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Heroin Addiction and Related Clinical Problems: 2017, 19, N5 (pages: 63 - 72)

Crime Issues in Substance Use Disorders: Need for a Medically-Based Algorithm

Pacini M., Maremmani A.G.I., Patricio L., Barra M., and Maremmani I.

Summary: On political grounds, the liberalization and decriminalization of treatment instruments, as long as they are used for medical purposes, have become a priority in improving treatment standards. Scientifically based interventions should never be hampered by restrictive regulations targeting substance classes, let alone specific medical preparations. Pathways to recovery should also be made easier by lessening the restrictions on work and travel that are generally applied to substance users or offenders against laws on drugs. In other words, the figure of the patient should be allowed to prevail in legal contexts over that of the offender, as long as treatment can guarantee a positive outcome. For non-responders, alternative sanctions or ‘decriminalization' may be considered too, although the need to prevent social harmfulness may justify restrictive measures. Decriminalization should stop being a substance-related matter, and become a diagnosis-related one. Categories of mentally ill patients (addiction being one main issue) should be decriminalized in so far as their offence can be considered a result of their addictive behaviour. Intoxication-related behaviour may, therefore, be decriminalized when it springs from addiction, and generically sanctioned when it is independent of addiction or other brain disorders. In terms of social security, decriminalization should be distinguished from depenalization. The person in question should not be charged with legal responsibility, as long as he/she is addicted or mentally ill, but restrictions may be applied when there is no other way of preventing social harm. The definition of categories of abuse, addiction and mental illness is a medical matter. One consequence is that the most reasonable way to allow ‘pathologic' offenders to be given treatment is to check whether each offender belongs to a decriminalized category. The physician should become the central figure in assessing and handling social risk related to psychiatric disorders, because he/she is able to give medical criteria and knowledge priority over laws targeting generic substance use, trading in substances or substance-related crime.