The Archipelago of Pain | Opinion | The Seattle Times
We don’t flog people in our prison system, or put them in thumbscrews
or stretch them on the rack. We do, however, lock prisoners away in
social isolation for 23 hours a day, often for months, years or decades
at a time.
We prohibit the former and permit the latter because we make a
distinction between physical and social pain. But, at the level of the
brain where pain resides, this is a distinction without a difference.
Matthew Lieberman of the University of California, Los Angeles, compared
the brain activities of people suffering physical pain with people
suffering from social pain. As he writes in his book, “Social,” “Looking
at the screens side by side ... you wouldn’t have been able to tell the
The brain processes both kinds of pain in similar ways. Moreover, at
the level of human experience, social pain is more traumatic, more
destabilizing and inflicts more cruel and long-lasting effects than
physical pain. What we’re doing to prisoners in extreme isolation is
arguably more inhumane than flogging.
Yet inflicting extreme social pain is more or less standard procedure
in America’s prisons. Something like 80,000 prisoners are put in
solitary confinement every year. Prisoners isolated in super-maximum
facilities are often locked away in a 6-foot by 9-foot or 8-foot by
10-foot barren room. They may be completely isolated in that room for
two days a week. For the remaining five, they may be locked away for 23
hours a day and permitted an hour of solitary exercise in a fenced-in
If there is communication with the prison staff, it might take place
through an intercom. Communication with the world beyond is minimal. If
there are visitors, conversation may be conducted through a video
screen. Prisoners may go years without affectionately touching another
human being. Their only physical contact will be brushing up against a
guard as he puts on shackles for trips to the exercise yard.
In general, mammals do not do well in isolation. In the 1950s, Harry
Harlow studied monkeys who had been isolated. The ones who were isolated
for longer periods went into emotional shock, rocking back and forth.
One in six refused to eat after being reintegrated and died within five
days. Most of the rest were permanently withdrawn.
Studies on birds, rats and mice consistently show isolated animals
suffer from impoverished neural growth compared with socially engaged
animals, especially in areas where short-term memory and threat
perception are processed. Studies on Yugoslav prisoners of war in 1992
found those who had suffered blunt blows to the head and those who had
been socially isolated suffered the greatest damage to brain
Some prisoners who’ve been in solitary confinement are scarcely
affected by it. But this is not typical. The majority of prisoners in
solitary suffer severely — from headaches, an oversensitivity to
stimuli, digestion problems, loss of appetite, self-mutilation, chronic
dizziness, loss of the ability to concentrate, hallucinations, illusions
or paranoid ideas.
The psychiatrist Stuart Grassian conducted in-depth interviews with
more than 200 prisoners in solitary and concluded that about a third
developed acute psychosis with hallucinations. According to rough
estimates, as many as half the suicides in prison take place in
solitary, even though isolated prisoners make up only about 5 percent of
Prison officials argue that they need isolation to preserve order.
But the research on the effectiveness of solitary confinement programs
is ambiguous at best. There’s a fair bit of evidence to suggest that
prison violence is not produced mainly by a few bad individuals who can
be removed from the mainstream. Rather, violence is caused by conditions
and prison culture. If there’s crowding, a culture of violence, and
anarchic or arbitrary power, the context itself is going to create
violence no matter how many “bad seeds” are segregated away.
Fortunately, we seem to be at a moment when public opinion is
turning. Last month, the executive director of the Colorado prisons,
Rick Raemisch, wrote a moving first-person Op-Ed article in The Times
about his short, voluntary stay in solitary. Colorado will no longer
send prisoners with severe mental illnesses into solitary. New York
officials recently agreed to new guidelines limiting the time prisoners
can spend in isolation. Before long, one suspects, extreme isolation
will be unacceptable.
The larger point is we need to obliterate the assumption that inflicting social pain is OK because it’s not real pain.
When you put people in prison, you are imposing pain on them. But
that doesn’t mean you have to gouge out the nourishment that humans need
for health, which is social, emotional and relational.
© , New York Times News Service
David Brooks is a regular columnist for The New York Times.
