Drug Wars, Drug Addiction, and Social Justice Issues


I have been reading Johann Hari’s Chasing the scream: The first and last days of the war on drugs. 

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This book provides a very detailed account of how we came to be an anti-drug and pro-prohibition nation that lead the way toward making criminals out of people who struggle with use of substances and millionaires out of people/ cartels who sell drugs on the black market. I have found the book in some aspects hard to read because the political manipulation of our global population and the injustices that have arisen from this global movement. I get angry about what has happened as I read and I have to step away for awhile.

Some key points from this text for nurses to consider:

  • The dominant medical establishment (in particularly the AMA) was initially very against “drug” prohibition, but key vocal players were forced into silence by the government.
  • Overall, 90% of people use substances we call “illicit drugs” without having addiction issues, yet we continue to think that people need to be cautious with drug use. For instance, many (not all) soldiers used heroin in Vietnam to get through the hellish experiences, yet many (not all) had no issues with heroin addiction when they returned stateside.
  • There is a clear connection between lack of social support, childhood abuse, and adverse childhood experiences (ACEs: see the CDc website for more info on this) with addiction. We need to be compassionate toward those who are suffering, because these childhood experiences literally changed how their brains function, making them very vulnerable toward addiction. Adverse childhood events impact young people across the socio-economic spectrum, and many people who came from “good families” have also experienced a lot of childhood trauma.
  • When it comes to death and illness, our two leading “drug use issues” are likely nicotine and alcohol, both legal, and both toxic and deadly. Yet, we simply put warning labels on these drugs and let folks self-determine their fate. Why are these drugs okay, but others are not? Because they are socially acceptable? Because they are “cheap”?

When we think of the opiate crisis, one of the biggest issues of course is people not having safe and affordable access to opiate medications: when people are cut off from safe supplies (ie, their pain prescriptions which the medical establishment has endorsed and prescribed, with potentially some of the cost covered by their medical insurance ), they may turn toward heroin and other “street” opiate medications. These drugs are expensive, sometimes hard to find, and in many ways they force or perhaps support people to live a life of crime in order to maintain their habits, if people have gone that far they must get help. And people overdose because they have no idea what is in the products they are obtaining.

Maybe, we have created an addiction monster in our society.

However, Portugal has found a way out of the addiction monster’s clutches. In 2001, with a growing heroin addiction problem, Portugal decriminalized all drugs and began to consider addiction to be a public and personal health issue. Drug addiction was viewed for what it is:  a chronic, debilitating illness. People caught with a 10 day supply of any drug are referred to a sociologist who helps to determine their treatment options. And what Portugal has realized is that not only is this a more humane approach, it is also far less expensive to provide adequate medical care and treatment to addicts versus incarcerating them. Portugal has experienced a 75% drop in addicted persons from the 1990’s, and their addiction rates are 5 times lower than the rest of the EU. Meanwhile, drug related HIV infections have dropped by 95%, and the stigma around addiction has lessened dramatically.

http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime

As nurses, we are concerned about social justice issues and public health issues. I would posit that nurses and politically active nursing organizations should be taking action around the opiate crisis in several ways:

  • Calling for safe injection sites and distribution of clean needles (or needle exchange centers) and free condoms.
  • Looking at prevention and early identification of at risk persons (both ending early childhood trauma through supporting parents at risk for enacting trauma and assessing for early childhood trauma both across the lifespan and across all populations to determine risks for addiction).
  • Supporting harm reduction techniques.
  • Supporting a view of addiction as a public health issue, and a chronic disease issue.
  • Considering a call toward decriminalization of drugs and ending incarceration for addicts (the Portugal Model).
  • Acting compassionately toward all addicts (even the “drug seeking” ones).

If you are interested in this topic, I do recommend reading Chasing the scream. This text provides great historical insight into how we came to where we are at with the global  “war on drugs” and the escalating issue of for-profit prisons.

