07/15/18 Doug McVay

Century of Lies
Doug McVay
Drug War Facts

This week on Century of Lies: Congress debates HR6082, a measure that would take away privacy protections from patients who are diagnosed with a substance use disorder; plus, decriminalization and the Republic of Ireland's national drug strategy.

Audio file



JULY 15, 2018

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Welcome to Century Of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

On June 28, the Irish parliament discussed the implementation of its national drugs strategy. We're going to hear statements from a couple of members of the Dáil Éireann that were delivered on the floor of the Dáil in just a moment.

First, on June 20, the US House discussed a piece of legislation, HR6082. It's called the Overdose Prevention and Patient Safety Act. That title is a lie. What this bill does is remove privacy protections from people who have been diagnosed with a substance use disorder.

On the floor of the House on June 20, there was a debate on this. One of the speakers was Frank Pallone, Democrat from New Jersey. Let's give a listen.

REPRESENTATIVE FRANK PALLONE, JR.: Mister Speaker, I rise in opposition to HR6082, the Overdose Prevention and Patient Safety Act. This legislation would greatly harm our efforts to combat the opioid epidemic. If we really want to turn the tide on this crisis, we must find ways to get more people into treatment for opioid use disorder.

In 2016, there were about 21 million Americans aged 12 or older in need of substance use disorder treatment, but only 4 million of those twelve [sic: 21] million actually received treatment. That means 17 million people are going without the treatment they need. Failure to get individuals with opioid use disorder into treatment increases risk of fatal and nonfatal overdoses as people continue to seek out illicit opioids as part of their addiction. The increasing presence of fentanyl in our drug supply only heightens this concern.

Strategies that increase the number of people getting into and remaining in treatment are particularly important because, as these treatment statistics show, major challenges exist to getting people with substance use disorders to enter treatment in the first place. And this House should not, and I stress should not, take any action that puts at risk people seeking treatment for any substance use disorder, but particularly opioid use disorders.

Unfortunately, this bill risks doing just that, reducing the number of people willing to come forward and remain in treatment because they worry about the negative consequences that seeking treatment can have on their lives. And this is a very real concern.

This bill weakens privacy protections that must be in place for some people to feel comfortable about starting treatment for their substance use disorder. Ensuring strong privacy protections is critical to maintaining an individual's trust in the healthcare system and a willingness to obtain needed health services, and these protections are especially important where very sensitive information is concerned.

The information that may be included in the treatment records of a substance use disorder patient are particularly sensitive because disclosure of substance use disorder information can create tangible vulnerabilities that are not the same as other medical conditions. And for example, you are not incarcerated for having a heart attack, you cannot legally be fired for having cancer, and you are not denied visitation to your children due to sleep apnea.

According to SAMHSA, the negative consequences that can result from disclosure of an individual's substance use disorder treatment record can include loss of employment, loss of housing, loss of child custody, discrimination by medical professionals and insurers, arrest, prosecution, and incarceration. These are real risks that keep people from getting treatment in the first place.

While I understand that the rollback of the existing privacy protections to the HIPAA standard would limit permissible disclosures without patient consent to healthcare organizations, this ignores the reality. It may be illegal for information to be disclosed outside these healthcare organizations, but we know, Mister Speaker, that information does get out. Breaches do happen. Remember the recent large-scale Aetna breach that disclosed some of its members' HIV status?

But there are also small-scale breaches that don't make the news that can have devastating consequences for patients trying to recover and get treatment. For example, a recent ProPublica investigation detailed instances where a healthcare organization's employee peeked at the record of a patient 61 times and posted details on Facebook, while another improperly shared a patient's health information with the patient's parole officer. Breaches such as this are very concerning and could occur more often as a result of this legislation.

While I appreciate the sponsor's efforts to alleviate these concerns, I do not believe the potential harm that could be caused by eliminating the patient consent requirement under existing law for treatment, payment, and healthcare operations can be remedied through the measures included in this bill.

