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TCNJ Magazine: Spring 18

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32 The College of New Jersey Magazine Although the White House last year declared the widespread abuse of opioids a "health emer- gency," current policy focuses on a crackdown on illegal immigration and penalties for drug dealers. Some countries have adopted parts of the Portugal model, but only Malta, a tiny island nation off the coast of Italy, has actually decriminalized drugs. Other nations, primarily in Western Europe, have created legally sanc- tioned facilities, known as safe injection sites, where people who use intravenous drugs can inject them under medical supervision. According to the Drug Policy Alliance, about 100 safe injection sites operate in at least 66 cities in nine countries (Switzerland, Germany, the Netherlands, Nor- way, Luxembourg, Spain, Denmark, Australia, and Canada). The first such site in North America opened in Vancouver, Canada, in 2003. Accord- ing to the alliance, safe injection sites "reduce HIV and hepatitis transmission risks, prevent overdose deaths, reduce public injections, reduce discarded syringes, and increase the number of people who enter drug treatment." Yet no safe injection sites operate in the United States, though they have been proposed in Philadelphia, Seattle, San Francisco, Denver, and Ithaca, New York. Gibson believes that the U.S. would need a national healthcare system to replicate the Portugal model. And she's not optimistic a nonissue," he says. "People who want to continue are allowed to. If not, they can go into treatment." At first, it was easy to find drugs. Dariano just looked in the medicine cabinets of his parents and grandparents. The pills were often expired, but that didn't matter. "Opiates were a part of everything, just lying around in everyone's cabinet," he says. Then one day he took his first OxyContin pill. "It was cheap, and it was such a rush," he says. "There was no going back to taking Percocet." When the medicine cabinets emptied out, Dariano tried other means to score drugs, and that's what got him evicted. He came home one day to find that his mother had intercepted a box of pills he'd ordered about the prospects for reforming the nation's drug policy. Given the current climate in Washington, she says "there's no way you're going to get any kind of progressive drug policy passed." Many beset by drug addiction walk a crooked path to recovery. Dariano tried going cold turkey on his own, but he relapsed. He tried a 28-day treatment program but relapsed again. He called hospitals and treatment centers, seeking a bed in a long-term program but could not find one. "I didn't have insurance," he says. "I didn't have money." Dariano finally connected with an inpatient treatment center in Boston called Teen Challenge, whose 15-month regimen took a holistic approach to treatment that included four hours of academic study each day. He was 26 years old. "Even a year is not enough time. It takes time to walk into the woods. It takes time to walk out of the woods." If Dariano had sought help under the Portugal model, Gibson says, he could have begun treatment immediately. And his discharge date would have been determined not by an insurance company, which typically covers only up to 28 days of treatment, but by his medical needs. "He could have stayed 30 days, 90 days, a year, whatever his need was," Gibson says. (Ninety days is considered the minimum length of time required for successful addiction treatment.) Not incidentally, she says, under Portugal's national healthcare online. His mother confronted him, and as he recounts their conversation, he can still see the tortured look on her face. "I can't watch you do this," she told him. "I can't watch you die." Yet even at that pivotal moment, Dariano heard conflicting voices in his head. One said, "Look what you're doing to your mother." But the other said, "Now you can use whenever you want." Portugal's response to opioid abuse is a far cry from the approach taken in the U.S., where addiction is largely treated as a criminal matter, and those caught with drugs face much harsher penalties.

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