Dita Bhargava’s son Alec was a warm, loving, funny, handsome and athletic young man with mental health issues, including mild bipolar disorder, who self-medicated as a teen, going from marijuana to oxycontin, then street opioids — but after seven years of struggle, he was doing better in a sober house as he approached his 26th birthday in 2018.

Alec had a voice in his head that would urge him to stay on the path to recovery, but also a voice that urged him to feel good one last time, and on that birthday he listened to the second voice in his room at the sober house, Bhargava said at a recent roundtable discussion following a “Stigma to Strength” conference at the Blair County Convention Center — sponsored by local organizations dedicated to dealing with the opioid crisis.

Alec overdosed and died then of a fentanyl-laced hit, despite a package of naloxone lying on the table next to him, with housemates just outside his room who would have used it to revive him, if they had known what was going on — but they didn’t, because Alec was ashamed of his relapse, according to Bhargava.

Alec, and the three children of two other discussion participants who also died of overdoses, would likely be alive today if not for the persistent stigma connected with substance use disorder and the widespread resistance of society to learn about harm reduction policies like safe injection sites that Alec could have used in his time of temptation, according to Bhargava, who lives in Connecticut.

If such a place would have been available, he might be alive today, perhaps as a husband and a father, Bhargava said.

“That’s what stigma does,” she told the group, which included U.S. Sen. Chris Coons, D-Delaware.

Not long before her son died, Bhargava was running for statewide office, and she asked what he thought about her sharing his story during her campaign.

He pointed out that she wouldn’t have hesitated if he had had cancer — an observation that made her realize that she herself was part of the stigmatization problem, she said.

Thus, when he died, “he left me with a rallying cry and gave me permission to come out with his story,” Bhargava said. “My marching orders, to get out and be an activist and make a difference.”

Society is resistant to harm reduction policies because of a lack of understanding, according to Bhargava.

She has a child with diabetes, and as difficult as that has been to accept, it only took a few months for her to find out how best to take care of him, so that he will be safe and on his way to reaching full potential, she said.

She tried and failed for seven years to do that for Alec, she said.

“It should be the same” for both, she said.

Portugal’s policies

At the beginning of this century, Portugal decriminalized all drugs for amounts consistent with personal use, making possession an administrative violation.

It “turned around their heroin epidemic 90 percent in seven years,” with the help of support services, Bhargava said.

It was a transition motivated by “understanding and compassion,” she said.

The literature on that transition is mixed.

The data show that Portuguese decriminalization was “a resounding success,” with lessons applicable in other places, according to a Cato Institute white paper written by Glenn Greenwald in 2009.

“(N)one of the nightmare scenarios touted by preenactment decriminalization opponents — from rampant increases in drug usage among the young to the transformation of Lisbon into a haven for ‘drug tourists’ — has occurred,” Greenwald states.

Drug use remained low in Portugal, and drug related pathologies like secually transmitted deseases and deaths decreased dramatically, largely due to support made possible by decriminalization, according to Greenwald.

But there are some shortcomings in the Cato paper, according to a fact sheet published by the Office of National Drug Control Policy during the Obama administration in 2010.

While the Cato study is often cited as proof that “softening drug laws does not increase illicit drug use or its consequences,” it’s difficult “to draw any clear, reliable conclusions from the report,” due to non-definitive supporting analysis, factors that were not recognized in the paper, adverse data trends that were not reported, inconclusive drug-use reduction claims in the paper and methodological limitations, the fact sheet states.

There are other studies that provide evidence contradictory to the Cato findings, according to the fact sheet.

Supervised injection sites were not part of the decriminalization setup in Portugal, according to a 2022 blog on the americanaddictioncenters.org website.

But they have been successful in other places, including in Canada and New York City, according to Bhargava.

Virtually no parent who has lost a child to a drug overdose would oppose creation of these sites, according to Bhagava.

Blair County supports the provision of the overdose reversal drug naloxone and medically assisted treatment using substances like methadone, along with test strips for fentanyl and xylazine, according to Marianne Sinisi, founder of Families United for Change, a local organization.

But there is not likely going to be support for safe injection sites or needle exchanges, according to Sinisi, whose son died of an overdose.

Opponents of such support feel that it’s “enabling,” Sinisi said.

The good of harm reduction is that it prevents disease and saves lives, said roundtable participant Eric Kocian, associate professor of criminology, law and society at Saint Vincent College.

One objection, however, is that “it’s not getting to the root of the problem,” Kocian said.

“Some people think it’s more of a Band-Aid approach,” he said.

There’s also the common wish not to have the activities connected with that support near where one lives — the Not In My Back Yard or NIMBY phenomenon, he said.

“Do (people) want that type of population in and out of (their) area,” he asked rhetorically.

“(But) it’s about keeping somebody alive,” Sinisi said. “To get the treatment they need.”

