Homeopathy and drug diversion

No, diversion to treatment under California’s Prop 36 doesn’t work worth a damn. But that’s no reason to start sending users to jail again.

Compared to antibiotics, homeopathic cold remedies are highly useful in treating the common cold.

That is to say, the homeopathic preparations are just as useless as the antibiotics, but they’re useless at much lower cost and with no risk of breeding disease-resistant micobes.

By the same token, drug diversion programs are highly useful in dealing with drug users, compared to jail. Neither does much if any good, but diversion does approximately nothing at lower cost and imposes less suffering.

There are good reasons to make selling drugs illegal, and even for making the possession of some drugs illegal. But it’s very rarely a good idea to actually put someone behind bars simply for using.

[Using the threat of intermittent short jail terms to force abstinence from drug use on those who who have been convicted of commiting other crimes under the influence, or to get money to buy drugs, makes much more sense, as I’ve argued at length elsewhere.]

No diversion program works well. Anywhere from a quarter to a half of those who are sent to drug treatment in lieu of prison or jail will never show up for treatment in the first place, and the typical probation department doesn’t have the resources or the will to do anything about it. Another good-sized chunk will show up for treatment for a while, and then drop out, again facing roughly no consequences. That’s just what diversion programs are like.

Nor is it obvious that the quality of treatment services provided under the average abstinence program is high enough to make a difference, especially for cocaine and methamphetamine users. (Opiate maintenance — methadone or buprenorphine — will certainly cut down on heroin use, but stimulant maintenance is virtually a contradiction in terms, and the various varieties of talk-therapy are about as useful in dealing with methamphetamine dependence as they would be in dealing with any other bad habit: that is to say, not much at all.)

The futility of coerced treatment — not the futility of treatment, but the futility of trying to use the criminal justice system to coerce treatment — is one reason I prefer coerced abstinence as an approach to dealing with drug-involved offenders. But if the choice is straight-up between diversion to treatment and incarceration, it’s the rare user whose criminal record is so heavy that it’s worth spending the money to keep him behind bars if all he got caught for this time was using.

All of this makes me think that there’s less than meets the eye in the latest attack on California’s Proposition 36 — this time by the San Mateo County (SF peninsula) Grand Jury. The finding that Prop 36 participants behave a little worse than participants in other diversion programs is no surprise: since everyone by statute is entitled to diversion for a first possession conviction, virtually no one gets in to Prop 36 who hasn’t already failed once.

Would I like to see Prop 36 made more sanctions-oriented? Sure. If I’d written the law, it would have had frequent testing with automatic sanctions for everyone, and treatment only for those who wanted it and those who repeatedly failed to show up or tested “dirty.” But that’s just to say I wish Prop 36 were coerced abstinence instead.

As a coerced treatment/diversion program, Prop 36 is neither better nor worse than anything else. Compared to jailing people for having crack in their pockets, or sending parolees back to prison for ninety days for testing dirty for marijuana, it’s an improvement. If sanctions are to be written into the law, they ought to be automatic, formulaic, and above all short: two days is plenty. There’s simply not room in jail for lots of people doing 30-day sentences for testing dirty. (LA County jail is so overcrowded that a burglar sentenced to six months gets out after 18 days.)

Yes, of course Prop 36 was sold to the public on lies (about first-time drug possessors going to prison) and absurd promises about treatment compliance and treatment efficacy. But such lies are part and parcel of California’s insane experiment in direct-democracy-by- checkbook-and-TV-spot, also known as the initiative process. That’s not a good enough reason to get rid of it now. “Mend it, don’t end it.”

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com