Rethinking Kristin’s Law, Guest MINDSETTER™ Dr. Fine
Guest MINDSETTER™ Dr. Michael Fine
Rethinking Kristin’s Law, Guest MINDSETTER™ Dr. Fine
Most people who use, use with others. People who sell to one another or use together are the most likely people to be arrested in the case of an overdose death, and the further criminalization of substance use disorder is likely to push that use further and further underground. Kristen’s Law doesn’t take us to the labs where fentanyl is made, or to cartels or the banks and other businesses that profit when drug money is laundered. People worried about Kristen’s law as written are right: almost a hundred years of criminalizing substance use disorder has done nothing to reduce its prevalence. Criminalization has likely worsened the social problem that is substance use disorder – too many families were destroyed because they were afraid to talk about what was happening to someone they loved; and way too many people of color were imprisoned ( and their families destroyed in the process) because they did what too many others did without arrest or conviction.
I’m afraid that I may have contributed to Kristen’s Law, which is why I am writing now. In 2012 or 2013, at the beginning of the big upswing in drug overdose deaths, I began to argue that we should treat each overdose death as a felony, that we should devote the same care and attention to people who died of an overdose that we do to people who die as a result of gun violence or overwhelming infection. I made that argument because I was concerned about the way the human beings who died of overdoses were routinely ignored. The medical examiner’s office would take pictures at the scene; we’d draw blood so we’d know what drugs were implicated, and sometimes there was an autopsy, but there was almost never a police investigation; there was no front page article in the newspaper; often there was no obituary, or, if there was an obituary, it was typically only a few lines, as if the person who died had left the human world the moment they became involved with drugs, as if their lives stopped mattering the instant the pushed the plunger of a needle, or inhaled.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTIt was clear then, and it is clear now, that we aren’t going to stop this epidemic by ignoring the humanity of those who died. We certainly aren’t going to stop the epidemic by imprisoning those who are alive and struggle with substance use disorder, and we more certainly aren’t going to stop this epidemic by ignoring the many thousands at risk, people who need more opportunity and engagement than our culture now provides.
Truth be told, there is no evidence-based approach to community prevention. We just don’t know how to help everyone using from getting into treatment, and we have no idea how to prevent people who are at risk for overuse from using at all. Many of us believe that the best prevention is to bring back social programs that give all Rhode Islanders lives of meaning and engagement -- better schools, more community centers, more sports for more people, more active community organizations, more adult education, and more jobs with work that matters – but we just don’t know if that kind of engagement will b effective either.
What I meant, when I began to talk about treating each drug overdose death like the human tragedy it represents, is that we should surround the life of every person who dies from a drug overdose death with honor and with attention. When someone dies unexpectedly in the hospital, we do a process called M and M – Morbidity and Mortality Report. We study what went wrong and why, and then we bring fifty to a hundred people into the room, to talk through the case, so we understand what went wrong and learn from that person’s life and death. We should be doing the same for every person who dies of an opiate overdose. We’ll need a bigger team -- nurses and doctors, community health workers, social workers, teachers and community organizers, priests, imams and rabbis, substance use disorder treatment experts, sociologists and anthropologists, police and criminologists -- so we can think together about the life of each person who died, about their families, communities, and opportunities, and learn together about what we need to do to prevent the next death.
So let’s not adopt the law as considered by the General Assembly. Let’s change Kristen’s Law. Let’s start doing and M and M on every drug overdose death. Let’s value every human life in Rhode Island. And let’s tell ourselves the truth about substance use disorder: we can’t arrest ourselves, treat ourselves, or interdict ourselves out of this epidemic. But we can look deeply into our culture, use our science to guide us, and change what matters.
Dr. Michael Fine is the former Director of the RI Department of Health