Editor’s note: This commentary is by Rep. Linda Joy Sullivan, a Democrat who represents the Bennington-Rutland District in the Vermont House of Representatives.
In the late 1960s, at the dawn of the computer age and as the public’s confidence in government was beginning badly to wane, a lively discussion took place about the dangers of “big government” collection of data about Americans. Several years of debate – and abuses by the Nixon administration – led to the passage of the landmark Privacy Act of 1974. Since then, poll after poll has confirmed the wisdom of that law, as Americans have steadfastly voiced distrust of the government’s bulk collection of personal data.
One would think, then, that the current administration’s efforts to construct a broad database of every voter in the United States would have been initiated reluctantly and only in response to some clear exigency. The populist response, “No way!,” voiced by officials in every state of the union, was totally predictable.
Another lesson learned in that same era seems likewise to have been forgotten. This time, however, the public response has been but a disturbing collective shoulder shrug.
I’m referring to how Vermont and much of the rest of the country have chosen to deal with our drug abuse problem. This is not the first time, of course, we have had a raging – and terrifying — opioid crisis. Heroin use spiked in the ‘60s and ‘70s. Local governments in response launched aggressive methadone treatment programs, leading often to a lifetime of government-sponsored drug dependency. Certainly, from a public health standpoint, methadone was preferable to heroin, but there was always great unease associated with the government’s involvement in the drug business and the establishment of public clinics to administer a dangerous (and addictive) substitute. One then-very popular mayor of New York City, while in the midst of a larger effort to clean up the city, closed down its methadone program entirely, complaining loudly that all the government was doing was swapping one addiction for another. The federal government, for its part, acknowledging the dangers of this treatment course, itself enacted very rigorous regulatory guidelines relating to the operation of methadone treatment centers.
Earlier this year, without much if any dissent, Vermont regulators decided to allow the “take at home” opioid substitute suboxone (addictive and itself also subject to abuse) to be prescribed not just by physicians but by certain nurses and physician assistants, specifically in order to make suboxone more available to Vermonters. No doubt suboxone can be an effective short-term tool towards getting addicts on the road to recovery. However, and notwithstanding the existence of treatment “guidelines” issued by the Department of Health, the expansion of this program (and the ready federal Medicaid subsidization of it) deserves some deeper thought and discussion. Should this really be our priority strategy? Are we limiting and regulating its use rigorously enough? Is the substitution of one prescription for another wise? Truly effective? What are the long-term fiscal implications of a potential lifetime of dependency?
Unquestionably, from a macro perspective, public health costs and crime statistics decline when the government gets in the business of doling out addictive drugs. As a result, detractors of the “medical assisted treatment” of opioid addiction are often portrayed by bureaucrats and policy makers as short-sighted “science deniers.” But the important policy (and philosophical) implications of the government’s arguably dystopian involvement in supplying addictive and readily abused medications can’t be denied.
There are other options – more difficult, clearly, but without the disturbing optics of our indefinitely numbing out whole swaths of our population.
The attorney general in Ohio just two months ago sued pharmaceutical companies for their contribution to the current opioid abuse crisis. That state is demanding Big Pharma contribute directly to the cleanup, citing the aggressive and inappropriate marketing of prescription drugs by some companies and the alleged concealment by them of the dangers of prescription drug use. Ironically, it’s been estimated that Americans, directly and through taxpayer-funded health programs, are returning to Big Pharma $1.55 billion a year to pay for suboxone prescriptions. Better, one would think, to wind down that lucrative payback program and demand that Pharma help us pay for better education and outreach, traditional abstinence treatment facilities, and other such resources.
Consider as well another message we might deliver to our attorney general and his state’s attorney colleagues around the state. While no one in Vermont much likes to talk about aggressively prosecuting so-called “non-violent” drug felonies, tough prosecution policies plainly have their place in protecting communities and mandating treatment. The prosecutions associated with the now disfavored “war on drugs” arguably did much to reduce the cocaine, crack and meth epidemics. One can very easily make the case that the unfortunate swelling of prison populations in the U.S. had much more to do with the rigid severity and inflexibility of the federal sentencing guidelines enacted in the late 1980s than by the number of drug prosecutions.
There is absolutely a role for the active participation of our judges in Vermont in protecting our communities, even at the cost – oh my – of sentencing distributors to lengthy prison sentences, when individually appropriate. Better to trust our judges to do the right thing in individual cases than to discourage the vigor of law enforcement in the prosecution of drug offenses that have wreaked much damage on our communities and Vermonters.
