Thursday, March 13, 2014

Eliminating Barriers IS Smart Drug and Crime Policy

Smart drug policy is inextricably linked to smart crime policy. When treatment of substance use disorders (SUD) is the primary response to criminal behavior tied to untreated addiction and use, it has a profound impact on reducing not only costs to the public safety system but also to the health care system. However, crime and drug policy do not end there. Ensuring the successful reintegration of justice-involved individuals into the community is equally important to ensuring that people get the care and supports they need. Yet many people in recovery face an overwhelming array of discriminatory barriers as a result of their addiction and/or criminal histories, which make it difficult to obtain employment, housing, education, public benefits, and other necessities of life.
During the 1980s and 1990s, the nation engaged in a “war on drugs” that led to the United States having the largest incarcerated population in the world. Legislators enacted policies that erected collateral consequences or extended punishment for people with drug convictions beyond completion of their sentences. These policies stripped away from millions of people, including many in recovery, rights and eligibility for vital services. While in most cases, states were permitted to opt out of these bans, the message across the country was clear1.
YEAR FEDERAL LAW EFFECT
1992 Federal Highway Apportionment Act Permits the federal government to withhold 10 percent of certain highway funds unless a state enacts a law revoking or suspending the driver’s license for at least 6 months of anyone convicted of any drug offense whether or not it involved the operation of a motor vehicle under the influence of such a substance.
1996 Personal Responsibility and Work Opportunity Reconciliation Act Prohibits anyone convicted of a drug-related felony from receiving federally funded food stamps and cash assistance (also known as TANF – Temporary Assistance for Needy Families). This is a lifetime ban — even if someone has completed his or her sentence, overcome an addiction, been employed but got laid off, or earned a certificate of rehabilitation.
1996 Housing Opportunity Extension Act of 1996 Requires: 1) PHAs to deny public housing to any individual evicted from public housing because of drug-related criminal activity for three years following the eviction unless the individual completes drug treatment and 2) denial of admission to public housing and permit eviction from public housing, respectively, for individuals who are illegally using drugs or whose pattern of drug or alcohol abuse interferes with the health, safety, or enjoyment of other tenants; PHAs and landlords may consider evidence of rehabilitation in determining whether to enforce the exclusion or eviction.
1997 Adoption and Safe Families Act Bars people with certain convictions from being foster or adoptive parents and prompted State foster care systems to act aggressively to terminate parental rights of parents who test positive for drugs.
1998 Higher Education Act of 1998 Made students convicted of any drug-related offense ineligible for any grant, loan or work assistance. This federal legal barrier cannot be altered by the states.

Legal Action Center and others continue working to eliminate these barriers by encouraging states to modify these bans. Advocates have continued to educate Congress about the impact collateral consequences has on the health and public safety systems. There has been some encouraging progress in the states and at the federal level. Several states are considering modifying their state laws and policies to be less restrictive and more supportive of reentry. These policies include adopting criminal record anti-discrimination protections; employer hiring standards and incentives; expungement or sealing of criminal records; eliminating the ban on TANF and/or SNAP benefits; creating special housing programs and assistance; and other reentry initiatives that support rehabilitation.
The Obama administration has shown a strong commitment to improving reentry. The U.S. Attorney General established the Interagency Reentry Council, whose membership of over 20 federal agencies is coordinating and advancing reentry policies and removing barriers to successful reentry. The Attorney General also announced its “Smart on Crime” initiative that directs focus on pursuing alternatives to incarceration for low level offenses and reduce unnecessary collateral consequences for people with criminal histories. The Equal Employment Opportunity Commission released important guidance on the use of criminal records for employment purposes and discouraged blanket bans against hiring people with criminal histories. The Secretary of Housing and Urban Development issued guidance to all the country’s housing authorities highlighting their broad discretion to admit most people with criminal records into housing. There has been progress in eliminating these discriminatory federal policies against people in recovery and those with criminal histories, but more can and must be done to truly reform our policies to promote health and justice.
[1] See Legal Action Center’s publication After Prison: Roadblocks to Reentry. (Updated 2009).

