Since September, I’ve asked Vox’s readers to tell me their stories about drug addiction treatment for our Rehab Racket project. In less than four months, we’ve gotten a lot of responses — now more than 1,000.

From all of these experiences, one theme emerges: Addiction treatment in the US is expensive, hard to navigate, and far too often fails people. In the middle of an opioid epidemic that’s helped lead to more than 700,000 drug overdose deaths since 1999, America’s main defense against addiction is deeply flawed.

The stories we’ve published so far speak to these problems. Kim and Tim Blake spent more than $110,000 on treatment for their oldest son, yet much of the treatment was unhelpful and he died anyway. Michel Cote’s daughters went through $200,000 worth of treatment over a decade before they finally found something that worked for them. Nan Warren faces financial ruin after she lost her oldest son to addiction and has spent years trying to avoid the same fate for her surviving daughter.

Health insurance alone is not enough to protect patients from high costs and low quality. Maureen O’Reilly lost her son to addiction after their health insurance plan wouldn’t cover addiction care near home and he was sent to shoddy treatment facilities — some of which were later shut down — in Florida.

Here are four lessons from the project so far -

1) Poor insurance coverage leads to high addiction treatment costs

This is a big problem nationwide: Based on the National Survey on Drug Use and Health, federal researchers estimated that roughly 314,000 people in the US in 2018 needed drug addiction treatment but couldn’t get it because they didn’t have health coverage and couldn’t afford the costs. About 100,000 couldn’t get it because, while they had health coverage, it didn’t cover treatment at all or it didn’t cover the full cost. (There’s some overlap between the groups because participants were able to select multiple responses.)

2) We know disturbingly little about addiction treatment in America

While reporting on addiction treatment in the US and asking experts about the evidence for addiction care, there has been one answer I’ve gotten used to hearing a lot: “I don’t know.”

It was a common response when I asked if certain addiction treatments worked. Many facilities, for example, now use equine therapy, in which patients connect with horses. But we have next to no research on whether this works. The same is true for wilderness therapy that emphasizes outdoors activities, which also has little reliable scientific evidence behind it.

3) We don’t make good use of what we do know about addiction treatment

For example, the research shows that medications for opioid addiction — methadone, buprenorphine, and naltrexone — are very effective: Studies show they cut the mortality rate among opioid addiction patients by half or more and keep people in treatment better than non-medication approaches.

Yet in the US, the majority of addiction treatment facilities don’t offer any medications. According to federal data, only 42 percent of the nearly 15,000 facilities tracked by the Substance Abuse and Mental Health Services Administration (SAMHSA) provide any type of medication for opioid addiction. Less than 3 percent offer all three federally approved medications.

When writing about anything addiction-related, there’s an explanation I can expect for just about any problem: stigma. Indeed, it’s the thing that ties the lessons on this list together.

This has stuck with me ever since I went to Vermont in 2017 to see how the state built up its addiction treatment system. When I asked officials about the hurdles to building up the new system of care, I expected to hear a lot about money (a common problem in policymaking). But officials told me, in fact, that money wasn’t that big of a deal. Instead, the main barrier was stigma around addiction, fueled by the notions that addiction is a moral issue — not a health issue — and people with addiction don’t deserve public resources. Once that stigma was overcome, the money came easily.

1,000 people sent me their addiction treatment stories in the United States. Here’s what I learned

The proposal for a new Norwegian drug policy was tabled by the Drug Reform Committee on Thursday, December 19. The proposal marks a historic step away from punishment as a reaction for use and possession of drugs in Norway. As the title "From punishment to help" indicates, people who use drugs will now be met with offers of help and treatment. Although the use and possession of drugs will still be prohibited, it will no longer be punishable as a criminal offence.

The committee proposes a model where drug users are summoned to a meeting with a municipal counselling service. Although there is a duty to attend, failure to attend will not be punished. The report states: “The duty to attend is intended to clarify that the use of drugs is still illegal, while the meeting itself is intended to provide the basis for people to receive help and follow-up as needed. People will also be informed about potential consequences and risk factors associated with drug use.”

If people are caught with large amounts of drugs, they can be prosecuted for sale or distribution, as is the case today.

