Across our country, people are dying from opioid overdoses at an alarming rate because of the prevalence of potent synthetics like fentanyl. In 2016, Maine’s overdose rate of 28.7 per 100,000 people was 10th highest of states. Washington County’s rate of 76.3 per 100,000 was 10th highest of all counties across the country.
The Department of Justice looked at that evidence and provided the Maine U.S. attorney’s office with an additional prosecutor to focus on dealers who sell synthetic opioids. We will use that prosecutor to play our part in what must be a group effort to combat the opioid crisis. My office’s primary role in that effort is to enforce federal law criminalizing the unlawful distribution of opioids. We have never prosecuted mere users, and we will not be doing so under this initiative. If we are going to resolve this crisis, other components of society must play their part by preventing and treating opioid abuse, and I welcome their help.
We inhabit a large, diverse, complex and fractious society. We have to divide responsibilities and specialize, while maintaining a general understanding of the larger context in which we operate. We are citizens of a democratic republic in which we govern ourselves. In the first instance, that means that each of us is responsible for ourselves to the extent that we are able. Beyond that, it means that we make law through our elected officials and we live under the rule of that law — not the whim of some monarch, the corruption of some local government official, the pandering of some politician, the poorly-conceived notions of some actual or virtual mob, nor the opinion of some commentator.
That law includes criminal law to control our most anti-social inclinations to harm others and ourselves. In that regard, our laws criminalize the abuse of opioids to limit the amount intoxication in society to maintain the order that characterizes our way of life.
In general, we hold people criminally responsible if they understand right from wrong because we value self-determination and believe that it is fair to expect people to behave if they can do so. Intoxication is not a defense to crime in general and the distribution of drugs in particular.
We punish people who commit crimes in fairness to people who obey the law, to create an incentive for them to obey the law, to incapacitate those found guilty from committing further crimes, and in the hope that they will accept responsibility for their misdeeds and resolve not to violate again.
It is all premised on the belief that, individually and collectively, people do better the more that they govern themselves.
Opioid addiction is confounding because of the sense that it renders people unable to control themselves.
According to the National Institute of Health and other experts, the current consensus is that opioid dependence is a brain-related medical disorder caused by a variety of mechanisms including a person’s genetics, socioeconomic and psychological factors, and environment. It has a neurobiological aspect in that opioids cause pleasure by binding to receptors in the brain, and continuous exposure induces pathophysiologic changes in the brain.
It is associated with high rates of criminal behavior. While a drug-free state may be the optimal goal, other laudable goals can be achieved with treatment, such as decreased drug use, reduced criminal activity and gainful employment. Current preferred practice is medication-assisted treatment with agonists like methadone that act as a substitute for opioids and reduce cravings and withdrawal symptoms and antagonists like Naltrexone that block the effect of opioids.
However, even medication-assisted treatment requires a patient’s commitment. It can’t work if patients don’t abstain from abusing drugs or don’t take their medicine as prescribed. Duration and continuity of treatment, involvement of non-pharmacologic support services such as psychotherapy and counseling, and motivation to change are crucial to the treatment’s success.
In that regard, it is difficult for treatment to succeed if patients are surrounded by users and dealers who are selling opioids. Synthetic opioids are brought to Maine from away by criminals who are motivated to make money in a relatively undeveloped market for captive consumers. Those criminals bring with them violence that is relatively unfamiliar here. They are not deterred by treatment of addicts. So that, even within the context of the disease theory of addiction, law enforcement is an important part of the group effort to address the opioid crisis.
Halsey B. Frank is the United States attorney for the District of Maine.
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