Who is the Colorado Criminal Justice Reform Coalition?
Our chief areas of interest include drug policy reform, women in prison, racial injustice, the impact of incarceration on children and families, the problems associated with re-entry and stopping the practice of using private prisons in our state.
If you would like to be involved please go to our website and become a member.
Sunday, March 09, 2014
The Archipelago of Pain | Opinion | The Seattle Times
Friday, March 07, 2014
By Jerry Markon and Alice Crites, Published: March 6From the beginning, the U.S. government’s decade-long crackdown on prescription drug abuse has run an unsettling risk: that arresting doctors and shuttering “pill mills” would inadvertently fuel a new epidemic of heroin use.
State and federal officials have pressed their campaign against prescription drug abuse with urgency, trying to contain a scourge that kills more than 16,000 people each year. The crackdown has helped reduce the illegal use of some medications and raised awareness of their dangers.
But at the same time that some pain medications have become less available on the street and pricier, many users have switched to cheaper heroin, since prescription pills and heroin are in the same class of drugs and provide a comparable, euphoric high.
With the nationwide heroin problem gaining greater attention after the recent death of actor Philip Seymour Hoffman from heroin and other drugs, experts on addiction say the government’s actions contributed to the problem it is now confronting. The war on drugs, they say, is an unwieldy conflict where targeting one illicit substance can be an unintentional boon to another.
“Absolutely, much of the heroin use you’re seeing now is due in large part to making prescription opioids a lot less accessible,’’ said Theodore Cicero, a psychiatry professor at Washington University in St. Louis. He co-authored a 2012 study, cited in the New England Journal of Medicine, that found that a reformulation of OxyContin to make it harder to abuse caused heroin use to nearly double.
Although policymakers “did the best they could at the time” in fighting prescription drugs, Cicero said, “there were signs years ago that this was going to happen, and there was just a lot of inaction.” He said the government could have acted sooner to mitigate heroin’s toll, such as by promoting the use of medicines to fight overdoses and ease withdrawal symptoms.
The government itself predicted that targeting prescription drugs could give heroin use an unintended lift. The Justice Department’s drug intelligence arm in 2002 highlighted the potential consequences: “As initiatives taken to curb the abuse of OxyContin are successfully implemented, abusers of OxyContin . . . also may begin to use heroin, especially if it is readily available, pure, and relatively inexpensive.’’
A long-emerging trend
Yet those projections did not factor into discussions by top drug policy officials, even after numerous government reports and congressional testimony indicated that the shift to heroin was happening, according to current and former federal officials. Heroin use began to rise at the end of the Bush administration and has surged in the Obama years.
John Walters, who ran the Office of National Drug Control Policy as President George W. Bush’s “drug czar,’’ said he doesn’t recall “anyone raising’” the prescription drugs-heroin link, though the reports warning of the link were screened by people in his office. “The heroin problem was getting better, and the real issue was the growth of pharmaceuticals,” he said.
Gil Kerlikowske, who took over as President Obama’s drug czar in 2009, said the connection between prescription drugs and heroin “was not on the radar screen” during most of Obama’s first term and that he “didn’t do everything I should have” to raise awareness of the growing heroin problem. Now, he said, heroin is a “much larger concern.”
Between 2007 and 2012, heroin use rose 79 percent nationwide, according to federal data. Within the same period, the data show, 81 percent of first-time heroin users had previously abused prescription drugs.
The likelihood that many prescription-drug abusers will switch to heroin because it is much cheaper is widely accepted among addiction treatment professionals and law enforcement officials.
Justice Department officials reject any direct linkage between the crackdown on prescription drugs and rising heroin use, although it was a Justice Department unit — the National Drug Intelligence Center — that warned that the campaign against illegal use of prescription drugs was fueling heroin use. The center, which closed in 2012, was separate from the unit employing prosecutors and agents who fight drug use.
Moreover, these officials defended their fight against prescription drug abuse, saying those efforts prevented numerous overdose deaths. Even with heroin use on the rise, they said in interviews, it still represents a much smaller problem than prescription medications. Heroin kills about 3,000 people a year, less than a fifth of the toll from prescription drug abuse, government data show.
