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Witnessing the Horrors of the War on Drugs Made this Physician an Outspoken Opponent

JAISAL NOOR: According to recent reports, Attorney General Jeff Sessions is considering doing away with Obama Administration rollbacks of the drug war, including reducing mandatory minimums for low level drug offenders. Critics say Sessions is escalating the War on Drugs when a growing number of people agree it has failed. As part of our ongoing series on the impact of the drug war in Baltimore and beyond, we recently sat down with the Dan Morhaim who has been a leading opponent of the War on Drugs as a member of the Maryland House of Delegates since 1995. He’s also been an emergency medicine physician for over 40 years, and he’s on the faculty at the Johns Hopkins School of Public Health. This year, Morhaim defended himself against sanctions by the General Assembly Ethics Committee for not disclosing his interests in a successful application for medical marijuana license. Finding while he didn’t break the law, he violated the spirit of them.

Dan Morhaim: My entire perspective on the War on Drugs comes from my clinical experience. Fortunately, I don’t have a family or personal experience but let me say up front I’m opposed to substance abuse. Seeing the ravages of substance abuse on people in many different ways. Back when I first got elected back in 1994, I was strongly pushing for addiction treatment programs and passed the first major bill to support addiction treatment. As a clinician, I’ve seen the ravages of the War on Drugs, and I believe it’s a failed policy. The ravages are on the general public, on innocent bystanders, the drug users themselves, and on their families. We’ve had policy going for 50 years plus that, no one’s for substance abuse, and I’m not, but that policy clearly isn’t working. We’re hardly in a position to pat ourselves on the back and say, “What a great job we’ve done addressing this problem.”

As you just pointed out, things are worse. Violence and homicides in Baltimore City an around the nation are up. The opioid overdose death crisis has become a major public health epidemic. I think it’s long past due time to analyze what we’ve been doing and say, “It’s not working. Let’s try some other approaches.”

My perspective is specifically to promote a public health approach and to start dealing with this problem that way. Not that we’re going to solve the addiction issue or substance abuse issue. Human beings have been using substances since they’ve had consciousness. We like to change our conscious. There’s ways to do. You can go for a walk, you can listen to music, you can play sports, you can pray, you can mediate. There are all kinds of ways, and choosing to use drugs is something that people have done for a long time, or alcohol, but it’s not really the healthiest way. We’ve got to recognize that that’s been part of American culture for a long time. My perspective is that we can decompress these issues. We’re not going to solve them over night. No one’s that naïve, but by taking some very specific steps that are evidence-based, I think we can make a huge difference in reducing the toll, personal, medical, financial, spiritual, that this failed policy has taken.

JAISAL NOOR: Is there a particular moment for you that opened your eyes or changed your perspective on this issue?

Dan Morhaim: It’s an interesting question. I do remember one. It was about two in the morning, and I was early in my career as an emergency medicine physician. I was called to see a guy who had a laceration running down the side of his head. As I approached the room, there’s this odor that every emergency person knows. It’s the odor of blood, alcohol, and saliva and sometimes vomit. You can just smell this bouquet of odor, and I went in and the guy has this giant laceration. In the course of sewing it up, which I have done hundreds of, or maybe thousands I guess, probably thousands at this point, I started talking with him. “Tell me about the evening.”

The evening started pleasantly enough. People were having a few beers, and then things go out of hand. Somebody made a crack that another person took exception to, and he was hit upside the head with a beer bottle.

I began to think more and more, “How many of these situations I’ve seen that had an antecedent, could’ve been nipped earlier in the bud?” Drug overdoses. I remember an elderly woman pushed to the ground broke her arm and shoulder as someone was stealing her purse. I talked to people who had family member who the clock radio went missing. It was used to buy drugs. Never gets reported at the police, but they knew someone in the family had an abuse problem. Had to feed their $50 a day habit. I talked to a lot of the substance abuser themselves, and in the context of being a physician, we just have conversations. I’m not the police. They know they’re not going to be arrested, and often those conversations would take place while I was doing some procedure on them. Draining an abcess or sewing a laceration and just chatting.

I was able, therefore, to get a lot of perspective that maybe others don’t get. I would ask addicts, “How did you start using and why?” There is sort of the pyramid scheme of addiction. Everybody’s trying to get somebody else addicted so that they could make money on theirs. “How much does it cost?” $20 to $100 a day times 365 days a year. If we use Baltimore as an example, with 20,000 hardcore daily users, do the math. That comes out to almost $400 million a year just to buy the drugs. That doesn’t count police, court, jail, all the healthcare costs. I would ask them, “Would you like to get into a treatment program?” Overwhelmingly, they said, “Yes.”

I also recognize there’re some folks that are just hardcore. I wish we could help them. We can’t, just like there’s diseases people get. Try to help but are really not going to be cured of. Even if we got half of those people who wanted to get into drug treatment, into a treatment program tomorrow, you get the payback immediately. Someone goes into a treatment program on a Monday, Tuesday that harm reduction, things that they’re likely to do, decrease substantially because they don’t have to come up with 50 bucks a day to maintain their habit and where are they going to get that money.

There’re very clear strategies that are cost-effective. It’s not going to solve the problem over night. No one’s that naïve. Going back to the 20,000 hardcore users in Baltimore City, and there’s many more around the state, I don’t want to just pick on the city but it’s in every jurisdiction in the state, if you got 5,000 into a treatment program tomorrow, which is a very doable thing, over night you would decompress a considerable amount of the harm that the situation has been causing us.

JAISAL NOOR: You’ve been an advocate of reforming the drug war on a state level. We know that there is considerable opposition to that, especially from police unions and prison guard unions. They have a lot to use if the War on Drugs is ended. Talk about what your efforts have been and what the opposition looks like in Annapolis.

Dan Morhaim: Like so many things, when you promote new ideas, you do run the risk of getting opposition. There are people opposed for a variety of reasons. This’ll be a radically new way of thinking. I understand that. Even some of the things that I now believe, I probably didn’t support five or 10 or 15 years ago. For example, Safe Consumption Facilities, which I put in legislation the last two years. You could say it is a place where addicts go to shoot drugs, and we’re enabling and allow that and supporting that. On the other hand, the evidence shows that clearly they reduce the rate of addiction, reduce the rate of crime, get people into treatment, make neighborhoods safer, fewer syringes on the street. Every so often you got to go with the evidence and the facts and change your thinking. I understand the reticence and the political concerns that people have. All I can do is persist and try to persuade them.

We’ve seen changes like that before. The first tough bill I voted on in 1995 was as heavily lobbied as anything. People said, “If you support this, it’ll be terrible. If you don’t support it, it’ll be terrible.” We passed the bill. It was to ban smoking in restaurants. We were told all the restaurants in D.C. area of Maryland would close and Baltimore City would close down. Well, we banned smoking in restaurants, business went up. The opposite occurred. I think the same thing here too.

Look at issues like marriage equality or wearing a seatbelt. The worst night in the my life as an ER doctor was three kids killed in a car accident because that was before bucket sets and baby and kids were restrained. We don’t let that happen. No one would say, “Oh, just let your kid run around in the back set of a car while you’re driving,” but that was the way it was 20, 30 years ago.

I think there’s a change here that’s taking place. People are beginning to think about it. I don’t have all the ideas. There’s lots of good ideas out there, but it’s time. It’s well past time that this issue be confronted head on. Tragically, the crisis that’s happening now with opiod deaths spread throughout the state, throughout the United States, is bringing new attention. I think there’s a little bit of change of thinking in the legislature here and maybe elsewhere. Unfortunately, the federal government seems to be taking steps backwards.

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