Fight Against Prescription Drug Abuse May Have Fueled Heroin Use: Experts

Some addiction experts say the U.S. government’s fight against prescription drug abuse may have inadvertently contributed to the rise in heroin use, according to The Washington Post. Now that some pain medications are less available and more expensive, many people who used to abuse those drugs have switched to heroin, which is cheaper.
The crackdown on “pill mills” has helped to reduce the illegal use of medications, the article notes. But many people who had abused prescription opioids simply switched to heroin, which provides a comparable, euphoric high.
“Absolutely, much of the heroin use you’re seeing now is due in large part to making prescription opioids a lot less accessible,” said Theodore Cicero of Washington University in St. Louis, who co-authored a 2012 study that found OxyContin abuse decreased after the painkiller was reformulated to make it more difficult to misuse. Many people who abused the drug have switched to heroin, according to the study.
The study included more than 2,500 people who were dependent on opioids, who were followed between July 2009 and March 2012. During that time, there was a 17 percent decrease in OxyContin abuse. In 2010, the company that makes OxyContin introduced a new version of the drug that is more difficult to inhale or inject. During the same period, heroin abuse doubled.
According to Cicero, the government could have taken steps sooner against heroin use, such as by promoting the use of medicines to fight overdoses and ease symptoms of withdrawal.
Not everyone agrees that the crackdown on prescription drug abuse has led to the rise in heroin use. Joseph T. Rannazzisi, who runs the Drug Enforcement Administration’s Office of Diversion Control, told the newspaper, “I don’t think one thing has anything to do with the other.” He noted many lives have been saved by the effort to reduce prescription drug abuse.

Alarming Rise in American Adults Taking Medications for ADHD

The number of young adults in the U.S. taking medications for attention deficit hyperactivity disorder (ADHD) nearly doubled from 2008 to 2012, according to Express Scripts, the nation’s largest prescription drug manager, The New York Times reports.
In processing prescriptions for 90 million Americans, Express Scripts found that almost one in 10 adolescent boys were taking Rx medications for the disorder – usually prescription stimulants like Adderall, Ritalin or Concerta.
These prescribed medications help ameliorate common symptoms associated with ADHD, like severe inattention and hyperactivity, sleep deprivation, appetite suppression and, more rarely, hallucinations.
Some experts noted the new research report provides clear evidence that ADHD is being diagnosed and treated with medication in children far beyond reasonable rates, and that rapidly increasing diagnoses among adults might indicate similar problems.
In examining actual prescriptions filled, the report also strongly corroborated data from several government surveys that many mental health experts had discredited for relying on parents’ own recollections of their children’s health care.
“It’s hard to dismiss the data in this report,” said Brooke Molina, an associate professor of psychiatry at the University of Pittsburgh School of Medicine and one of the disorder’s leading researchers. “There are limitations with every study, but it’s hard to do anything here but conclude that we have a continually forward-marching increase.”
A study released last year from The Partnership at Drugfree.org also found some concerning trends, with one in eight teens reporting they had taken Ritalin or Adderall when it was not prescribed for them and almost one-third of parents saying they believed Rx stimulants can improve a teen’s academic performance, even if the young person does not have ADHD.

West Virginia Senator Calls on Head of HHS to Overrule Decision on Zohydro

West Virginia Senator Joe Manchin this week called on Health and Human Services Secretary Kathleen Sebelius to overrule the Food and Drug Administration’s (FDA) decision to approve the pure hydrocodone drug Zohydro ER (extended release).
Fox News reports Manchin sent Sebelius a letter expressing his concern that Zohydro could add to the national epidemic of prescription drug abuse. “Given the potentially imminent release of Zohydro later this month, it is imperative that you act as soon as possible to keep this dangerous drug off the market,” he wrote.
Late last year, Manchin and three other senators wrote to the FDA, saying they disagreed with the agency’s decision to approve the drug. In October, the FDA approved Zohydro for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Drugs such as Vicodin contain a combination of hydrocodone and other painkillers such as acetaminophen.
In December, the attorneys general from 28 states asked the FDA to reassess its decision to approve Zohydro.
A panel of experts assembled by the FDA voted against recommending approval of Zohydro ER. The panel cited concerns over the potential for addiction. In the 11-2 vote against approval, the panel said that while the drug’s maker, Zogenix, had met narrow targets for safety and efficacy, the painkiller could be used by people addicted to other opioids, including oxycodone.
The agency will require postmarketing studies of Zohydro ER to evaluate the known serious risks of misuse, abuse, increased sensitivity to pain, addiction, overdose, and death associated with long-term use beyond 12 weeks.
Zohydro is designed to be released over time, and can be crushed and snorted by people seeking a strong, quick high. The opioid drug OxyContin has been reformulated to make it harder to crush or dissolve, but Zohydro does not include similar tamper-resistant features.
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