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Responses to Trump’s Drug Plan
Opioid epidemic experts weigh in on president’s drug policy speech

04/05/18



 On March 19, President Donald Trump visited Manchester and gave a speech outlining his policies aimed at tackling the drug epidemic. He emphasized stronger penalties for drug dealers, including an expanded use of the death penalty and minimum mandatory sentences. But he also talked about expanding access to prevention, treatment and recovery services as well as creating a national prescription monitoring database. Here, local experts in the opioid epidemic weigh in on some of these policy proposals.

 
David Mara is the Governor’s Advisor on Addiction and Behavioral Health and former chief of police in Manchester.
 
Let’s start with the death penalty. Do you think using that option more in drug dealer cases would have the desired effect of combating the opioid epidemic, broadly speaking?
Instead of talking about the death penalty, [I will focus instead on] what I need to do in my job. My job is to get services to the people who need it. We have a lot of people who are suffering from addiction that we need to get services to. We need to get them off drugs. And then we have many more people that we don’t want to start taking drugs. 
 
Was there anything from the president’s recent proposals in the speech that he gave here that you think will help you with those goals?
Yeah, talking about getting help here, talking about getting funds and resources that are needed, he talked about prevention. 
 
Anything you want to add about the role of law enforcement? 
I think that enforcement is a very important part of what we need to do. It’s prevention and education, treatment, recovery, but enforcement is still part of this. ... The ones that are selling the large quantities of drugs, the ones that are selling the fentanyl and carfentanil and that are causing all these deaths, we have to incarcerate [those] people.
 
Do you think we’re doing what we should be doing when prosecuting those cases? Including charging dealers with “death resulting” when a client dies of an overdose?
Yeah, I think we need to do that. I think that will make people think twice about what they’re selling. … It will make them think twice that if you sell drugs you’re going to face the consequences. I’m not talking about the people that are selling the small quantities of drugs. I’m talking about the people that are bringing drugs over our border and distributing large quantities and wreaking havoc in New Hampshire. 
 
Tym Rourke, as director of New Hampshire Tomorrow, manages substance abuse grantmaking at the New Hampshire Charitable Foundation, and he’s a member and former chair of the Governor’s Commission on Substance Abuse.
 
Do you think the increased use of the death penalty against drug dealers would make a positive change in battling the opioid epidemic?
No, I think the focus really needs to be more on the health care and prevention and treatment interventions that the president mentioned, [as opposed to] the death penalty and … a return to minimum sentencing policies, which in the past demonstrated an increase in the incarceration rate without a lot of alleviation on the substance abuse epidemic. It feels like the conversation over the past few years on the opioid epidemic has been ‘how do you address the demand side through effective prevention, treatment and recovery?’ That’s really where the attention needs to be focused.
 
If something like this was implemented and federal prosecutors had the marching orders to use the death penalty more, and they do here in New Hampshire, do you think it would have a deterrent effect?
I don’t think so. I also think … good drug control policy is a balance between reducing the supply side and reducing the demand side. And we’ve come to learn that efforts that really over-emphasize supply-side interventions, which largely include increased incarceration rates or steeper penalties, don’t yield a direct impact in long-term outcomes for people. … And also, recognizing that very often … those kind of harsher penalties disproportionately impact minority communities.
 
Do you think we as a state are striking the right balance between the demand and supply side of this issue right now?
I do think that New Hampshire has a balanced approach … [but] there are questions still to be answered. The utilization of “death resulting” cases is a relatively new phenomenon and I’m not sure of the extent to which there’s been real data work done around what kind of effect the utilization of that tool has had. Obviously, with efforts like Granite Hammer and Granite Shield, there’s been an appropriate increase in law enforcement capacity to address substance use in the community, but I know that there’s been a real attempt by law enforcement to differentiate between when they might come into contact with a dealer who is dealing to make a profit versus someone who might be dealing to feed their own substance use disorder. … There are some concerns that the increased law enforcement is still catching in its web those who might be dealing drugs to feed their addiction and are putting them into the court system rather than into treatment. But, again, it’s very early to tell. … Also … set aside for a moment the question of death penalty, even the minimum sentencing piece, … if you look at the rest of the president’s plan, it’s a pretty balanced plan. There are good recommendations for prevention and reducing misuse of prescribed opioids, there is new resourcing for treatment and recovery supports, there is language that articulates the support for what Congress has done with their latest appropriation, which is to prioritize states to receive additional funding based on need, not based on population size.
 
Benjamin Agati is a Senior Assistant Attorney General at the New Hampshire Department of Justice and the head of the drug prosecuting unit.
 
Do you think that an added emphasis on or the increased employment of the death penalty, at least on the federal side, would have a positive impact on the opioid epidemic?
In terms of what the federal government might be able to do, that’s one area where I will be kind of a little bit limited in whether I think that will or will not. The impact in a change in federal law will only have a real impact if there’s a change in federal prosecution, if there’s an increase or difference in how those go forward. I can tell you, though, from the state side … the penalty for providing a drug or dispensing a drug that causes an overdose can be all the way to life with the possibility of parole, and there’s no minimum mandatory either, so it really gives state judges a great deal of leeway in setting what they think is the appropriate sentence for that particular individual. And we’ve seen sentences range from down in the single digits all the way up to the 15- and 20-year range. … Whether the death penalty on the federal side will provide further motivation for an individual to not sell or not dispense, it depends on whether or not that will be an uptick in federal prosecution.
 
Do you think that it would be an effective deterrence for someone selling drugs to think twice about those kinds of consequences, potentially?
It really depends on your individual dealer. That deterrence may have an effect on somebody who is not an addict themselves, who is selling purely for profit, selling large amounts or causing multiple deaths. That’s a possibility. Whether that deterrence is going to be the same for somebody who has an addiction or is selling merely to support their habit, it all is very dependent on the individual. So, if the federal government were to bring a charge that may have a deterrent effect on some individuals, it really may not on others.
 
Do you think that we are striking a good balance between the demand side and supply side of the drug issue here in New Hampshire?
I almost don’t view it as a balance. I view it as everybody needs to be putting more into it. … If we’re just saying that too much law enforcement means too much incarceration, I agree it cannot be about incarceration alone. That does not solve the problem. Incarceration is a component. … Drug courts are great. They have a lot of fantastic things that they bring to the table. It’s another component that the courts can use in the right situation. … If there’s one thing that we have learned in the last three to four years that we have been battling this [it] is that you cannot take a one-sided approach. It has to be interdisciplinary. You have to involve everyone in those groups: prevention, treatment, recovery is a huge part of this as well.
 
Katja Fox is the director of the Division for Behavioral Health at DHHS.
 
Do you think that the increased use of the death penalty would have a positive impact on the opioid epidemic in New Hampshire?
I’ve heard a lot of the debate and I think that there’s still a question out there. It’s not something that the department is focused on due to our angle on the issue, which is really focused on treatment, recovery and prevention. … But we’re certainly aware of the debate.
 
The president also touches on some of those issues you focus on like treatment and recovery. Do you think some of those proposals, such as tamping down over-prescription of opioid painkillers, would be helpful here in New Hampshire?
Gov. Sununu has convened a group that meets on a regular basis to address these issues. And prescription drug monitoring is one of those areas. And a lot work has been done, not only by government but with our community providers, to really see what makes sense, because there are concerns by some individuals that we may be going too far, and there are others that want us to go further. I think we have found a sweet spot with working with the Medical Society and other stakeholders, but that’s always something that needs to be reviewed and look at the data and the impact that we are having with the more recent policies that have been put in place.
 
What is it that you need most from the federal government to accomplish your goals in terms of providing that treatment?
This is something we’re pretty passionate about. We need more flexibility in the federal funding streams that come forth. So, for example, recently, under the state targeted response grants that we received, the $3.1 million for two years [each year], it restricted it in such a way that we were to use those funds and we had to track our data to indicate that it’s only for opioid use disorder. … We know that opioids right now are extremely prevalent and potent and having a significant impact on our communities, but we know that addiction is underlying all of these issues. So we want to be able to build systems that not only support the opioid response, but allow us to address addiction, whatever that addiction may lead to. So flexibility in the funding streams to permit things that treatment providers are asking for and they need funding support for, which includes housing. … There is a need for capital so treatment providers and others can build buildings … and add … beds or outpatient services. And we really want to address those individuals who are in correctional institutions and transitioning out and being able to provide services to to them. I think, also, we want to focus on additional populations. 
 
Seddon Savage is a physician, professor of anesthesiology at Dartmouth College and advisor to the Dartmouth-Hitchcock Substance Use and Mental Health Initiative. She also co-chairs the Opioid Task Force on the Governor’s Commission on Substance Abuse, though she does not speak on behalf of the commission.
 
Do you think an increased use of harsher penalties and the death penalty for drug dealers would have a positive impact at all on the opioid epidemic in New Hampshire?
I don’t think the death penalty — that there is any evidence that the death penalty reduces crime rates. … It’s an uncivilized, cruel and unusual punishment, and not becoming a society such as ours. And, in the case of crimes related to drug and alcohol issues, often the people selling drugs, who would be framed as criminals, are people who have the disease of addiction and are influenced in their actions by that. So, no, I don’t think the death penalty would be appropriate for any of those things. … We need to individualize our responses to people who commit crimes related to drugs and alcohol. So I think mandatory sentencing is not appropriate. I don’t think it deters crimes. And I’m not a criminal justice person, I’m a physician, so I don’t know the literature as well. … But because so many people who are involved in drug-related crimes are using the drug, some of whom have addiction, I think having available drug courts and expanding our drug court system so that we can begin to treat people who need treatment and divert them from the criminal justice system when it’s appropriate would be very, very helpful. I think we’re doing that well in New Hampshire. I think our drug court system is evolving fairly rapidly. 
 
Were there any proposals made by the president that you think would be helpful?
I think the most important thing that the federal government can do is support a robust health care system by making sure that all people have access to quality, affordable health care. And some of the policies of the current administration that seek to … [limit] access to health care and discourage states from accessing Medicaid services … only hurts the drug and alcohol problem and is counterproductive to what we’re trying to do to address the opioid epidemic. That would be No. 1. And I think having a … prescription drug monitoring program that allows clinicians to query across borders is very helpful at identifying people who may be doctor-shopping. … That’s one policy that I would support. Certainly, money spent on prevention and increasing access to treatment is … good. 





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