NH ALCOHOL and DRUG ABUSE PREVENTION and TREATMENT ACT

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1 NH ALCOHOL and DRUG ABUSE PREVENTION and TREATMENT ACT Preamble: Drug and alcohol addiction and abuse have played a significant and damaging role in our society for well over a century. During that time many attempts to curb, control and treat addicts and their behavior have been undertaken without ANY significant success. There are very few of us who have not been touched by addiction in one form or another (family, friend, child, colleague). Below, please find a comprehensive, multifaceted approach to the current crisis. Though I have no illusions that this act, if accepted at all, will not be changed, adjusted, tweaked or abandoned I do have several requests to the preservation of particular portions. First, I request that we all (that is all who are involved in addressing this problem from a legislative stand point) do our very best to resist our own prejudices and the prejudices of others (business, medical, political, monetary, religious, emotional), and for the wellbeing of our community work together not as republicans, democrats, independents, Catholics, Christians or Jews, but as concerned members of a cohesive community whose primary goal is to improve conditions for ALL of us. Secondly, I implore you not to address this crisis insufficiently. That is, for a problem as complex, comprehensive and ubiquitous as drug and alcohol addiction, a halfhearted financially insufficient response will be a waste of time and a waste of money. As my father taught me, if a person is to do something, they should do it right, or don t do it at all. Lastly, and I believe most importantly, I attempted to write a degree of objective neutrality throughout this act. As stated, this is likely the most important aspect of this piece of legislation. In my experience, as soon as a person or an organization with a different or separate agenda is left in charge, the initial and ultimate goal becomes secondary, and likely to the detriment of the people of NH. That being said, leaving this very important task in the hands of business or religion would likely ultimately lead to failure. Though government run operations often are inefficient and cumbersome, they always maintain service to the tax payer as primary. In the name of transparency, I have no particular affiliation with a religious, medical or financial organization that is liable to benefit from this act, nor am I, in anyway, liable to benefit from this act. I am merely a concerned tax payer with a specific set of experiences that are germane to this particular issue.

2 Oversight and Funding Because this act encompasses many different departments and divisions with a common goal, it seems prudent to bring the goal and the many different departments under the leader ship of one office. This office or department (referred to herein as the office of oversight ) would best serve the population if they were to report directly to either the governor or the legislative body and did not report to or fall under one of the other effected departments. The person in charge of this mammoth undertaking will require appropriate skills, experience and training to fulfill the following job description (Notably I have given no title here): Objectively review and evaluate the actual effectiveness of current treatments, interventions and prevention methods being used throughout the world and over time. Apply said objective information to guide each department in forming a program with likely or proven desired outcomes. Design a method of reviewing and measuring effectiveness of prevention and treatment, make changes as necessary and provide reports to governing body (measurements of outcomes should be done on a yearly basis). Act as liaison to each department, between departments and between departments and the governing body. Conduct quarterly meetings with representatives from each of the involved departments to cultivate a flow of information that is to include, successes, failures, specific cases, new ideas and barriers. (Note: The leader of this office will have the authority, where it is legally and constitutionally acceptable, to change, adjust, advise, guide and/or wholly accept or deny the programs or plans of any one department in order to address drug addiction, prevention and/or treatment.) Seek out and initiate unique and creative ways to fund this office and support financially the other departments involved in this act. (i.e. federal grants, donations, nonprofit fundraising, etc.) Funding for this act and office will come from several sources. First, each department will provide 50% of the funding for their portion from their current budget. Though it is recognized that all named departments are currently struggling to provide services at current budget levels, it is also understood that appropriate treatment of drug and alcohol addiction leads to a more productive community with increased tax base and less money spent in