The inclusions of these provisions cannot compensate for the risk of stigma, discrimination, and negative health and life outcomes for individuals with opioid use disorder that could result from the weakening of the existing privacy protections, and that's why every substance use disorder patient group has come out in opposition to this bill.

According to the Campaign to Protect Patient Privacy Rights, a coalition of more than 100 organizations, and I'm quoting now:
"Using the weaker HIPAA privacy rule standard of allowing disclosure of substance use disorder information without patient consent for treatment, payment, and healthcare operations will contribute to the existing level of discrimination and harm to people living with substance use disorders.'' Unquote.

The Campaign goes on to say, and again I quote: "This will only result in more people who need substance use disorder treatment being discouraged and afraid to seek the healthcare they need during the Nation's worst opioid crisis.''

And this is a risk we simply should not take, and yet the majority is bringing this bill to the floor today despite the very real concerns of these experts. And these groups uniquely understand what's at stake from this legislation because many of their members live with or are in fear of the negative consequences that result from the disclosure of substance use disorder diagnosis and treatment information.

DOUG MCVAY: That was Frank Pallone, a New Jersey Democrat, speaking in opposition to HR6082, which has been mis-titled the Overdose Prevention and Patient Safety Act. Again, that title is a lie. What this bill really does is take away privacy protections from people who have received a diagnosis of a substance use disorder. HR6082. Unfortunately, this thing has already passed the House and has been assigned to committee in the Senate.

You are listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

The national drug strategy for Ireland was introduced on June 28. They had a discussion in their lower house of the Oireachtas. We're going to listen now to portions of that debate. The first person we're going to hear from is Alan Kelly. Alan will be followed by Gino Kenny.

DEPUTY ALAN KELLY: The new drug strategy, we shouldn't be debating this a year later. It's kind of crazy, just so much talk about the need to address this issue and we're debating strategy a year later. I think, you know, we talk a lot about new politics but this is as an example of where it's not working.

It's rightly called Reducing Harm, Supporting Recovery, and I welcome the shift in tone towards caring for people who suffer from addiction, which is an illness. And therefore, it makes sense to take a health-led approach to drugs use, but we must not underestimate the scale of the challenge.

Cases of people in treatment for drug addiction have gone up steadily since 2007. Back then, there were 5,259 people in treatment for addiction, not including alcohol. In 2015, this figure was 9,710. That's an 84 percent increase. The number of new cases each year has also gone up, from 2,431 cases in 2007 to 3,650 cases in 2015, an increase of 50 percent.

And these, Minister, are just the people in treatment. We know that many more people are affected by addiction but they're not included in these numbers. Some because they do not want to admit it. They don't want to make it public. They don't want to show the impact drugs have had on them. Others because the State actually doesn't offer them any services. So these figures are way higher.

And the issue in relation to these figures is that the service provision that is there is not there at the same level, I'll say this as a Tipperary Deputy, outside of Dublin or maybe one or two other main urban areas.

I welcome in particular that the Department of Health engaged in a much more comprehensive consultation process this time round regarding this strategy. It is important that the Department continues to engage in serious listening exercises because the whole area of drugs use has changed, and it's affecting people across Ireland in different ways now. The Department needs to continue to listen to how addiction is affecting communities and families across Ireland, because this isn't a problem that is just isolated in one period of time, it's iterative and continuing.

We used to see the drugs issue as something concentrated in urban areas where there was a concentration of social housing. Now the drugs issue is nationwide. Proportionately, villages and rural areas may even be more affected by addiction than some urban areas. I am not sure if anyone has said that before in this House. Some villages in rural counties probably have a higher percentage of drug abuse than actually inner city Dublin. Smaller sample, but bigger problem proportionately.

But the state has nowhere near the level of service provision required to tackle the addiction issue. The new strategy will need to be backed up by serious investments in services if even half of the intended actions are going to be implemented. Otherwise it is just wishful thinking. Ireland's level of opiate addiction, to heroin among other substances, is much higher than in other western European countries. Opiate addiction affects seven in every 1,000 people here, compared with four in every 1,000 across Europe.