We have become the nation with the greatest number of incarcerated individuals (not %, but sheer number!): though we only have 5% of the world’s population, we incarcerate 25% of the world’s total prison population (this link looks at the complexity of these numbers and supports the idea of the truth that in the land of the free, we incarcerate a much higher percentage of people due to lack of alternative ways to provide help https://www.washingtonpost.com/news/fact-checker/wp/2015/07/07/yes-u-s-locks-people-up-at-a-higher-rate-than-any-other-country/?utm_term=.1ca70c3620af).

Columbia University’s CASA group has released multiple reports that link drug addiction issues to crime, incarceration, and repeat offenses. Sadly, while 65% of our prison population qualify for addiction treatment, only 11% actually receive treatment. Meanwhile, the majority of violent crimes are committed by those suffering from addiction. https://www.centeronaddiction.org/newsroom/press-releases/2010-behind-bars-II

Poverty, race, and income inequality also play a role in both addiction and incarceration, and as nurses, we are ethically obligated to advocate for change in healthcare and system wide policies that impact vulnerable populations. Raising awareness is a first step, but perhaps nursing organizations need to also start taking stances and lobbying for more humane treatment of those who struggle with addiction.

 

 

Stand with the ANA


Today, within hours of the US House of Representative acting against the health and well-being of all Americans, the American Nurses Association issued a strong statement opposing this action. While many nurses do not belong to the ANA, it is an important organization with a strong voice for nursing. Here is the press release:

For Immediate Release
May 4, 2017
Contact: Veronica Byrd
301-628-5057
veronica.byrd@ana.org

David L. Allen
301-628-5391
david.allen@ana.org

American Nurses Association Disappointed with the

Passage of the American Health Care Act  

 

SILVER SPRING, MD – The American Nurses Association (ANA) strongly opposed the American Health Care Act (AHCA) and is deeply disappointed with the passage of this legislation by the United States House of Representatives.

ANA, which represents the interests of more than 3.6 million registered nurses, has expressed serious concerns throughout negotiations about the critical impact the AHCA would have on the 24 million people who stand to lose insurance coverage if the bill becomes law.

“Over the past several weeks, nurses from across the country expressed their strong disapproval of this bill which would negatively impact the health of the nation,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Today, Congress not only ignored the voice of the nation’s most honest and ethical profession and largest group of health care professionals, it also ignored the almost 15 million people in the United States with pre-existing conditions who will now have no protection from insurer discrimination.”

As it is currently written, the AHCA would cut Medicaid funding by $880 billion over 10 years, dramatically increase premiums on seniors, restrict millions of women from access to health care, weaken the sustainability of Medicare, and repeal income-based subsidies that have made it possible for millions of families to buy health insurance. In addition, states would have the option to waive essential health benefit protections that prevent insurance companies from charging individuals with pre-existing conditions significantly more for coverage. Even worse, insurers could decline coverage for substance abuse treatment, maternity care, and preventive services. Late efforts to stabilize the bill’s risk pools for more than 15 million people with pre-existing conditions were wholly inadequate and will leave the nation’s sickest vulnerable.

As this legislation moves to the United States Senate, ANA urges the Senate to allow for opportunities for thoughtful, public feedback in the face of reforms that would have such a far-reaching and personal impact across the nation.

ANA asks the Senate to oppose AHCA in its current form, and stands ready to work with Senators to protect and improve health care access, quality and affordability for all.

# # #

The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 3.6 million registered nurses. ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all. For more information, visit www.nursingworld.org.

If you would rather not receive future communications from American Nurses Association (ANA), let us know by clicking here.
American Nurses Association (ANA), 8515 Georgia Ave, Silver Spring, MD 20910 United States

Nurses Take DC for Safe Nurse:Patient Ratios on May 5!