Norwegian Drug Reform Committee report: Remove penalties for use and possession

At a seminar held in Brussels today, the Civil Society Forum on Drugs urged the European Parliament to prioritize and fund drug policies based on evidence and human rights.

On 5 December 2019, the EU Civil Society Forum on Drugs (CSFD), an expert group of the European Commission, organized a seminar for Members of the European Parliament (MEPs) entitled ‘The Future of European Drug Policy’.

The event comes at a time when the EU is facing significant challenges in tackling the illicit drug market. Despite the EU’s efforts to counter the drug problem, drug trafficking and production remain among the most profitable criminal activities in the region, while the health and social harms associated with drug use continue to rise, with more than 8,000 drug-related deaths reported in 2019. Drug-related issues affect millions of people within the EU, bringing with them complex health, security, social and criminal justice issues.

The expiry of the current European Drugs Strategy (2013-20) and Action Plan (2017-20) represent a key opportunity to be seized by the EU. It is a chance to review successes and failures of European drug policy and to build on the learnings and challenges from the last decade, by continuing to prioritize a drug policy approach grounded in the principles of public health and human rights.

Civil society urges European Parliament to make drug policy a priority

By Pierre Smith, Louis Favril, Dominique Delhauteur, Freya Vander Laenen and Pablo Nicaise

For more than 30 years, drug consumption rooms (DCRs) have been implemented in Western countries. DCRs are supported by a large body of evidence about public safety and public health effectiveness. However, a political consensus has never been achieved in Belgium on amending the existing law that explicitly penalises the supply of a room for facilitating drug use. Despite this adverse legal and policy framework, a DCR opened in the city of Liège in 2018. In this case report, we applied the theoretical framework proposed by Shiffman and Smith for policy agenda setting, in order to describe and assess how political and legal barriers were overcome in the process of opening the DCR.

For some years, fieldworkers and some city policymakers argued for DCR implementation in Belgium, but without gaining the support of the national authorities, mainly for ideological reasons. In order to address this debate, a feasibility study of DCR implementation in Belgian cities was commissioned. At the national level, an institutional debate took place about the political responsibility for DCRs as a public health intervention, as health care is mainly a matter of regional policy. The lack of consensus led to a situation of political deadlock. Meanwhile, the publication of the study report and the context of local elections offered an opportunity for Liège authorities to reignite the local debate on DCRs. At the local level, law enforcement, care professionals, residents, users, and the press were all involved in the implementation process. Therefore, a local consensus was formed and despite the absence of any national legal change, the DCR opened 1 month before the local elections. It has been working without major medical or legal incident since then. Incidentally, the mayor of Liège was re-elected.

Although the lack of a legal framework may engender instability and affect longer-term effectiveness, the DCR implementation in Liège was successful and was based on a local consensus and effective communication rather than on an appropriate legal framework. The experience provides lessons for other cities that are considering opening a DCR despite an adverse legal and political context.

How to overcome political and legal barriers to the implementation of a drug consumption room: An application of the policy agenda framework to the Belgian situation

A former Mexican security minister has been arrested in the US, charged with taking bribes from a drugs cartel.

Genaro García Luna is accused of allowing the Sinaloa cartel of "El Chapo" Guzman to operate in Mexico in exchange for millions of dollars.

Prosecutors say Mr García Luna gave the cartel safe passage for drug shipments and access to sensitive information.

They say that on two occasions cartel members delivered up to $5m (£3.7m) in two briefcases to him in person.

Mr García Luna, 52, served as public security chief in the administration of President Felipe Calderon between 2006 and 2012.

His arrest in Texas is a major development in Mexican politics, the BBC's Mexico correspondent Will Grant reports.

Mr García Luna was not just an important figure in Mr Calderon's administration - he was Mexico's secretary of public security, the face of the country's federal police force, our correspondent adds.

Mr Calderon, with US backing, deployed troops against the cartels for the first time. Tens of thousands died in Mexico in drug-related violence during his "war on drugs".

