I saw this in a theater recently, and I cannot recommend it. It should not have been released because its premise — for-profit drug rehab outfits taking advantage of addicts — was largely invalidated by the time filming was finished.
The setting is Del Ray Beach in South Florida, which seems to attract heroin addicts. In 2016 alone, there were 596 overdose deaths in Delray’s county. Because addicts with health insurance or Medicaid coverage are eligible for medical treatment, the region also attracted for-profit detox centers, drug-testing labs and “sober homes” that serve as halfway houses between inpatient treatment and community release. There also developed a market for addicts with insurance; detox centers would pay procurers up to $2,000 for each referral. (Perhaps it is not a coincidence that Florida also is notorious for very high levels of Medicare fraud.)
Heroin recovery is a lifelong challenge, and the typical relapse rate is 90 percent, which is hard for people who are addicted but which provides recurring business for operators of treatment facilities. (Addicts without insurance, presumably a lot of them, are out of luck.)
“American Relapse” set out to expose this cynical for-profit/treatment nexus. Unfortunately for the filmmakers, Florida in 2017 passed legislation that clamped down on the worst excesses of the treatment rackets just as filming was under way. Since then, there have been hundreds of arrests and prosecutions and many facilities closed. The current situation may not be perfect, but it is demonstrably better. In other words: Never mind.
Besides the scams, the movie focuses on Allie and Frankie, two recovering addicts who have devoted their lives to getting current addicts into treatment. This work is heroic; once addicted, users wear out even the most devoted parents and siblings by stealing and lying. And while public agencies provide “services” to drug abusers, they are no substitute for individuals who understand addiction and who commit themselves to helping individual addicts, even over extended periods.
Still, you don’t need to see the movie to get the latter message. Allie and Frankie were featured doing the same work in “Dopesick,” a Vice network series that covered the same ground for two seasons and still can be found online.
Seattle Is Dying
Here’s an hourlong documentary from a local news station that you can watch right here.
For those who have not spent time in West Coast cities recently, it’s an eye-opener. For people who have visited Seattle, Portland, San Francisco and/or coastal Southern California, it rings true.
The presenter opens by talking about homelessness in downtown Seattle and then dismisses the idea; The problem, he says, is addicted people living on the streets.
The movie shows the street people and their behavior, and also police and other citizens expressing their frustrations at laws not enforced and public safety under threat. There is the repetition of the recent estimate that Seattle agencies spend about $1 billion annually — or $100,000 per homeless person per year — with no apparent effect on the homeless population or the situation on the streets.
A woman who has lived on the streets for several years tells an interviewer that the homeless are addicts — “100 percent,” in her experience.
The documentary ends describing a seemingly effective program in Rhode Island, where addicts are removed from the streets and kept in a previously empty military facility while they are treated with substitute drugs — methadone, suboxone, vivitrol — that, taken over the very long term, may help them maintain sobriety and resume normal lives. It may not be a cure-all, but it sounds more promising than anything cities are doing on the other side of the country.
Let me add some other data points to this stew:
— As of last year, San Francisco was distributing 40,000 syringes per month to street addicts and deploying 10 or 11 employees full time to collect the thousands of used syringes that were not dropped off in official city disposal containers.
— I have visited Los Angeles County Superior Court morning sessions twice since January. (It was a private matter; I am neither a felon nor a court officer.)
The first time, the judge made the same offer to two different men who had been arrested for actionable possession of non-trivial amounts of meth or heroin: 1) go into drug treatment at government expense, or 2) take a felony conviction and go to prison for 16 months. Both men chose the prison option. California prisons are full now, and many felons serve their sentences in city and county jails. Because the jails are also full, a 16-month sentence is actually much shorter, generally ranging from two weeks to two months as old prisoners are cycled out to make space for incoming prisoners.
On my second visit, a man made his first appearance after being apprehended with 72 grams of meth or heroin. The amount suggested he was a distributor or a street seller with a sizable clientele. The frustrated judged rolled his eyes and then released the man on his own recognizance and with a court date.
Maybe Later: Thoughts on Homelessness