John Giordano, Doctor of Humane Letters, MAC, CAP

woman in handcuffs

This is the second installment of this article. In Part 1, I examined the first two prongs of the administration’s proposed three prong approach to ending the opioid epidemic. I showed how building a wall on our Southern border would do little to slow the import of illicit drugs, as they are coming into this country at every port, with fentanyl increasingly coming from our northern border and from China through mail carriers. I also demonstrated how revitalizing the “Just Say No” campaign would be an effort in futility as it was an abject failure in the 80’s.

Perhaps what is most astounding about the third prong of the new policy is the intent of the President and Attorney General to execute drug dealers. If I am to be completely honest here, I must admit upon hearing this policy, I wondered if opioid Pharmaceutical company’s CEOs, opioid distributer CEOs, pharmacists who knowingly fill opioid prescriptions for addicts and doctors who over prescribe opioids would fall into the “drug dealer’ category and be subject to the death penalty considering that 8 out of 10 opioid addicts got started with prescription opioid painkillers.

What most people don’t realize is that many addicts sell drugs to finance their own habit. Additionally, executing them, as good as it might make some people feel, will have no effect on curbing illicit drugs coming into our country. The threat of capital punishment means nothing to drug dealers. The reality is these people face the death penalty every morning when they wake up. The vast majority of street drug dealers are poorly educated individuals from economically depressed areas; they have no skills or hope for a better life whatsoever. When you take one of them off the street another pops right back up in his or her place. Its economics 101: as long as there is a demand for a product or service there will be a supply.

The Philippines provides the best insight into the efficacy of capital punishment as a deterrent to drug trafficking and abuse. It’s been nearly two years since President Duterte declared a War on Drugs. Estimates range between 7,000 and 12,000, mostly poor addicts and low level drug dealers, were killed in that time frame. The success or failure of this egregious and large-scale violation of human rights as a policy intended to deter drug trafficking and abuse is a bit murky.

When Elephants fight only the ants are killed.
The president and his loyalists are claiming a resounding victory in their “War on Drugs” policy; nevertheless, their own Philippine Drug Enforcement Agency’s data suggests illicit drugs have become even more available and cheaper in Manila. It appears as though the upper echelon drug dealers and drug lords have come out of this mass homicide unscathed and are importing more drugs than ever before to compensate for the drug labs lost in the war; supply meeting demand. There is no reliable information even remotely suggesting that drug abuse has abated in the Philippines due to the “War on Drugs” policy.

Moreover, this policy will catch addicts in the dragnet. It’s already happening right here in states with laws on the books similar to what the president is proposing. I read about a young woman, not too long ago, who was arrested for murder when the person she was with died from an overdose. The state charged her as a dealer even though the woman pooled her money with her friend’s so that they could get a better deal on the heroin. A lot of addicts will do that – pool their money with people they’ve just met. However, this case made state headlines and I’m sure it gave everyday citizens that heard about it a sense of relief and satisfaction that their state was ‘getting tough on dealers’ and doing something to fight this epidemic. But that is about the extent of the usefulness of these types of laws – to grab newspaper headlines and TV lead story lines that give a false sense of safety and security to an unsuspecting populace because it does absolutely zilch in stemming the tide of illicit drug sales and abuse.

The simple reality is that we are not going to change the tide of our raging opioid epidemic through banal policies and capital punishment – the Philippine’s experiment has proven this to be true. If we are to have an honest conversation about ending our epidemic we must first get past the white noise so that we can embrace a forward thinking strategy founded upon evidenced-based and scientifically-proven effective modalities.

The first area I would recommend we look at is mental health. We simply do not have enough resources dedicated towards treating people with mental health conditions. In 1955 there were 166 million people living in the U.S. and 560,000 state psychiatric beds. In 2016, we have twice the population (325 Million) and only 37,679 state psychiatric beds – less than 7% of the number of beds in 1955. In 1955, there were about 340 beds per 100,000 population; today it is closer to 11. Experts estimate that between 40 to 60 public psychiatric beds per 100,000 population is the absolute minimum necessary to treat today’s Americans with mental health issues.

There have been advancements in the treatment of mental health, but certainly not nearly enough to justify the egregious loss of psychiatric beds. This has far more to do with money and budget-cutting than treatment.

What could possibly go wrong? So what happens to the most vulnerable of all Americans; the ones with mental health conditions who are in dire need of treatment? Doctors prescribe them opioids. Every morning when you walk out your front door to face the world, you are surrounded by people with mental health issues using or abusing legal opioid painkillers prescribed by their family doctor. They may be driving the car behind you at the stop light, or it might be the crossing guard helping your children through a busy intersection. You just don’t know.