3 corrections, law enforcement, judicial involvement, and medical care, ultimately leading to a net gain. The other 50% will be provided directly from the State s overall budget, this is to be produced through usual and, hopefully, more creative taxation (i.e. Tax on substances of abuse, such as alcohol, prescription narcotics etc.). Funding for the office of oversight will have to be provided through usual funding methods to start. Addressing Supply Law Enforcement: Though there are current narcotics departments in both state and many local law enforcement agencies it is necessary at this time to take a hard look at the current methods and their effectiveness. Because law enforcement has been addressing this problem for many years, there should be data available to evaluate current and past programs. For the purpose of this act, once the data has been reviewed, funding for current programs that should be increased to provide needed man power, tools and training to continue and to expand such programs that have proven effective in addressing supply. Additionally, a law enforcement liaison to oversee, evaluate and adjust tactics, training and dispersing of funds should be hired. This liaison will also interact with the office of oversight named above, as well as the liaison of all other departments named in this act in order to encourage exchange of information throughout the state and the program. Funds should be dispersed fairly, dependent on communities with greater need, based on studied trends and number of cases. Cooperation from the entirety of the law enforcement with this law enforcement officer will be expected but not legislated, however, funding will depend on cooperation. Finally, begging for money in any community that has known services (soup kitchen, homeless shelter etc.) shall be illegal, as the money gained by most (if not all) beggars is used for drugs and/or alcohol. Judicial/corrections: Current punitive methods of addressing illicit drug dealers do not appear to be a significant deterrent. I propose the punishment for dealers have an increased minimum amount of years in prison for dealing, along with a program similar to the tracking method used in sexual predator cases. For example, they could be monitored after release to provide law enforcement with tools for future monitoring and investigation of their communities. Finally, if it can be established that a particular overdose or drug death can be proven to be connected to a particular dealer, that dealer can be held accountable for man slaughter and sentenced appropriately. Medical Community: There are several studies currently available that indicate a large number of current addicts (some quote 75%!) started initially with prescription narcotics. On multiple busts of dealers and/or users over the past several years prescription narcotics have been the

4 majority of the seizure. (I will add here, from a personal note, that working in corrections has opened my eyes as to how many of my colleagues are over prescribing pain medication, benzodiazepines and amphetamine). I propose that the governor and attorney general s recently rejected plan be reconsidered. As a practicing physician the only flaw I could find in that plan was that there was no grace period to allow physicians the opportunity to prepare, nor was there adequate time to carefully withdraw people who were found to be abusing the medications. In short, the medical community has directly and indirectly contributed to this complex and severe community problem, and thus should be willing to adjust their prescribing practices to promote the wellbeing of the community at large. Because the medical community is a private industry they cannot be compelled to provide liaison, however one should be sought by the director of the office of oversight. Addressing Demand Corrections: The department of corrections is in an incredibly unique and advantageous position to effect treatment and, thus, demand. There are several promising studies that support what can basically be described as forced treatment as having a far lower recidivism rate than most current available treatments. The two main aspects that have been shown to contribute are that the treatment has to be separate from the general population of inmates, and it had to be compulsory. This all being said, there are several significant problems with this method. First is that this would likely best be done at the county correctional level which is far more difficult to legislate and control through state oversight. Second, the majority of the population is often opposed to increases in spending for corrections. I recognize that new locations for new corrections activities is an incredibly expensive undertaking, however the dividends will be paid in the long run. In order to overcome the county concern I recommend that a single drug jail be created for the sole purpose of initiating and maintaining compulsory treatment with the ultimate outcome of actual rehabilitation. Doing so not only takes advantage of this unique opportunity, but it provides the state with incredibly valuable data, it centralizes this type of treatment, and if offers true hope to the addicts sent here and our community at large. The drug jail should only be accessible through the drug courts, such that it does not become at tool for wellintended lawyers wanting to minimize the punishment of their clients. Ideally, the drug jail will be appropriately staffed with mental health providers and social workers trained in transitioning the inmates to a safe and productive, free existence. The Director of this drug

