Strong alliances could curb the meth epidemic

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In summary

Prison shouldn’t punish people just for using drugs; a long incarceration will not help. Rather, we must use the criminal justice system strategically to promote behavior change among people whose drug use threatens public safety.

By Sam Liccardo

Sam Liccardo is the mayor of San Jose, the 10th largest city in the United States, and a former federal prosecutor.

Keith Humphreys, special for CalMatters

Keith Humphreys is the Esther Ting Memorial Professor at Stanford University and a former senior drug policy adviser to the Obama White House.

Drug addiction has become an ideological Rorschach test: a disease deserving treatment for some, and a crime deserving punishment for others. California’s meth epidemic challenges these polarized perspectives, as the drug inflicts both devastating harm on users and (all too often violent) victimization on others. To reduce the many harms of methamphetamine, we must turn our ideological swords into pragmatic plowshares.

While opiates such as fentanyl attract the brightest media spotlight, methamphetamine inflicts a greater toll. From rural communities in California to our largest cities, including Bakersfield, Fresno, Los Angeles, San Jose and San Diego, methamphetamine (individually and when taken in combination with fentanyl) kills more users than any other illegal drug. Since 2006, methamphetamine-related admissions to California emergency rooms have increased sevenfold and deaths tenfold. The psychological effects of methamphetamine exacerbate homelessness and often induce violent behavior, while sustained use also contributes to an alarming rate of psychosis.

Our criminal justice and health care responses to methamphetamine-related crimes are failing.

In large counties like San Diego, the majority of those arrested test positive for methamphetamine. County jail revolving doors return untreated individuals to the streets within hours of arrest, often still agitated and inebriated. Diversion benefits some people, but when combined with the lack of detox facilities or hospitalization, our communities increasingly experience the release of accused drug addicts destined to re-offend. More than 40% of pretrial arrestees released from jail in Santa Clara County (which has many meth users but a shortage of rehab or treatment beds) commit a new crime or don’t show up for court . Too often we see horrific consequences in the form of meth-induced assaults – and worse.

We lack FDA-approved drugs for methamphetamine addiction, but a promising behavioral therapy has emerged. “Contingency management” allows patients to earn rewards for repeated negative drug tests while participating in therapy. The Veterans Health Administration’s use of emergency management with 5,600 drug-dependent patients resulted in a 92% drug-free testing rate. State-funded contingency programs show promise, and we applaud the efforts of State Senator Scott Weiner, a Democrat from San Francisco, to expand successful pilots to other cities.

Contingency management succeeds where other treatments fail by providing certain and immediate consequences that reinforce abstinence. For methamphetamine users who refuse treatment and threaten public safety, quick and permanent consequences most effectively reduce the harms of use.

This requires careful and lawful intervention by the police and judges. Open-air drug markets present unique risks of violence in vulnerable neighborhoods, requiring proactive policing, implemented in partnership with community actors. We also need a dramatic expansion of detox facilities for arrested meth addicts to ensure they do not return to communities while still high, restless and prone to assault. . We must again empower judges to impose consequences in cases where an accused refuses to participate in treatment as a condition of release.

And yes, we still need prisons. Prison shouldn’t punish people just for using drugs; a long incarceration will not help. Rather, we must use the criminal justice system strategically to promote behavior change among people whose drug use threatens public safety. The nation’s most effective court-mandated treatment program for methamphetamine, Honolulu’s HOPE Probation, uses frequent drug testing and contingency management with modest prison sentences – typically one-to-many days. After one year, criminal offenders enrolled in HOPE reduced re-arrests by 55% and positive drug tests by 72%. Its success compelled other states to follow suit, rolling out frequent testing with modest prison sentences to reduce alcohol consumption and related domestic violence.

Local resistance and state laws, driven more by ideology than evidence, prevent pragmatic solutions. We need citizens to speak out, both on the lack of quality treatment and on the lack of consequences. Faith-based organizations and other nonprofits should continue to provide recovery support, but need public funding. We need stronger alliances between health and law enforcement professionals, community agencies and families to find evidence-based solutions.

We can only reduce the impact of methamphetamine on our communities by setting aside our political predilections and deploying all the tools at our disposal.

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Sam Liccardo has previously written about PG&E operations, solar metering rules and electricity rate hikes.

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