People with mental health conditions receive more than half of the total opioid prescriptions distributed in the United States each year. In a study published by the Journal of the American Board of Family Medicine (July 6, 2017), researchers found that more than 7 million adults with mental disorders are prescribed opioids each year – what could possibly go wrong?

This is particularly concerning because mental illness is also a prominent risk factor for overdose and other adverse opioid-related outcomes. Moreover, opioids may temporarily improve symptoms of some mental illnesses leading to patients who experience this to ask for more and/or stronger opioids.

Does it come as a great big surprise to anyone that people with mental health issues who are prescribed and taking powerful opioid painkillers might behave in a way outside of the norm and the law?!

Another catastrophic unforeseen result of our total inability to treat mental illness is the ever growing prison population. With less than 5 percent of the total global population, the U.S. has 25 percent of the world’s jailed population – meaning that 1 in 4 of all prisoners in the world are right here in the U.S.

But even more concerning is that Americans are being put in jail for substance abuse issues or mental health issues at an unprecedented rate. According to the non-profit Treatment Advocacy Center during 2014 in the United States, there was nearly 10 times the number of people with severe psychiatric disease locked up behind bars as opposed to the number of patients remaining in the nation’s state hospitals.

This is partially due to the “Get Tough on Crime” policies from the 80’s that was based in political optics intended to grab newspaper headlines and TV lead story lines rather than scientific rationale. A National Research Council report in 2014 revealed that; “Mental illness among today’s inmates is also pervasive, with 64 percent of jail inmates, 54 percent of state prisoners and 45 percent of federal prisoners reporting mental health concerns.”

To the best of my knowledge, we are the only modern country that puts the weakest, the most vulnerable members of our communities and society behind bars – an environment dreadfully ill suited to address – much less provide – the complex treatment needed by people with mental health issues. For all intent and purposes, we’re simply warehousing our mentally ill in jails and prisons.

The president acknowledged as much just a few weeks into his administration when he stated; “Prisons should not be a substitute for treatment. We will fight to increase access to life-saving treatment to battle the addiction to drugs, which is afflicting our nation like never ever before — ever.” However, the president’s sentiments do not square with those of his Attorney General Jeff Sessions who just a few months later reversed Obama era drug sentencing reforms, calling a harsher approach ‘moral and just.’ Now, both agree capital punishment for certain drug traffickers will somehow, someway curb an opioid epidemic raging out of control.

As I mentioned earlier, policies built around projecting political optics are more effective at getting headlines and TV lead stories and tend to make some people feel good, rather than having a positive effect on the issue they’re intending to resolve. This is one of them. Executing drug traffickers will make some people feel good, but will do absolutely nothing to help the millions of addicts and people with mental health issues who are in such desperate need of treatment. The Philippine’s “War on Drugs” experiment, if nothing else, has proven this to be fact.

Much has been accomplished in recent years in addressing the opioid epidemic with effective policy. It has been just a little more than two years since the CDC released it’s ‘Guideline for Prescribing Opioids for Chronic Pain’ that seems to be making inroads into one of the primary drivers of this epidemic, over prescribing. In fact, many doctors have stopped prescribing opioids all together. It was also in 2016 that congress passed
the Comprehensive Justice and Mental Health Act. This bill reauthorizes millions of dollars for state and local efforts to reduce the number of imprisoned mentally ill people. Recently, there have been national pharmacies with locations across the country that have taken it upon themselves to limit opioid prescriptions to one week. All of these policies will have a positive outcome over time.

Yet, even with all these accomplishments, there is still much more to be done. More than half of all the opioid prescriptions are written for people with mental health issues and that has to stop. Dr. Brian Sites, of Dartmouth-Hitchcock Medical Center and the senior author of the study: ‘Prescription Opioid Use Among Adults With Mental Health Disorders In The United States’ said, “We’re handing this stuff out like candy. “Adults with mental health disorders were more than twice as likely to receive an opioid prescription.”

We are doing a disservice to America’s weakest and most vulnerable by continuing to prescribe them strong opioid painkillers and think their lives are going to improve. In reality, they’re given a one way ticket to addiction and quite possibly jail. Doctors engaged in this practice need to consider non-opioid pain medicine and alternative therapies scientifically proven effective in managing pain such as acupuncture and massage therapy.

There is far more to this story, but you are going to have to wait until the next issue of Sober World Magazine is published where I go into over medicating, its negative and deadly effects and what can be done about it.

John Giordano is the founder of ‘Life Enhancement Aftercare Recovery Center,’ an Addiction Treatment Consultant, President and Founder of the National Institute for Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Beach Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment, check out his websites: