WAGE DRUG WAR IN COMMUNITY

The Global Commission on Drug Policy recently declared that the global
war on illicit drugs has "failed." The panel, led by former U.N.
Secretary Kofi Annan, British entrepreneur Richard Branson and former
heads of state representing Mexico, Colombia and Brazil, concluded
that anti-drug policies have not stemmed the tide of narcotics, as
global opiate use has increased 35 percent over the past decade while
worldwide cocaine use has risen by 27 percent.

This wholesale indictment of long-standing drug policy by respected
world leaders was certainly astonishing. While the commission's call
for decriminalization of drug possession will create widespread
controversy, the focus should remain on the commission's call for a
new model of addiction care.

This appeal creates a rare opportunity for new thinking on how society
might actually win the "war" on drugs. By developing and supporting
local, community-based, public health models of care that stress
ongoing medical, behavioral and social treatments for addicts, society
will give cities and towns across the United States the tools they
need to beat back the scourge of drugs.

The present drug epidemic is alarming. There were 91,698 hospital
admissions for substance abuse treatment in Massachusetts in 2009,
with nearly half for heroin and other opiates -- a 22 percent increase
over the past decade. Every day, 2.7 Massachusetts residents, on
average, die as the result of opiate addiction, which is substantially
higher than the flu pandemic. Nationally, the most recent Survey on
Drug Use and Health shows an 8 percent increase in drug use among
people age 12 or higher, with a total of 8 million people using
illegal drugs.

The idea of community-based treatment for epidemics is not new. When
applied to drugs and addiction, the concept blends proven public
health principles with psychotherapy and practical activities that
increase levels of personal and social responsibility. The "community"
for addicts is quite broad, encompassing family, medical
professionals, the legal system, caretakers and religious entities,
among others. The idea is to integrate disparate community-based
elements into a single model of care.

Research has shown that outcomes for addicts are directly correlated
with length of treatment. Because patients are more likely to stick
with treatment if a facility is local, it makes sense to encourage
localized treatment and other services in outpatient settings, and the
primary care setting in particular, if possible. Collaborative,
community-based therapy -- including treatment in the patient's home --
not only improves outcomes and maintains sobriety, it creates the
opportunity for enduring health and wellness education in the community.

Perhaps the most important element of community-based addiction care
is mapping of localized addict data. This "disease mapping" technique
allows officials to identify possible underlying causes for local
outbreaks of addiction and to direct resources in a manner that
produces the most cost-effective and beneficial outcomes. In
Massachusetts communities where this tool has been implemented, local
officials have been able to effectively direct services where they are
most needed.

The medical, behavioral and social problems associated with addiction
present a costly public health challenge. The best way to address
these issues and "win" the war on drugs is through adoption of
community-based models of care that give cities and towns the
resources they need to treat these chronically ill patients.