Genaro García Luna: US arrests Mexico ex-minister on drugs charges

THE HAGUE- The Office of the Prosecutor of the International Criminal Court (ICC) is looking at 2020 to finalize its preliminary examination on issues concerning the war on drugs in the Philippines, according to a report released Thursday.

“During 2020, the Office will aim to finalize the preliminary examination in order to enable the Prosecutor to reach a decision on whether to seek authorization to open an investigation into the situation in the Philippines,” the report read.

According to its annual report, the Prosecutor’s Office “advanced its assessment of whether there is a reasonable basis to proceed under Article 15 (3) of the Statute”.

Article 15 (3) of the Rome Statute states that “if the Prosecutor concludes there is a reasonable basis to proceed with an investigation, he or she shall submit to the Pre-Trial Chamber a request for authorization of an investigation, together with any supporting material collected.”

On Feb. 8, 2018, ICC prosecutor Fatou Bensouda announced the opening of a preliminary examination on the alleged crimes committed in President Rodrigo Duterte's drug war. This, after her office reviewed a number of communications and reports documenting alleged crimes including extrajudicial killings.

Prior to this, on Oct. 13, 2016, the prosecutor issued a statement “expressing concern about the reports of alleged extrajudicial killings of purported drug dealers and users in the Philippines.”

The prosecutor also recalled “that those who incite or engage in crimes within the jurisdiction of the Court are potentially liable to prosecution before the Court.”

Following the announcement of the preliminary examination, the Philippine government deposited on March 17, 2018 a written notification of withdrawal to the UN Secretary-General. The withdrawal took effect a year after, on March 17, 2019.

International Criminal Court aims to finalise preliminary exam on Philippines drug war in 2020

KUALA LUMPUR, Dec 10 — Having halted the mandatory death sentence on drug-related convictions, the Malaysian government is asking other countries to do the same.

De facto Law Minister Datuk Liew Vui Keong said governments needed to review their laws that provide for the execution of drug traffickers to discern between the masterminds and those being used to deliver the illicit substances.

“There are far-reaching implications of this, and mainly, if you are a drug addict or abuser, you need medical treatment and not imprisonment,” Liew told reporters after attending the Malaysian Human Rights Commission’s commemoration of the International Human Rights Day at the Sheraton Hotel here.

He said drug lords should be punished accordingly, and consideration given to drug couriers.

“For drug mules who have gone in for just a few hundred ringgit to a country, with most of them duped and led to do all these things, I definitely do not think they deserved to be hanged.

“They deserved to be sentenced to imprisonment, not hanged,” Liew added.

He said there were many cases in which the drug courier was presumed to have full knowledge that the goods they were transporting were illegal substances punishable with death.

“They love to use this word, presumption. They are talking about importing drugs into their country without even producing a shred of evidence that you are importing or trafficking all these things.

Malaysia urges neighbours to review execution of drug couriers, says people who use drugs need hospitals, not prisons

Human rights are key to ending AIDS and have been at the heart of every struggle and every success we have had since the beginning of the epidemic.

Without us demanding our human rights and the tireless call to ensure that human rights remain central to the AIDS response, we would not have more than 24 million people on treatment today and four in five people living with HIV would not know their HIV status. Vulnerable and marginalized populations and people living with HIV would not have access to stigma-free health care or the ability to hold governments to account.

Yet the AIDS response is not over, and barriers to human rights remain. HIV is still an epidemic of inequality, stigma, discrimination and violence. Where people’s rights are breached, they are at higher risk of infection and are less likely to take an HIV test or to be on treatment.

Key populations now account for 54% of new infections globally―75% of new infections outside of sub-Saharan Africa. Globally, in 2018, 6000 adolescent girls and young women became infected with HIV every week. Let me be clear, these communities are not being left behind―they are being pushed behind, by laws, policies and practices that are created, enacted and implemented.

UNAIDS Executive Director's message on the occasion of Human Rights Day

The Women and Harm Reduction International Network and TalkingDrugs position statement on women who use drugs and the violence of law enforcement is published on December 10th 2019, International Human Rights Day, also marking the conclusion of the UN 16 Days of Action to Eliminate Violence Against Women.

