The Lost War on Drugs

I admit it.  I have Obamacare fatigue.

I’m tired of endless stories about website glitches and the small numbers of people who rushed to buy health insurance three months before it would even go into effect.  But I am most fatigued by the newest invented controversy about the so-called “health-insurance-you-like” policies that have been outlawed because they do not meet even the bare minimum standards established by the law.  That’s right – the American people just love lousy health insurance!

Source: NSDUH, 2013

So I thought I would write about something less controversial – drugs.  Because some new facts suggest that if we really want to change a useless federal policy, we will end – as quickly as we can – our failed War on Drugs.

President Richard M. Nixon declared “War on Drugs” in June of 1971.  We have been fighting this war for forty-two years now, long enough to determine if it has made any difference in our lives.  It has. 

The War on Drugs has loaded up our jails and prisons, but has resulted in no discernible impact on illicit drug use among children or adults – except, maybe, to increase it.

Please don’t take my word for this.  Just take a look at the data.

According to the 2012 National Survey on Drug Use and Health, released a little over a month ago, only 19 percent of people over the age of 65 have ever used illicit drugs during their lifetime.  This was the last group that entered adulthood before the War on Drugs was declared.

But 47 percent of those born between 1948 and 1952 say they have used illicit drugs.  This was the group entering adulthood when the War on Drugs was declared. 

And for everyone entering adulthood after the declaration of war, lifetime illicit drug use is now greater than 50 percent.

So drug use may be up a little over the last forty years.  Is that enough to declare that the war is a failure? 

Maybe not, but here are some facts that are.  According to the NSDUH:

• An 18 year old (for whom drinking is illegal) is 10 percent more likely to drink than a 65 year old;
• A 16 year old (for whom smoking is illegal) is 36 percent more likely to smoke than a 65 year old;
• A 12 year old is three times more likely to use illicit drugs than a 65 year old.

So we’re losing our children to this war.  And not just compared to that older, pre-drug war generation.  In fact:

• A 15 year old is more likely to use illicit drugs than someone over the age of 40.
• An 18 year old is more likely to drive under the influence of alcohol than someone over the age of 45.
• And more than half of those who start to smoke still do so by age 18 – even though the number of people who first started to smoke after the age of 18 nearly doubled between 2002 and 2012.

When drug use leads to drug problems, it leads to jail and prison, but not to comprehensive drug treatment.

Thank goodness for peer support services, about which I have just written for Health Affairs.

Among the 4 million persons who received treatment for alcohol or illicit drug use last year, more than half – or 2.1 million – received that treatment from a self-help group. 

And despite the fact that prison populations have more than quadrupled since 1978 and that up to 75 percent of prisonershave been found to be dependent on alcohol or drugs at some point in their lives, year only 388,000 – a number equal to just 18 percent of the combined prison and jail population – received alcohol or drug treatment while in prison.

As pitiful as that percentage is, it is still better than what we offer in communities. 

Inadequate funding for drug treatment has meant that for the 1 million youths between the ages of 12 and 17 who needed treated for illicit drug use in 2012, only 121,000 – or 11.6 percent – received treatment in a treatment facility.  And of the almost 900,000 more who needed treatment for alcohol dependency, only 76,000 – or 8.9 percent – were treated in a facility.

And for everyone over the age of 12, 65 percent of those who needed treatment did not get it either because they had no coverage for it or no access to it.  

So you tell me - is this a war we won?

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/

The War on Health

Policymakers across the country have declared war on health.  You may have missed the headline, but this is a war with many casualties.

Its objective is to topple health care as we know it.  When health care falls, our health will be the victim.

Battles are raging in many states to cut the legs out from under health care financing.

The Arizona Senate Appropriations Committee recently voted to eliminate the Medicaid program.  This would make 1.3 million people uninsured and cost the state $7.5 billion in federal funding. 

A Florida Senate leader has threatened to eliminate Medicaid unless the federal government agrees to massive changes.  This would cost Florida over $10 billion, and make 3 million people uninsured.

Wisconsin’s Governor has proposed dropping over 60,000 people from Medicaid because they are too rich.  “Too rich” means a two-person household income of less than $29,100.     

Medicaid isn’t the only target. 

Pennsylvania just cancelled its state-funded health insurance plan for low income residents.  As a result, 42,000 people lost their insurance.  A half million more on the waiting list have to fend for themselves.

New Jersey’s Governor proposed a 15% reduction in state health appropriations this year, six times greater than the overall reduction in his budget in his recent speech to the Legislature.

Florida’s Governor proposed eliminating state-run health department clinics, even when they generate revenue.  In Palm Beach County alone, this would cost 60,000 people their regular source of care.    

This war began quietly while the eyes of the public were focused on federal health reform.  The Center on Budget and Policy Priorities has detailed a number of battles we have already lost:

• New Jersey lowered income limits and reduced eligibility for the state’s Children’s Health Insurance Program.  50,000 more people are uninsured as a result.  
• Mississippi reduced its mental health budget by 22% in the last two years. 
• Illinois and Ohio cut community mental health services for children and reduced or eliminated community mental health services for adults who are not on Medicaid.

Elected officials declared this war on health by suggesting that health care was the weapon of mass destruction of our state economies.  It wasn’t.  The real weapons were the war in Iraq and Afghanistan at a total cost of over $1 trillion (and counting), for which the federal government did not have the courage to pay, and the greed of a financial industry which fattened our burst housing bubble. 

Health care is not a foe of the state, and people who need it should not be treated as enemy combatants.

However, people with mental illness are this war’s prisoners, often jailed instead of given the care they need.  This is not an exaggeration. The three largest mental health institutions in the country are Riker’s Island, the Cook County Jail, and the Los Angeles County Jail.  The largest mental health institution in Texas is the Harris County Jail.  It has 2,400 “patients” on any given day. 

In 2011, Texas is considering cutting $1.1 billion from state mental health services.  

According to the US Bureau of Justice Statistics, in 2005, more than half of over 2 million prison and jail inmates had mental health problems.    Over 1.25 million Americans are being “treated” for mental illness in our prisons and jails.

Elderly women and children are this war’s hostages. 

The Medicaid program funds 68% of the 1.8 million nursing home beds in the U.S.  Almost a million people live their lives in these beds.

650,000 of them are women, the vast majority over 75 years old and widowed.  In his recent speech, New Jersey Governor Christie articulated a fearful future for them.  Others share his vision “to move our aged, blind, and disabled [Medicaid] recipients into modern managed care.” 

These sick, elderly women suffer the indignity of being blamed for the state budget crisis they had nothing to do with creating.  If the Governor’s vision becomes reality, they won’t just have to cope with incredible health challenges.  They will be put at the mercy of the discredited “modern managed care” denial system.

Mostly under the radar, 31 states have already implemented cuts in children’s health programs.  As representatives of the Iowa Child and Family Policy Center and Voices for America’s Children note in their recent publication, The Healthy Child Story Book, for the first time in our history children may live shorter and less healthy lives than their parents.

Meanwhile, legislative bodies in Ohio, Louisiana, and Arizona have found the time to pass laws banning animal-human hybrids.  This is no joke.  The Louisiana bill’s sponsor, State Senator Danny Martiny, said the Louisiana Conference of Catholic Bishops asked him to introduce it.    

Louisiana ranks 49^th among the states in health, ahead of only Mississippi.  While imaginary beings occupy the attention of political and religious leaders, this war will produce millions of all-too-real casualties.