By Alison Laurio
Coast-to-coast change is in the works to address drug use and how those who use drugs are treated.
In the East, Baltimore State’s Attorney Marilyn Mosby in 2020 stopped prosecuting drug possession and a few other minor charges “to keep people out of jail and limit the spread of the deadly virus.”
After statistics early this year showed crime had plummeted, she stopped prosecuting all drug possession, prostitution, and other nonviolent misdemeanors in the city.
In the West, Oregon voters passed a law decriminalizing possession of small amounts of all drugs, from heroin to oxycodone. It requires a $100 fine or a health assessment that can lead to required addiction counseling.
Though details differ, this joins decriminalization laws in more than two dozen states that stopped jailing residents charged with possessing small amounts of marijuana. And it cements the roles of social work in treatment and in advocating the public health approach of advancing treatment over punishment.
A 2013 NASW Social Justice Brief, A Social Work Perspective on Drug Policy Reform
, outlines a public health approach. Social workers likely will advocate for policies and programs that place low-level drug offenders in treatment, not incarceration, the brief says, as most members “are licensed clinicians who are adept at assessing and providing treatment for people with mental health and substance use disorders.”
The goals of a public health approach are to improve and protect community health using research, education and the promotion of healthy lifestyles, which aid improvement of the health and well-being of people and communities by using “both social work and public health theories, frameworks, research and practice,” the brief says.
Using research, policy, advocacy, and clinical and macro approaches, it says, “works across population levels, from individuals to groups, communities and whole populations. It’s strengths-based and emphasizes resilience and positive factors to promote health and reduce risk.”
The Reagan administration’s 1980s-era “War on Drugs” and criminalization of use resulted in “the arrests and incarceration of many thousands of mostly minority young men and women for minor drug offenses,” like marijuana possession, often caused by substance use disorders, the brief says. Quoting from Human Rights Watch, it states that data show arrest and incarceration for low-level drug crimes point clearly to racial disparities that likely leave long-term impacts, including to future employment. That holds risks for lifelong poverty.
The public health approach includes treating substance use as a chronic disease that is preventable; coordinating a national approach that includes “best practices prevention and treatment models; eliminating health disparities to accessing treatment; and facilitating access to care for low-income uninsured individuals,” the brief says. And treatment can work with those in the criminal justice system.
The brief points to the fact that drug treatment works. It lowers incarceration rates, improves life outcomes, decreases future involvement in the criminal justice system, and costs less than incarceration.
Overall, treatment can reduce “the revolving cycle of arrest, incarceration and rearrests of low-level offenders.” Social workers must work for criminal justice reforms, perform research and write about the issues “from a social work perspective,” and remember the profession has a “long history of introducing innovations to service delivery and of social justice problem-solving.”
“At the heart of public health is a commitment to social justice, based on the compelling desire to make the world a better place, free of misery, inequity and preventable suffering,” the brief says.
A March 16 story from National Public Radio’s Planet Money newsletter outlines what it calls “The Data On Legalizing Weed.” It has been almost a decade since Colorado and Washington state legalized marijuana, providing economists and researchers time to study the policy impacts, the story states. Those include: legalization didn’t substantially affect crime rates; it had little or no effect on traffic accidents and fatalities; it barely affected the price of marijuana; it created “lots of jobs;” and it is very good for state budgets.
Oregon voters passed Measure 110, which decriminalizes the use of all drugs and in April was awaiting legislative work on details, said Delmar Stone, executive director of NASW-Oregon and NASW-Idaho.
“Measure 110 has not yet been implemented, but it will (be),” he said. “The implementation of drug decriminalization has a lot of components, as you can imagine, and Oregon wants to do this right.”
The Drug Addiction Treatment and Recovery Act of 2020, Section 1, calls for expanded access to drug treatment because “drug addiction and overdoses are a serious problem” and “Oregon needs to expand access to drug treatment.”
“Making people criminals because they suffer from addiction is expensive, ruins lives and can make access to treatment and recovery more difficult,” it states.
The act calls for health assessment, treatment and recovery services for addiction to be available “to all those who need and want access to those services, and to adopt a health approach to drug addiction by removing criminal penalties” for “low level,” or smaller amounts, of drug possessions.
The plan generally calls for grant-funded addiction recovery centers to be established statewide by Oct. 1 that will provide immediate triage, assessment and address ongoing needs that include case management and services. An Oversight and Accountability Council will be formed to determine fund distributions to grant applicants and oversee implementation of the centers.
The council must have members with diverse backgrounds, and “a licensed clinical social worker” is one profession named in 17 required professions listed. Social work skills also fit well with some other skill areas listed.
Drug center staff must include someone who is certified in alcohol or drug counseling “or other credentialed addiction treatment professional,” an “intensive case manager,” and a peer support specialist. It all will be funded by taxes from legal marijuana sales.
Kendra J. Wells, MSW, is manager of research support at the Center for Social Work Research at Wayne State University’s School of Social Work in Detroit.
She hires, trains and supervises research assistants — primarily social work students — involved with social work research on a wide variety of topics supporting the social work school and outside grants. Wells uses legal medical marijuana, which helps her with severe anxiety, muscle spasms, chronic pain and nausea. Opiates and muscle relaxants had been prescribed in the past, but she said those caused unwanted side effects.