5 jail will either act as the liaison to the office of oversight or name a member of his/her staff to said position. Sentences will be carried out with periodic testing for participation, willingness, overall improvement and dedication to change. The program inmates found to be unsatisfactory in these areas will be returned to previous (presumably harsher) sentences such that space is maintained for those willing and ready to change. Judicial: There are current drug courts in operation in the State of NH. My proposal at this time is that drug courts be expanded to include several locations throughout the state such that access is equalized. It is financially feasible to pick several geographic locations and then offer a referral process that allows access by all counties. Transportation could be provided by county with reimbursement from state funds such that equality is maintained without the cost of putting one in every county. The current drug court model should, of course, be reviewed for effectiveness by the office of oversight, and should be duplicated where applicable. Additional resources that will be available to the drug courts will be the drug jail and money from the department of oversight. The drug courts will have the additional responsibility of screening candidates for the drug jail with ultimate sentencing duties for said jail and the impending harsher sentence for failure to comply or complete. The judicial department will hire or appoint a liaison to the office of oversight. Education: The department of education will explore and evaluate current evidence for educational prevention. Develop a curriculum to span grades 6-12 to educate the students with honesty on drug and alcohol addiction, its deleterious effects, treatment options, proven ways to avoid becoming addicted and available community resources. The department of education will further educate current guidance counselors on best methods for identifying at risk students and counseling them. The department of education will be responsible to create and lead a public information/education campaign with the ultimate goal of decreasing drug and alcohol addiction in our community. Finally, a liaison will be appointed to the office of oversight for free exchange of information, review of evidence, and measurement of outcomes. Treatment: Treatment for people suffering substance abuse disorders has been historically difficult to obtain, questionably beneficial and expensive. In regards to treatment paid for by the state it is clear that the sheer number of people who would need or who would seek treatment would be financially untenable. That being said, this act would establish a fund for treatment facilities that have shown positive outcomes. This fund would be appropriated by the director of the office of oversight based on community need, outcome measures and performance. Additionally, the state will fund, in entirety, one treatment facility for those with multiple complicating diagnoses and recurrent treatment failure. This facility will be placed on the grounds of NH State Hospital such that psychiatric and medical care can be provided by current infrastructure. The remainder of the care at this facility will be provided for by in house

6 staff. Admission to this facility will be accomplished through a collaboration of the office of oversight, corrections, law enforcement, the judicial and educational branch such that the worst cases are reviewed and agreed upon for treatment with in this facility. The facility director will either act as, or assign, a liaison to the office of oversight. Finally, the state will investigate and initiate multiple ways to make the environment in the state of NH conducive to providing substance abuse treatment such that NH residents may benefit from their operation in the state. For example, tax breaks, land deals, utility deals etc., such that for every so many paying customers these organizations provide for, they give one bed to a needy NH resident as decided upon by the office of oversight. CLOSING NOTES Stream lining: It was with purpose and intent that I did not include all interested parties in a discussion on this act. I have come to learn that the more people you bring to the table, the more agendas that come to the table, the less that gets done. That being said, I am fully aware that this act as I have named it will need significant specifics added to it, likely by attorneys and accountants. I request, in the interest of time and brevity, that a fairly objective attorney and accountant are sought out to add the necessary details without losing the spirit of the act. Collaboration: To my knowledge this is the first (and possibly only) act that brings so many departments together for a single purpose to benefit a single community. One of the complicating problems of substance abuse is the way in which families, communities, treatment and law enforcement have been fractured. This act not only addresses that, it abolishes it in the name of addressing a public health crisis. If successful, this act could be precident setting leading to a standard of care across the country that changes and improves all of our lives. Historically: History has shown us time and time again, any chronic public health issue increases when spending on that issue decreases. Drug and alcohol abuse has been a public health issue since the inception of our society, it is unlikely to ever be completely eradicated. This act is worthy of the complexity, chronicity and scope of the problem. If I were going to have my name associated with a piece of legislation, I would rather it be associated with an expensive one that made a true difference than an inexpensive one that didn t. Respectfully submitted, Matthew J. Masewic, MD