Joseph T. Rannazzisi, who runs the Drug Enforcement Administration’s Office of Diversion Control, denied that the spike in arrests for prescription drug misuse has affected their cost and driven users to heroin, saying street prices have been generally stable. “I don’t think one thing has anything to do with the other,’’ said Rannazzisi, who emphasized that the move against prescription pills saved many lives. The DEA is part of the Justice Department.
Tristram J. Coffin, the U.S. attorney for Vermont, who has been a leader in the battle against prescription drug abuse, also remains a staunch defender of that campaign. “Prescription drugs are incredibly addictive, incredibly lethal, and we had to deal with them,’’ he said.
But Coffin acknowledged that the crackdown made some doctors reluctant to write prescriptions for pain medications. “That in turn causes people, because they have an opioid dependency, to turn to heroin,’’ he said.
In 2010, Justice Department officials told The Washington Post that a federal probe of prescription drug abuse in Northern Virginia, the nation’s largest such investigation at the time, had caused black market OxyContin prices to nearly double. Police and addiction treatment professionals in three states said last week that actions such as closures of “pill mills” that dispensed massive amounts of pharmaceuticals had made them harder to get, raising their price as demand outpaced supply.
Still, “I can’t recall anyone at any point having a plan that would have limited the shift from prescription drugs to heroin,’’ said Marvin D. Seppala, chief medical officer at the Hazelden Betty Ford Foundation, a network of drug treatment centers.
Warnings of heroin use
It was without controversy that the Food and Drug Administration approved OxyContin in 1995. The powerful drug was a godsend for millions of pain sufferers.
Within a few years, however, authorities learned that addicts were crushing the time-release tablets and snorting or injecting them, leading to property crimes and overdose deaths.
A crackdown began at the end of the Bill Clinton administration and escalated under the George W. Bush administration, which dispatched anti-drug agents and encouraged state monitoring programs that detect suspicious prescriptions. Federal arrests for illegal use of prescription drugs skyrocketed more than 900 percent between 2001 and 2007, according to the National Drug Intelligence Center.
During the same period, federal heroin arrests fell 32 percent as heroin use was generally stable and even declined among adolescents, said the center’s reports, which cited DEA arrest data.
Bush administration officials said they targeted the more pressing threat. “Oxy was extremely accessible,’’ said Paul J. McNulty, a former U.S. attorney in Alexandria and deputy attorney general. “At the same time, many of us involved in drug policy from the 1980s onward saw heroin on the decline for a long period.”
Throughout the Bush administration and afterward, nearly every year between 2002 and 2011, the Justice Department’s drug intelligence arm warned that the crackdown could drive drug abusers to heroin.
As early as 2003, the center said, some Oxy users were already making the switch. “Not only is heroin less expensive, but efforts to control the diversion of OxyContin may be reducing the availability of OxyContin in some areas,’’ it wrote that year. The concerns were echoed in congressional testimony starting in 2008, transcripts show.
Michael F. Walther, the drug center’s former director, said the reports were read in advance by officials at the DEA and the Office of National Drug Control Policy.
“It never crossed anyone’s mind that cracking down on Oxy would lead to an increase in heroin,’’ said one current federal official involved in anti-drug enforcement, who spoke on the condition of anonymity to discuss internal deliberations.
A new focus on heroin
When President Obama took office, his administration also tackled the epidemic in front of it. “Prescription drugs were much more of a priority” than heroin, said Timothy Condon, who was a senior science policy adviser in the the Office of National Drug Control Policy in 2010 and 2011.
As heroin use rose in recent years, the government began reacting. Since 2009, the DEA has widely circulated a slide called “circle of addiction” that shows the linkage between pain medications and heroin.
Heroin trafficking cases rose 52 percent between 2008 and 2012, federal data show. And the drug czar’s office, which has publicly warned about the link between prescription drugs and heroin for the past several years, has begun a number of anti-heroin initiatives. The administration supports the use of naloxone, an anti-overdose medicine, and drugs such as methadone that help ease heroin withdrawal.
