New opiate policies can help NC prepare for next epidemic

By Nicole Schramm-Sapyta

Guest columnist

Nicole Schramm-Sapyta is an addictions specialist and assistant professor of the practice in the Duke Institute for Brain Sciences.
Nicole Schramm-Sapyta is an addictions specialist and assistant professor of the practice in the Duke Institute for Brain Sciences. Duke University

The North Carolina legislature's “Task Force on Sentencing Reforms for Opioid Drug Convictions” has started on a strong path toward smart policy in its early meetings. They’ve heard from experts on how the court system can help citizens with addiction, and examined statistics that show incarceration is more expensive and less effective than treatment for drug offenders.

Now, I ask this group to go one step further: in the next report to the General Assembly, recommend sentencing reform for ALL addictive drugs.

Opiate addiction dominates our news now, but it will eventually fade, as all drug fads do, and another class of drugs will take its place. All addictions are the result of a complex interplay between individual psychology, social factors and genetic vulnerability, fueled by exposure to the addictive substance and the ease of opportunity to obtain more drug. The next epidemic will result from a similar mix of circumstances, but a different substance.

Perhaps the next wave of addiction will sweep across a different subset of our population, but these people will be no less deserving of treatment resources and compassion, rather than criminalization.

History has taught us that epidemics are cyclical. For drugs of abuse, every epidemic starts among a small population of users. They make the drug seem “cool” and misleadingly safe.

The current opiate epidemic started from the misperception that prescription opiates were safe and non-addictive. A subset of prescription users became addicted, and some of them switched to illicit heroin and fentanyl because those drugs are cheaper.

Similarly, in the 1980s, cocaine was perceived as relatively safe and avant garde. A few experienced users educated others in its rituals, which eventually led to widespread use. Only then did the cheaper version – crack – have a market. The lower cost further increased use while also shifting the demographics of addiction.

We can't quite predict the next epidemic, but we know that prescription stimulants (Adderall, for example) and anti-anxiety medications are widely misused. An herbal stimulant called Kratom that the Food and Drug Administration considers a ‘drug of concern’ is easily available on the Internet. Early reports also suggest that cocaine is making a comeback. Will one of these be the next epidemic?

North Carolina has the chance to learn from the opiate epidemic and prepare for the next one, no matter which substance is involved.

All addictions require behavioral therapy, supportive services and opportunities to build a better, drug-free life. Trying to arrest our way out of it didn’t work against crack in the 1980s and it won’t work now. A person with addiction is, by definition, taking the drug despite all the terrible things that then happen to them, so the threat of arrest will not be a deterrent.

Sentencing reform for all drugs of abuse, not just opioids, would liberate resources from the high costs of prison, and make them available for treatment services.

Programs such as drug courts, Law Enforcement Assisted Diversion (LEAD), Crisis Intervention Teams (CIT) and the Stepping Up Initiative are proven to keep citizens out of jail and in treatment, and can easily be expanded statewide. All of these programs will work regardless of the drug driving the next epidemic.

Don’t misunderstand me -- we still need stiff penalties for high-level drug manufacturers and distributors. The volume they supply is directly proportional to the number of addictions.

But simple possession and low-level dealing to support addiction require treatment, not incarceration.

Let’s seize this opportunity, while so many concerns are focused on opioids, to establish the right long-term substance abuse policies for North Carolina’s children, grandchildren and great-grandchildren. Failure to do so will allow history to repeat itself – at a huge cost to all North Carolinians.

Nicole Schramm-Sapyta is an addictions specialist and assistant professor of the practice in the Duke Institute for Brain Sciences.