Sep 17, 2014

I Am a Fugitive from an Ohio Drug Court

It is time to reform some of our "reforms." As I visit elements of our mental health and addiction service systems, I am finding out that certain reform efforts are having trouble delivering on their promises.  For the people hit by these failures, people with mental health and addiction and their families, this is a scandal that causes as much suffering and death as old-style chain gangs. 


I spent a day in drug court recently. 

What a disappointment. It was an exercise in piling probation violations on top of felony convictions for being an addict.

The court does not offer medication assisted treatment,  so it is to be expected that nearly everyone relapses -- which then becomes a new conviction.

I was there with a man who had a 5th degree felony possession conviction for less than a gram of heroin (something actually against the prosecutor’s indictment policy) from two years ago. He’s still on and off the docket, and getting intermittently incarcerated.

What a waste of time and resources – and a profound extended life disruption for this man, who has extensive trauma, anxiety and mood problems, and needs stability, not this.

Everyone else on the docket seemed to be living out the same story.  

I hope this was not a typical day for Drug Court. If so it is a system failure. Everyone doing the work seemed appropriately committed to delivering a good result. They just had a tool that was broken, one that doesn't fit heroin.


I met a woman in a peer recovery center last month who is in trouble with her
Mental Health Court because she isn't taking her medication. She has a therapist she visits regularly, and a doctor who is happy with her not using medication, but the court keeps threatening to sanction her unless she starts taking medication.

Even though she is pregnant.


Methadone is the most widely used medication to manage cravings for heroin and other opiate drugs. It has been used for close to 50 years to stabilize people, especially those who have the most trouble moving past heroin use. The “market rate” cost of methadone treatment is about $15 per day. Most people who need methadone can’t afford it unless Medicaid covers this expense.

In Northern Kentucky, the local methadone clinic wants to bill Medicaid for its methadone dispensing service, but it can’t. The state has not set up a way for the clinic to enroll as a Medicaid provider. There is no code to use for billing, and no fee structure.

The State Medicaid Plan mandates methadone service, but state officials won’t act. This violates the federal benefit rights of vulnerable people and puts people’s lives at risk. When the people who have the most difficulty making progress without medical help are left without options, they relapse and die. 

This part of the Medicaid plan is just a lie that kills.

Sep 8, 2014

The first coherent strategy for the heroin epidemic

My focus this past year has been the heroin epidemic. The result is a book that delivers three things.
  • A coherent strategy to manage heroin overdose risk for the population.
  • A strong narrative of recovery that supports harm reduction.
  • A public policy framework that aligns service systems and creates the necessary infrastructure.
From the Introduction
Heroin is an epidemic, a health threat. What has kept us from attacking it effectively is a social stance we have taken towards the people who suffer. We face a decision point. We can attack it with all we've got. Our health system and legal system can align their efforts, work together, and solve this. Or we watch more people die.
This is a book for personal recovery, for advocacy, and for system building work. From the chapter "Social Infection"
Alignment and continuity matter. The fatal risk around heroin is frighteningly high, and people who use heroin are fragile. When people disconnect from service systems, relapse turns fatal fast.
Heroin is proving to be a kind of signaling system. It shows us how shunning, exclusion, violence, neglect, and system failure infect our safe world. This population is tough to serve, but so what. People in service systems have the capacity to adapt, and a duty to respond to the people at the heart of their missions.
Purchase SHARP Stop Heroin and Rescue People at Amazon

I have also started a meetup group to pursue development of systematic rescue in communities. Learn more at The website also features downloadable worksheets for community planning work.

The book addresses several audiences: community workers, people pursuing recovery and family members, and all the rest of us. The real alternative to heroin is a positive, safe world. It is our efforts, how we treat each other as well as the opportunities we create, that build and sustain that world.