There’s no missing the toll of heroin any more.
“Heroin is taking up a lot more of our attention and time,’’ said Kerlikowske, who said other measures targeting heroin are in the works.
Experts praised the recent steps but said they should have come much earlier. “The intent was good, but someone, somewhere, should have thought it through to say ‘now we’re going to have a flood of heroin overdoses,’ ’’ said Jim Takacs, executive director of the Licking County Alcoholism Prevention Program near Columbus, Ohio. He said the state’s recent crackdown on pill mills has driven the price of prescription medications “way up” and caused heroin abuse to spike.
“They should have known,’’ Takacs said.
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The jump in overdoses is alarming. The Substance Abuse and Mental Health Services Administration reported about 669,000 Americans used heroin at least once in 2012, and nearly 3,100 died from overdoses in 2010 — a 55 percent increase from the previous year.
State Net Capitol Journal reporter Rich Ehisen takes a look at how states are reacting by trying to save lives in this month’s issue:
Law enforcement and other emergency responders say that many of these deaths could have been prevented if someone with the overdose victim would have simply got that person help. Usually that means calling 911 or taking the overdosed person to get medical attention. But it could also come in the form of giving that person the anti-overdose drug naloxone, which works to block opiates from the brain’s receptor cells. A 2012 report from the Centers for Disease Control says naloxone — usually sold under the brand name Narcan and which can be injected or applied via a nasal spray — has reversed more than 10,000 opiate overdoses since its introduction in 1996.In recent years, 17 states and the District of Columbia have adopted “Good Samaritan” laws, which grant some immunity to those who seek medical help for an overdose victim. Eighteen states and D.C. have also given first responders the ability to administer naloxone to overdose victims.
But many overdose victims never get that chance because fear of being arrested often supersedes a drug user’s willingness to call 911. And in many states, there is no assurance that even emergency responders will be carrying naloxone when they arrive.
And the number of states seeking to get help for overdosers will expand in coming weeks: Legislation has advanced in Wisconsin, Tennessee, Ohio and Utah in just the past few months. Similar bills are before legislators in seven other states, Ehisen reported.
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A lot has happened in the two years since the publication of Michelle Alexander’s The New Jim Crow, a landmark book that showed how the “war on drugs” and the mass incarceration of black Americans has undermined much of the progress achieved by the civil rights movement.
States around the country have downsized their prison systems. Washington and Colorado legalized recreational marijuana for adults. U.S. Attorney General Eric Holder has promoted a less punitive approach to the prosecution of drug crimes.
And yet, in a press call on Thursday sponsored by the Drug Policy Alliance, a group that advocates for the decriminalization of drugs, Alexander warned against complacency. She called for the U.S. to not just stop the war on drugs, but to pay “reparations” and give a public platform to the communities of color most harmed by the drug war.
“When I see images of people using marijuana and images of people who are now trying to run legitimate marijuana businesses, they’re almost all white," she said, noting she supports legalizing pot.
“After 40 years of impoverished black men getting prison time for selling weed, white men are planning to get rich doing the same things," she added. "So that’s why I think we have to start talking about reparations for the war on drugs. How do we repair the harms caused?"
She added that the government should pay reparation money to families that have been destroyed by the drug war. “You can’t just destroy a people and say, ‘It’s over, we’re stopping now,'” she said.
The United States incarcerates more than 2 million people, mostly for drug offenses. Blacks make up more than 40 percent of the prison population, despite comprising less than 15 percent of the U.S. population as a whole, according to U.S. Census data.
In recent years, states around the country, including conservative places like Texas and North Carolina, have slashed prison budgets by investing more heavily in less expensive alternatives to incarceration, like ankle bracelets that allow people to serve time at home and at centers that treat drug addiction.
“We see politicians across the spectrum raising concerns for the first time in 40 years about the size of our prison state,” said Alexander, “and yet I worry that so much of the dialogue is driven by financial concerns rather than genuine concern for the communities that have been most impacted and the families that have been destroyed” by aggressive anti-drug policies.