This statement serves as the beginning of a joint effort to recognise and address the specific needs and experiences of women who experience the violence of law enforcement in the context of punitive and prohibitionist drug policy. It acts as both a public expression of solidarity and as a call to action to find new, immediate ways to reduce the harm experienced by women who use drugs.

Because the war on drugs is fuelled by the criminal justice system, people of all genders experience the violence and harassment of law enforcement in relation to drug use in their everyday lives. Conversely, people with marginalised gender identities experience specific forms of gendered harm whether or not we use drugs or are directly impacted by drug laws. In effect, women and gender non-conforming (GNC+) people are at risk of gendered violence whether or not we use drugs, while the stigma and discrimination levelled at people who use drugs means that we are often turned away from or further harmed in supposed ‘places of safety’ when we do use drugs.

This violence includes, (but is not limited to) rape, sexual harassment and extortion, loss of child custody, imprisonment for mere personal possession, extra judicial killing, capital punishment and penalisation for drug use in pregnancy and parenthood. The intersection between gender and drug prohibition brings specific, overlapping forms of harm requiring specific and intersectional responses.

Position statement: Women who use drugs and the violence of law enforcement

Mexico's president has rejected any US intervention in his country, after President Donald Trump said US forces were willing to "go in and clear out" drug cartels.

"Co-operation, yes; intervention, no," Andrés Manuel López Obrador said in response to Mr Trump's comments.

The US president announced in a Tuesday interview he would legally designate Mexican drug gangs as terrorist groups.

Earlier this month nine US citizens were killed in an ambush in Mexico.

The victims - three women and six children who also had Mexican nationality - were killed while travelling through a remote area in the north of the country.

After the attack, the victims' Mormon community - the LeBarons - petitioned the White House to list the cartels as terror groups.

The legal move outlined by Mr Trump would enable a wider scope of action against them.

Speaking at a news conference in Mexico City on Wednesday, President López Obrador said Mexicans "had nothing to fear" and that the foreign minister, Marcelo Ebrard, would address the issue after the US Thanksgiving holiday on Thursday.

On Twitter, Mr Ebrard said he was already in contact with US authorities and that his efforts would be focused on "defending [Mexico's] sovereignty and its own decisions".

Earlier, he said Mexico "would never accept" any violation of its sovereignty and that the government was committed to tackling transnational organised crime, adding: "Mutual respect is the basis for co-operation".

Mexico rejects US intervention after Trump outlines drug cartel plan

A Lang Son court sentenced 11 people to death Wednesday for trafficking 561 kg of heroin from Vietnam into China.

Another member of the gang was sentenced to life in prison, making this one of the harshest verdicts in recent years, the 

According to the indictment, the drug trafficking ring had transported the heroin from the northern mountainous province of Lang Son across the border into China between 2016 and 2018.

Vi Van The, 48, who was sentenced to death, was identified as the gang leader. The indictment said he had a close relationship with partners in China and had trafficked drugs many times into the neighboring country. He was arrested in July last year while attempting to flee to Laos.

11 sentenced to death in Vietnam for drug trafficking

The much-awaited NSW coroner’s report into music festival deaths was released today.

In the report, Deputy State Coroner Harriet Grahame recommends pill testing, a ban on sniffer dogs and a reduction in the number of strip searches, among other measures to prevent deaths.

These evidence-based strategies for harm reduction are to be applauded. But it remains to be seen if the NSW government will change its stance on drug use and harm reduction to implement the coroner’s recommendations.

The inquest examined the deaths of six young people who died during or just after attending music festivals in NSW between December 2017 and January 2019.

All died as a result of taking MDMA or ecstasy. Five of the six also had other drugs in their system.

It can be hard for the community to grapple with some of the underlying issues when drug use is illegal and drug users are stigmatised. It is difficult to properly explain the potential risks to young people if our only permissible message is “just say no”. While we continue to hide the true extent of drug use, it remains inherently more dangerous.

However, Grahame noted the NSW government had already put in place, since these deaths, a range of measures including more formalised emergency medical responses at festivals and clinical guidelines on how to manage drug incidents before the person reaches hospital.

She also noted festival organisers had implemented strategies that improved safety since these deaths.

News