Medical marijuana “works better for me with nausea and prolonged pain,” she said. “It helps my anxiety and gives me the ability to eat. This is a natural remedy that’s safer, so I’d rather do that.”
Wells has experienced lack of acceptance and some condescension from social workers who apparently disagree with her preferred treatment.
“In my experience, I think people are afraid of change,” she said. “In my experience, a lot of social workers had held opinions and now they’re being challenged with facts.”
“I think we need to be more open-minded, toss everything out and relearn to accept it. I’ve said for a long time, not everyone needs to use it, but some people do.”
Wells thinks that is why she likes being a social worker who is open about her condition and about her chosen treatment—so people can see it’s not something you have to whisper about or be afraid to talk about for fear of being judged.
“I think the more I talk about it in a professional way and the more people open up about their experiences, it will normalize use and people will know professionals can use it, too,” she said.
Wells said another benefit of that choice is “you can adjust it to when you need it, and you can’t do that with prescription drugs.”
Medical marijuana is very expensive, which is a concern for many cancer patients. That is an area where macro social workers can help, she said, because they understand the system. They could support the creation of an equitable medical marijuana industry, support the community the businesses are selling to, and help people of color who are the most victimized by the industry.
Help also may be needed to obtain a prescription or with a legal issue, and social workers can be an advocate, write regulations, do research or be policymakers, Wells said. “I think social work can be a more level voice in those (areas). States already are making good money. I think we can be a part of the change.”
Better Life in Recovery
The environment, genetics and pre-existing mental health issues can all play roles in developing a substance use disorder, said David Stoecker, MSW, LCSW, executive director of Better Life in Recovery Inc., in Springfield, Mo.
Stoecker said he was a “picture-perfect kid” from a “picture-perfect family”—his mother, a doctor, and father, a CEO. He used drugs for two decades, beginning as an injured high school baseball player being eyed for college play, then as one of many for whom the prescribed pain reliever turned into regular use to feel normal.
“Drugs were a respite for me,” Stoecker said.
He stepped into recovery, became a social worker focusing on helping others recover, and co-founded the Springfield Recovery Center and the Missouri Recovery Alliance. He also founded Better Life in Recovery Inc., where he works full time. Well versed in recovery programs, he wanted something different.
“I sometimes feel anonymity causes problems,” Stoecker said. “It’s almost like we’ve created silos in recovery. I thought … let’s do something to celebrate people in recovery and get together with people in the community.”
It began with a community picnic and barbecue, then a co-event with a church the next year with 5-K and 10-K recovery runs. The events since, partnering with other community members, have included live music, a trip to watch the St. Louis Cardinals play, and a variety of other activities like movie nights and game nights.
“Last year there were more than 800 events,” said Stoecker, who calls some of them community impact events. Those included picking up 10 tons of trash along Missouri riverways and school service events like playground cleanups. Many things they do include family, friends and community members in “pro-social activities,” he said. In 2020, more than 10,000 people “came through our doors” and not all were people in recovery.
Stoecker said he see advantages to decriminalizing drugs, including knowledge of what the supply of drugs out there really is. And, he added, decriminalization has been effective elsewhere in the world.
“Portugal decriminalized years ago, and they didn’t see a negative impact,” he said. “They saw a decrease in deaths, a decrease in overdoses, and they also saw a decrease in HIV infections and drug-related crimes.”
The same impacts could be seen here in the U.S., he said, as well as decreased hepatitis C infections. Stoecker doesn’t think decriminalizing drugs would increase use, but it could increase use of what he calls access points—locations where people can get clean syringes.
“We’ve spent trillions of dollars on the War on Drugs, and that, so far, hasn’t been effective. Imagine what we could have done with that kind of money. If we legalize marijuana (nationwide), 650,000 people could go to public universities for free every year.”
Stoecker said he’s glad for the changes that led to his current life, and he will continue to focus on the recovery aspect for himself and others. “It’s really neat to watch people reach their full potential and strive to be better than they were before. We’ll never be recovered, never be at the point where we can’t improve.”
Stoecker also wants to build the program, work on legislative changes, and advocate for people who have lost themselves along the way—do what in baseball they call being a utility player. “That’s what I feel social work has the ability to do.”
A View From the ER
“We’ve been incarcerating people for 50 to 60 years and that hasn’t worked,” said Dr. Dan Morhaim. “Many people come to the ER with social issues.”
Morhaim, an emergency room physician at Baltimore’s Sinai Hospital and former Maryland General Assembly member, gives presentations and webinars and also is an author and consultant who said the next stop for many of his ER patients is jail.
Jailing people for drugs “runs counter to the things most of us use to survive,” Morhaim said. “People have wanted to alter their moods for thousands of years.”
He said it’s necessary to acknowledge that many people suffer from childhood trauma, and arresting people simply for drug possession does not help them. “I know from my patients. I talk to my patients, and they tell me. Turning people into criminals hasn’t helped. We’re stuck in a way of thinking that hasn’t worked for 50 years and it still doesn’t work. I’m frustrated that we continue to do this.”
The nation should turn to a public health approach, and social workers “absolutely” should be involved, Morhaim said. “It’s all hands on deck. I wish we had more of them on the (emergency room) team.”