Unless “we have a real conversation” about the magnitude of the damage caused by the drug war, “we’re going to find ourselves, years from now, either having a slightly downsized system of mass incarceration that continues to hum along pretty well,” she said, "or some new system of racial and social control will have emerged again, because we have not learned the core lesson that our history is trying to teach us.”
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Wednesday, March 05, 2014
many have focused on the individual mandate, and the online (and
glitchy) insurance exchanges, one of the most potentially impactful
elements of the Patient Protection and Affordable Care Act (ACA) has
flown more or less under the radar. It may be the biggest piece of
prison reform the U.S. will see in this generation.
the face of it, there’s no direct connection between the ACA and what
experts refer to as the “justice-involved population.” There’s no
mention of prisons or jails or even crime in the language of the law.
However, in what proponents of the act are considering a happy public
policy accident, the ACA may inadvertently change the makeup of the U.S.
prison population by getting early help to those with mental health and
drug abuse issues, ultimately reducing recidivism rates and saving
states millions, if not billions, of dollars annually.
years, the prison population in the United States stayed more or less
the same, hovering between 150,000 and 200,000 total incarcerated in
either state or federal correctional facilities. In the early 1980s that
number began to skyrocket, and by 2010, 1.57 million Americans were
very little argument why. The “epidemic of incarceration over the last
four decades,” as Josiah Rich, a professor of medicine and epidemiology
at Brown University, and co-founder of The Center for Prisoner Health
and Human Rights at The Miriam Hospital, puts it, can be mostly
attributed to two diseases: addiction and mental illness. “The natural
history of these diseases, when not treated, leads to behaviors that, in
our society, result in incarceration,” Rich tells Newsweek.
backs Rich up. In 1980, the number of Americans incarcerated for
drug-related offenses was around 41,000. Then, in 1982, the country’s
“War on Drugs” officially commenced, and by 2011, that number had shot
up to 500,000. In conjunction with funding the front on drug users,
President Ronald Reagan defunded federal mental health programs,
dropping total mental health spending by over 30 percent.
As a result, many of the nation’s mentally ill lost what was
essentially their home and place of work, and many ended up on the
conducted by the Bureau of Justice Statistics, found that 64 percent of
inmates in state and federal prisons met the criteria for mental
illness at the time of their booking or during the twelve months leading
up to their arrest. For comparison, the rate of mental disorders among
U.S. citizens stands at around 25 percent, according to the NIH. Sixty-nine percent of the country’s prison population was addicted to drugs or alcohol prior to incarceration.
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Thursday, February 27, 2014
Call of Duty
charge of the Colorado Department of Corrections in the wake of his
predecessor’s murder. Now it’s his job to reform our state’s beleaguered
the Colorado Department of Corrections is responsible for transporting,
housing, feeding, educating, medicating, supervising, protecting, and
rehabilitating the individuals who have violated our laws. Some 20,400
offenders populate its 20 state-run correctional facilities. There are
more than 6,000 DOC employees, including corrections officers, wardens,
and associate wardens; the victims services unit; medical staff; mental
health care providers; educators; and the parole division, which is
responsible for around 700 new parolees every month. There’s the
fugitive apprehension unit, charged with tracking down and arresting
those who escape or abscond from parole. There are community corrections
programs that include halfway houses and treatment programs. The
executive team, of which Rick Raemisch is now the head, determines and
manages departmental policy and best practices.
sheer heft of the corrections system means there can be reams of red
tape and plenty of cracks through which offenders can fall. This is
complicated by the fact that most people follow one of two divergent
corrections philosophies: the belief in rehabilitation, and the belief
that punishment is all offenders will ever deserve.
many people cling to, especially victims and their families, is the
conviction that some criminals are beyond salvation, divine or
otherwise. Rick Raemisch says he believes the exact opposite: that most
people, no matter their histories, can and do change. He has to believe
this because he knows about 97 percent of those who enter prison will
one day return to our communities and become our neighbors and
acquaintances. Raemisch has to believe in the possibility of their
reclamation because it’s his job to fix them before they’re out.
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