For a number of years, nurses have marched on DC to call for changes in nursing and healthcare that the conditions under which nurses care for patients.  This year the specific issue is safe nurse:patient ratios, calling for passage of bills that are already in both the House and the Senate that set national standards for nurse:patient ratios.  This event promises to be an invigorating event with inspiring speakers and the opportunity to be part of a strong, non-partisan event focusing on issues of great concern for all nurses.  The march also coincides with the following week designated as “nurses week” – a U.S. tradition highlighting tokenism at its best (full disclosure – my personal opinion!).  The march has the potential to energize nurses across the country to bring the activism home, and during nurses week take local action calling for safe ratios at home – in place of roses!

For more information, visit the Nurses Take DC website.  You can also follow the Nurses Take DC Facebook page, or follow #NursesTakeDC on Twitter.

The Power of Ten!


Sigma Theta Tau has now published the 2nd Edition of the book “The Power of Ten,” a book of essays by nursing leaders that address ten top issues for nurses to rally around for the next few years.  These issues were identified prior to the results of the 2016 election, and now they are issues of increasing importance!  The essays provide ideas and inspiration for actions to strengthen nursing’s focus and activism.  The issues are:

  1. Educational Reform
  2. Academic Progression
  3. Diversity
  4. Interprofessional collaboration
  5. Systems thinking
  6. Voice of Nursing
  7. Global Stewardship
  8. Practice authority
  9. Delivery of care
  10. Professional handoff

This is an important resource for all nurses who are determined to act on the fundamental values of nursing.  The essays are a follow-up to the 2012 “Future of Nursing” report; the issues dovetail with the four recommendations of the report, and sine a light on the actions that nurses can take now to bring a culture of health to the center in shaping the future of nursing and healthcare.  The essays are short and to the point, and there are inspirational quotes from nursing leaders throughout that point the way forward.

Check it out! The book is available in several different formats directly from Sigma Theta Tau or from Amazon.  All proceeds from the book are being donated in equal parts to the American Red Cross nursing programs and the American Nurses Foundation.

Dear Senator – an idea for an invitation!


We recently received a message from Suzanne Fontanesi in Baltimore, sharing a letter she is sending to her Senator asking them to shadow a nurse to inform their health care debate by seeing reality up close and personal. She has given us permission to post the letter here so that other nurses can follow through with their senators as well!

Dear Senator _______,

I am a nurse writing to you on behalf of tens of thousands of my fellow nurses, who are deeply concerned about the possibility of Americans losing health care coverage. Before the Senate votes to repeal and/or replace of the Affordable Care Act, Congress members should be very clear eyed about who will be impacted, and how that impact will shape lives.

Nurses are ranked as the most trusted professionals in the nation. Members of Congress are ranked among the least trusted. In the eyes of the American public, nurses have distinguished themselves as moral, responsible and compassionate professionals. One important practice among nurses is that of ”shadowing”. Before committing to a workplace, a nurse spends time observing at close hand, the minute to minute reality of the people they will be serving.

Senators have great responsibility and many demands on their time, which function to keep them at a distance from many of the realities of daily life for the average American, not to mention the most vulnerable.

On behalf of the American people, I am inviting every United States Senator to spend a full work day shadowing a nurse, prior to voting on the repeal of the ACA. I ask them to observe a full work day, not as honored guests, but as quiet and anonymous observers in settings where nurses are caring for vulnerable Americans. Go with an open mind and ask questions.

I am requesting that you pause and take in the reality with your own eyes, ears and noses. Then, you may more legitimately resume the debate that will shape the lives of the most vulnerable millions of Americans. Regardless of party affiliation or political ideology, each Senator will bring relevant, firsthand information to the conversation.
Among 100 Senators, you will have collectively taken in the reality at schools, nursing homes, hospital emergency rooms, community mental health clinics, churches, drug treatment centers, and homeless shelters. Only then can you look us in the eyes and say that you understand our lives.

Please share this request with your fellow Senators. I will be happy to facilitate a shadow day for you or any of your colleagues.

Thank you for your consideration,

Your name
Your contact information