Most of the State's infrastructure for dealing with drug addiction is focused on opiates, since the heroin epidemic of the 1980s. In addition to that serious problem, the situation on the ground has moved on. Cocaine and crack cocaine are prevalent and highly addictive. We have few detoxification and rehabilitation options for people. Amphetamines, cannabis, and ecstasy are all widely used. There also continues to be abuse of solvents. And people are becoming addicted to sedatives or tranquilizers, which they may or may not have acquired on prescription.

Drug dealing has changed too, with people ordering drugs online through so-called dark web websites, and even getting drugs delivered by post. This kind of thing has spread addiction to every corner of Ireland, including every village. There is a risk of drug addiction becoming totally out of control unless the Government puts in the necessary resources to get a grip on the issue. There is obviously a divide between legal and illegal drugs in this mix. We could mention tobacco and alcohol, which are legal, are also associated with addiction.

One of the actions under the national strategy is for the consultation on the potential decriminalization of the personal possession of illegal drugs. The consultation is currently ongoing. I understand that more than 14,000 submissions from the public have been received to date. I welcome this because, you know what, it is clear evidence, Minister, if any were needed, of the level of public interest in and concern over the issue of drug misuse.

There's a real opportunity here, Minister, and this is the most important point I want to make to you. There's a real opportunity for Ireland to take a new approach to the whole issue of addiction. We don't always often get to spend much time in government but if there is one issue regarding which you have an opportunity on, it is this.

Countries such as Portugal have achieved a major reduction in the use of opiates and much fewer drug-related deaths because they changed strategy. There is something wrong, however, with the focus on the question of what substances should be legal or illegal. That is not the real issue; the real issue is how we treat people who have an addiction.

The Labour Party's proposal is that we should decriminalize the person who is addicted to drugs. It should not be a criminal offence to be in possession of a small amount of soft drugs when one is addicted to them. Fear of a criminal record should never stop a person from seeking the medical help that they need. The vicious drugs gangs involved in drug dealing of course need to remain outside the law. Garda resources should be freed up to deal with them.

At present, by contrast, Garda time is taken up with minor cases where people who are addicted to drugs are found in possession of small quantities. If we make it clear that possession of drugs by addicts will not be a criminal offence, we can focus on getting people into treatment for addiction.

In Portugal, people are offered the choice of medical and social supports instead of getting a criminal record and facing a judicial sentence, which hangs over them for the rest of their lives. This is the option we should be discussing for Ireland but it will not work if there are not the services put in place to help people deal with addiction.

A wide range of services is needed to deal with different types of drug addiction and different groups of people. For example, different services are needed for long-term heroin users compared with services for young people. The real test of the national drugs strategy will be whether the Government is ready to put the serious resources into the front-line services that actually help people to escape from addiction and to move forward with their lives.

Massive cuts were implemented in services since 2008 and none of the funding has been restored proportionately. Staff working in drugs services have had their pay cut and frozen. Since they are in the community and voluntary sector, funded through section 39, about which we all know, they are not getting the pay restoration that public servants are getting in the HSE.

Rent costs and insurance costs have increased and many of the services are on their knees. At the same time, as I said at the outset, the number of people presenting to services with drug addiction problems has grown enormously.

Simply decriminalizing substances in the absence of funding for addiction services would be a dereliction of duty by the Government and the Minister of State and would lead to anarchy. There is a need for the creation of proper working conditions for those who provide addiction services. They need proper working conditions like me, the Minister of State and everyone else.

There should be some standardization among addiction workers to ensure minimum quality standards. That would involve a lot of training and the development of addiction practitioners. It would also have to include pay grades and career opportunities equivalent to those enjoyed by HSE workers. That is simply not the case now. It is part of the problem when it comes to the provision of services because we cannot get the people.

The final point, the new national drugs strategy is going to be health-led but the HSE is not in a position to lead on this topic. We need to think outside the box because if we just throw it in as part of the mix of what the HSE is meant to be doing, we will still be here. We will have a nice, shiny document but no implementation. Therefore, we need to think outside the box and create a different format and pathway for dealing with this issue.

