Friday, June 4, 2010

The curious matter of helping methadone addicts

The Sacramento Bee posted an editorial that seems straightforward, simple and right, but I believe raises issues that are very interesting, not at all simple and worthy of thought and more-nuanced consideration.

The base issue is the elimination of the subsidy for methadone, which is used to ween addicts off heroin.

The Bee editorial insists that by cutting the state's $53 million subsidy, as Gov. Schwarzenegger proposes, California forgoes $60 million in federal matching grants. And "more importantly, most of the 35,000 people who are benefiting from the program would be in danger of returning to their old addictions. To feed their habits, many would return to lives of crime, costing society far more."

I don't really dispute the logic in the editorial, but I do wonder about the math and about the questionable ethics surrounding the idea of paying people to prevent them from committing crimes. And I wonder about what is curiously absent from the editorial: The matter of what works best at reducing people's suffering, long term.

Sacramentans are also Americans.

Whenever we read about the possibility of getting "matching funds" we are primed to think we must spend the local money to get that "free" matching money. Heck, it's two for the price of one! What a deal!

But if we think globally rather than tribally, we would realize that us Californians NOT getting the $60 million isn't the same as an uninsured $60 million building burning to the ground and it being a complete, clear, and absolute loss. If California doesn't take the $60 million it could be used instead to fund something important through the US government, or to pay down the national debt. There would still be $60 million dollars of utility to be used beneficially for some different purpose if we don't use it to buy huge quantities of methadone, used, to ween many former-herion addicts off methadone in stages.

Should people be paid to not commit crimes?

There just simply is something askew about the idea of paying people not to commit crimes. If the government is going to do that, then I have to ask Where is my $300/mo not to commit a crime!? Yes, I wasn't going to commit a crime anyway, but why does that matter? Indeed, in many ways I am a better person to whom $300 should be paid since I would use the money in a more-socially responsible way than a methadone addict, or a recovering methadone addict, might. I'd use my $300 to buy V-8 cocktail juice and use the services of a laundromat.

I do recognize that good and noble politicians often have to agree to do rather wacky things for the betterment of society. I just want to lay it out there that we should not get comfortable with the idea of bribing people not to commit crimes. It is one of the slickest of slippery slopes down the embankment of fiery hell.

Already, we bribe other countries to not go forward with nuclear enrichment, which they do anyway. And we bribe a great many homeless people with SSI checks so that they can drink and party (ruin their health and die at a young age) without robbing others and then drinking and partying.  We enable irresponsibe behavior in defference to other behavior that is, supposedly, more destructive to society. 

It's a wacky world. I don't have any answer, here. I just submit that we should be uncomfortable with the whole idea.

If we don't spend $113 million on methadone, what happens, exactly?

If we spend $113 million subsidizing methadone addicts' substance they're addicted to (which is methadone) we know what happens: many of the addicts stay with their addiction and come back for more methadone next year.  Others recover from their addiction.

If we DON'T spend the $113 million buying methadone for methadone addicts, what happens? We could spend it for police and prison personnel. And then, maybe (or maybe not) we won't have to spend as much as $113 million next year.

I note a May 27 Associated Press story tells us that "Some heroin addicts who got [that] drug under medical supervision had a better chance of kicking their habit than those who got methadone"

Quoting the story:

In a British study of 127 people who previously failed to beat their addiction, scientists gave them either injectable heroin or methadone. After six months, those who got heroin were much less likely to continue taking the drug illegally than those who got methadone. The results were published Friday in the British medical journal, Lancet.
So.  Should we buy methadone and heroin addicts more heroin?  I'm just asking.

Re suffering.

What is the path that lessens suffering in the long run? I don't know. I would want somebody to study that. I wouldn't want somebody to spend as much as tens of millions on such a study, but I would want some comprehensive research done

I would want us to try to look at all the possibilities and then do what's best.  If buying $113 million-worth of methadone (or heroin) next year is what's best.  OK.  Fine.  Let us do that.



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