Las Vegas Review-Journal (Sunday)
Opioid abuse isn’t victimless
Scourge is harming many U.S. children
THE Trump administration is being widely criticized for its get-tough approach to the nation’s opioid crisis. Targeting negligent doctors and pharmacists, and focusing on reducing the illegal drug trade — a war that includes President Donald Trump’s call to execute convicted drug dealers — will not do much for those suffering from addiction, the critics say.
Indeed, the Trump administration’s attitude seems to be at odds with popular opinion. In recent years, there has been a growing consensus among Americans that the war on drugs has failed. A 2014 Pew survey found, for instance, that two-thirds of Americans say that the government should focus more on providing treatment for those who use illegal drugs such as heroin and cocaine. Just 26 percent think the government’s priority should be on prosecuting users of such hard drugs.
The question of whether drug users are criminals or victims of an illness is a thorny one for policymakers, and especially for child welfare workers and family court officials.
Every day they must determine whether thousands of parents with drug problems are fit to care for their children or whether those children are in such danger from abuse and neglect that they should be removed and placed with relatives or a foster family, or into an institutional setting. The notion that illegal drug use is a victimless crime, and therefore not a crime at all, is belied by the sharp increase in children taken into state custody in recent years.
Even if substance-abusing parents are not prosecuted in criminal court, the government must decide whether to remove children and even permanently sever parental rights or to keep children in their families while offering more services and support to parents.
Two new reports from the Department of Health and Human Services shed light on the problem. It may seem obvious, but for the first time research finds definitively that rates of overdose deaths and drug-related hospitalizations have increased child-welfare caseloads.
The authors find that a 10 percent increase in drug-related hospitalizations is correlated with a 3.3 percent increase in foster-care entry rates. While most middle- and upper-class Americans likely could find a family member or friend to take in a child in case they were hospitalized, those most affected by drug abuse often lack social networks, and their kids are much more likely to end up being cared for by a stranger.
As one report said, it was “more difficult to get parents with substance use disorders to comply with court orders or safety plans for their children.” And in the hardest-hit communities, there is a growing “difficulty of finding family to care for children because in many cases multiple members are misusing opioids.”
In recent discussions I’ve had with foster mothers in Arkansas and West Virginia, they could each think of only one or two cases among the dozens of children they have taken in in which substance abuse was not an underlying factor.
The response to all this seems haphazard at best. One of the government reports notes that assessment of parents’ substance abuse “was often cursory and lagged behind placement decisions.” Treatment for parents was often insufficient or not in keeping with what medical professionals would suggest. For instance, child-welfare workers expressed skepticism about the use of medication-assisted treatment (which combines medication with counseling and behavior therapies).
There are no doubt ways to help these parents recover. But it is common for addicts to try to kick their habits multiple times. Many never succeed. Meanwhile, chil-
OPIOID
“best interest of the students.”
Much has been written in recent years about the possibilities for “nudging” people to do things they otherwise might not choose to do. In particular, would-be social engineers who have run into trouble, and often political backlash, when trying to order people to change their behavior have looked longingly on more subtle means of influence.
So when does “nudge” come to “shove”? We don’t have to theorize about the far end of that spectrum. The future is now, in the form of China’s new “social credit system,” already in effect for volunteers and becoming mandatory in 2020.
Citizens conforming to governmentally approved behaviors will earn a high numerical rating; nonconformists can expect unhappy consequences. Those with high scores will enjoy a multitude of preferences, ranging from VIP hotel rooms and air travel to better schools for their children. Paying your bills, or spending money on work clothes instead of video games, will be worth points.
But to protect your high rating, be sure to say nice things, and never, never skeptical things, about the government in your digital life, or be linked to others who do. This all is designed to deliver, in author Rachel Botsman’s apt coinage, “gamified obedience.”
This subject needs a highly public examination sooner, not later. The data is here, it is in fact “Big,” and it calls out to the sincerely curious to be analyzed and utilized for good, in all the institutions suddenly knowledgeable about the previously most private aspects of our daily lives.
Somewhere between connecting a struggling student with a tutor and penalizing for life a person insufficiently enthusiastic of a reigning regime, judgment calls will be required and lines of self-restraint drawn. People serene in their assurance that they know what is best for others will have to stop and ask themselves, or be asked by the rest of us, on what authority they became the Nudgers and the Great Approvers. Many of us will have to stop and ask whether our good intentions are carrying us past boundaries where privacy and individual autonomy should still prevail.