So there are clear political challenges to do with drug addiction that need clear political leadership, which returns me to my point that we do not always get to sit there for very long. This is your opportunity, and in fairness I know you have a passion for this issue. So please try and deal with it. So you need to deal with this issue and you need to put up the money to develop addiction services. You need put in place the right format and the right organisation and should ensure it provides services nationwide and not just in Dublin.

And one final point, Minister, it's relating to services in prisons. I've reason to believe that these services across many of the prisons have simply, are absolutely not working. The number of prisoners who are addicted to drugs and are not being provided with the services needed, I believe is going to be a big issue that's going to blow up in this country. I also believe many of the people working in the Prison Service are being treated appallingly, where they have to actually go and deal with prisoners in this situation but yet the backup services aren't there.

And furthermore, when they do find people in possession of drugs, sometimes they feel they are the ones who are getting into more trouble than those who are bringing them in or carrying them inside, in the prison service. The whole issue of drugs in prisons, how those who work in the Prison Service are being treated and the lack of services has been left behind. It will blow up in our faces. Thank you.

DOUG MCVAY: That was Deputy Alan Kelly. Now, Deputy Gino Kenny.

GINO KENNY: I too want to add to the debate, and the frustration that, I mean, this debate has been going on for years but, it seems to be stalled, and it seems to be doing a lot of talking but no action. But, we are talking about obviously the, kind of the debate at the moment, and it's glad to see that 14,000 submissions have been received so far to the public consultation. I look forward to the report being completed by October, Minister, and hopefully, the recommendation can consider some of the issues around personal drug use, which is critical to what I'm going to say the next few minutes.

I also want to say -- mention the critical roles of community drug projects, local drugs task forces, to continue to deliver a fantastic service in their communities, even though they've been kind of, you know, they've been, like, have been subjected to serious cuts over the last seven, eight years, where 37 percent of their cuts [sic: budgets] have seen dramatic changes to what they can actually give to the community, and I've seen it with my own eyes, in Clondalkin, what it has done.

Just from the outset, Minister, you know, the strategy of criminalizing people for drug use has been an abject failure. And I know this is kind of a catchword that the war on drugs has been a failure. It has been an abject failure. It just does not work. It has failed. It's failed communities, and you know, it's failed systems, it's failed judicial systems, and it just doesn't work.

So you obviously have to look at a radical approach to drug use and what that entails, because whether we like it, people will continue to use drugs. They used drugs generations ago and they'll probably use in generations to come.

Do we criminalize them? No, we should not. They shouldn't go through a criminal justice system if for personal use because that system has failed. From the community I'm from, I have seen drugs, and the abuse of drugs, ravage not only friends of mine, family members, whole communities literally destroyed. And what that does to people’s mindsets, it's a cancer almost in communities. Words cannot articulate what drugs does, what they actually leave people behind, and young people that were never born into addiction.

Nobody's born a heroin addict, but, sometimes addiction chooses them. And when you know, heroin gets a hold of you, it's a very, very, very difficult drug to get away from. Some people do and others do not. I know friends of mine have passed away, I know people that have got away from addiction and have done very well. They have children and have good jobs and so forth. But sometimes, you know, drugs, whether we like it, it takes hold of people.

And, I think what drugs does, Minister, I don't know if you'll agree with me this, but, I mean, I hear this all the time, that there -- the debate on drugs, that cannabis is a gateway to harder drugs. Absolute rubbish. Absolute rubbish.

What is the gateway to heroin, and crack, and all the drugs which bring misery, is alienation and poverty. So, I think this argument that softer drugs lead onto hard drugs, yes, people that have, say, chronic heroin problems, they probably did smoke hash, but it didn't, it just doesn't lead on to harder drugs.

Because I know many people who smoke cannabis but will never touch heroin, crack, cocaine and so forth. So, we need a radical approach to that. And also, decriminalization, you know, it's, as the last Deputy said, it decriminalizes the person rather than drugs. I think that's very, very, very important.

