneered the Ambulatory (Outpatient) Detoxification model and it has delivered far better outcomes relative to inpatient detoxification,” said Dr. Cidambi.

  •     Prevention is Key: President Trump is right about prevention when he said yesterday, “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off.” In 2015, 58% of overdose deaths involved prescription medication. To reverse this trend, Mr. Trump’s rhetoric should be followed by vastly greater investment in educating the public about the addictive potential of some prescription medications, and, maybe, allowing only physicians in certain specialties with a fuller understanding of the underlying disease requiring addictive medications to prescribe them.

“I suggest that the government mandate that every physician's office display educational posters that warn about the addictive potential of certain medications, such as opiates (used to treat pain), benzodiazepines (used to treat anxiety), and stimulants (used to treat Attention Deficit Hyperactivity Disorder),” Dr. Cidambi said. This approach will encourage patients to have an informed conversation with their physicians about limiting the use of addictive medications.

While prescriber education is important, a near-term alternative would be limiting the ability to prescribe addictive medications to physicians with deep expertise in the ailment for which these prescriptions are required. For example, the ability to prescribe opiate pain medications could be restricted only to physicians with specialized training in pain management (such as surgeons, oncologists and orthopedic and pain management specialists) and the prescription of anti-anxiety medication (benzodiazepines) could be restricted to psychiatrists. “We need to stop creating addicts as a more comprehensive curriculum on addictive potential of certain medications is worked into the medical education system,” said Dr. Cidambi.

Drug Law Violations Data: https://ucr.fbi.gov/crime-in-the-u.s/2015/crime-in-the-u.s.-2015/persons-arrested/persons-arrested

About Center for Network Therapy
Center for Network Therapy (CNT) was the first facility in New Jersey to be licensed to provide Ambulatory (Outpatient) Detoxification Services for all substances of abuse – alcohol, anesthetics, benzodiazepines, opiates and other substances of abuse. Led by a Board Certified Addiction Psychiatrist, Indra Cidambi, M.D., experienced physicians and nurses closely monitor each patient’s progress. With CNT’s superior client care and high quality treatment, Dr. Cidambi and her clinical team have successfully detoxed over 1,000 patients in four years. The Center for Network Therapy also offers step down to Partial Care (PHP and Intensive Outpatient (IOP) levels of care.

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Marisa Amador
Center for Network Therapy
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