Most of the participants at the roundtable labeled substance use disorder as a disease.

“(But) the other side says it’s a choice at first that metastasizes into a disease,” Kocian said.

Decriminalization not the answer

Many people say you can’t arrest yourself out of the drug problem, Kocian said, “but you’re not going to decriminalize your way out of this, either.”

Kocian referenced Oregon, which had decriminalized possession of small amounts of illicit drugs.

“Crime is out of control,” he said, noting he felt unsafe visiting his brother in Eugene, Oregon.

Kocian, a former Marine, said he would not run there without a knife and was repeatedly offered sex for money while on the trails in the daytime.

There were also needles in the playgrounds and sex acts occurring in such places, also in daylight, he said.

“It was not a good atmosphere,” he said.

According to the Associated Press, Oregon’s first-in-the-nation experiment with drug decriminalization came to an end Sunday, Sept. 1, and possessing small amounts of hard drugs is once again a crime in that state.

Decriminalizing drug possession was a measure approved by 58% of voters in 2020. Instead of jail time, possessing illicit drugs like heroin was punishable by a ticket and a maximum $100 fine. The emphasis was to put more money into addiction services.

But, those who championed it as a way to treat addiction as a public health matter, not a crime, are instead contending with one of the nation’s largest spikes in overdose deaths

Now in Oregon, possession of drugs for personal use is a misdemeanor punishable by up to six months in jail. The new law also establishes ways for treatment alternatives to criminal penalties. Supporters of decriminalization continue to say treatment is more effective than jail in helping people overcome addiction and that the decadeslong approach of arresting people for possessing and using drugs hasn’t worked, according to the Associated Press article on Oregon’s experiment.

Holistic approach needed

Society needs “a more holistic approach” to the drug problem, according to Kocian.

Addiction attacks people physically, intellectually, emotionally and spiritually, and the current approaches are too narrow, he said.

A variety of tactics are needed: prevention, law enforcement, including interdiction at the border; harm reduction, intervention, treatment and recovery support, according to Bill Stauffer, executive director of the Pennsylvania Recovery Organization Alliance.

“This is our most complex social problem,” Stauffer said.

Virtually all extended families anymore have one or more members who’ve experienced substance use disorder, including his own family, said Coons, who has connections with central Pennsylvania.

Drugs, especially fentanyl, don’t “discriminate,” Coons said.

It’s good to talk about those difficult situations, because talking reduces the stigma, he said.

But it can be hard even within families to make people understand the challenges, said State Rep. Jim Gregory, R-Blair, a meeting attendee who is in recovery.

He once asked his wife to understand his struggles, but later came to realize that it would have been better simply to ask her to accept them, he said.

“I don’t understand physics,” Gregory said. “(But) I accept the law of gravity.”

Social media platforms that facilitate drug dealings are part of the problem, according to Coons.

Lawmakers are trying to curb the effectiveness of that distribution tool through legislation, he said.

The “badly broken border” over which fentanyl is shipped is also part of the problem, according to Stauffer.

Yet 90% of fentanyl entering the U.S. comes through legal ports of entry, carried by U.S. citizens or through the U.S. mail, Bhargava said.

A tariff exemption for small packages that leads to lack of thorough screening aggravates the mail problem, according to Coons.

Fentanyl precursors manufactured in China and the fraught relations between the U.S. and China are other aspects of the problem, according to Stauffer.

The heavy demand of substance users in the U.S. is yet another, participants said.

As long as there is a demand, “someone will fill it,” said DeAnna Brooks, founder of Kaysie and Stevie’s Hope, who lost two daughters to overdoses.

Long-term care needed

Corrections also need to be made in the insurance and health care industries so that care for people with substance use disorder is equivalent to the care that people receive for ordinary medical problems like cancer or heart disease, according to Stauffer.

Under the current system, people with substance use disorder generally receive services for a period of time nowhere near long enough to ensure remission, he said.

Ideally, the system shouldn’t declare a patient to be in remission from substance use disorder until recovery has lasted five years — after which there is an 85% success rate, Stauffer said.

There also should be a mix of treatment approaches, depending on what is working for individual patients, as there is with patients who have cancer, for example, which is treated with surgery, radiation and chemotherapy, or a combination of those, depending on what works best, said Stauffer, who has been in recovery himself for 38 years.

A high percentage of people coming out of rehab or jail overdose in the first week, according to Brooks.

Short-term rehab stints of 21 days just don’t work, she said.

Court ordered follow ups for people who lack housing or transportation set former users up for failure, because in many cases, parole violations are inevitable, Brooks said.

It would be far more cost-effective for the government to invest in parenting programs and drug-use prevention, so kids running in the halls and chewing gum in middle school don’t end up decades later with far worse behaviors that are far more costly to society, according to Brooks.

Mirror Staff Writer William Kibler is at 814-949-7038.