I think one model that we speak about is Portugal. In 2001, they decriminalized drugs for personal use. So, if a person has that particular drug on them, they don't go through the criminal justice system. They're given counselling or health-led products, which is harm reduction.

And even in this state, Minister, last year, 80% of drug-related offences are for personal use. So, that runs into probably 10,000 people have gone through the criminal justice system for personal use. That is a complete waste of time. It's a complete waste of time for the criminal justice system, for the police, and even the police will actually say this. You know, the police are in the front line in the war on drugs, and they'll even say it, I mean, they'll even say it's a fail -- it's failing them, it's failing civil society, and we need a new approach, and I think decriminalization is one approach to that.

And also, people that are found in possession for personal drug use, if they get a criminal record, that has a profound effect on their future job prospects. And, I know people that have, ten, 15 years ago they were found for a small amount of cannabis, and they still have a drug offence, and you know, that leads on to -- I mean, it's a ridiculous situation, absolutely ridiculous situation.

I remember going to a festival ten, 15 years ago, and you know, undercover police were looking for people for small possession of cannabis and arresting them. It was ridiculous. I mean obviously, we've moved on. I think civic society has moved on, that we cannot criminalize people, particularly for cannabis use, because that's a complete waste of time.

So, Minister, I think the more profound effects, I think decriminalization is inevitable to come into this country. It's inevitable. And I think another issue, which I'd like to kind of, is the Misuse of Drugs Act 1977.

I think you've got to look at the whole range of that Act. I think you need to reschedule cannabis. I think cannabis as a Schedule 1 drug that has no medical or recreational use is ridiculous. For example, Minister, which is probably going to shock you a little bit, last -- this year, the Minister for Health granted a licence for medical cannabis. One of them licenses was the raw form of cannabis. Meaning that, that person was granted a licence for a bag of grass. That's fact. That's fact.

So the Minister for Health, of which I'm glad he done it, he has granted licence to a person in the State for medical use, proving that that particular drug helps that person for their medical benefit. So you have a ridiculous situation where it's a schedule one drug, while the Minister for Health, you know, he kind of gives a license for that plant, and that drug.

And, just the last thing, Minister, I think, more controversially, you know, at the moment, in this country, all illicit drugs are controlled by criminal individuals or criminal gangs. Them individuals do extremely well out of selling drugs. Very very well. Big cars, holidays, and so forth.

Now, there's going to come a time, I don't know, it's a very nuanced argument, where we're going to have to look at the war on drugs has been a failure. You've got -- not you personally, but I think society has got to look now at ways of taking it out of the hands of criminal gangs and criminal individuals and take that back. It's not a panacea by any means, you know, it's a difficult situation, difficult situation, but we've got to take it out of the hands of illicit gangs, because illicit gangs are unregulated, they don't care what they actually sell.

They give it, you know, children will take it, they die, individuals, communities are destroyed. We've got to look at legalization of some drugs. Now, that is an argument that some people in this country will find it difficult very, very difficult to do. It's a very nuanced argument. But I think cannabis should be reschedule, and then we've got to look at, even a more radical approach than decriminalization.

Because, my starting point and finishing point, is this going to save somebody's life? Can this save somebody's life? And if it can, then it is worth approaching and it's worth looking at. Because at the moment, hundreds of people die of overdose, opiate use, and are affected by drugs.

If we can cut that down, you know, by half, by any means, if we can save one life by decriminalization, regulation, legalization as well, by some drugs, I think we can have a different approach to this issue. Because at the moment, we are losing the war on drugs. It shouldn't be a war, because it's a war on people.

So, Minister, if you can comment on that, particularly about the repealing of the drug act of 1977. Thanks.

DOUG MCVAY: That was Gino Kenny, a deputy in the Irish parliament. He was preceded by Alan Kelly, also a deputy, both serve in the Dáil Éireann. They were discussing the Irish national drugs strategy.

That's it for this week. Thank you for joining us. You've been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at DrugTruth.net.

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We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.