A 44-year-old man came to my office to begin Suboxone in hopes of stopping his injecting heroin. He was raised well by married parents, whose other four children have not indulged in narcotics.

He lives with a friend, unable to contribute to rent while “not working” yet somehow he affords $50 per day for narcotics through (self-admitted) hustling (comprising: working as one tentacle of the drug-dealers’ network, shoplifting, borrowing with no intent to repay, and under-the-table jobs).

He casually mentions having been treated in more than 70 previous detoxification-attempts: none of which he has paid for. Does he value the detoxes, not having any investment in them? He pays nothing for his insurance (which is free, via state-largess: Medicaid), which endlessly cycles him through these detoxes.

There is no specific incentive to stay clean, knowing that someone else will perform this task soon enough, with no personal repercussion, responsibility, or fee. Trying to relate this situation of lack-of-seriousness to him in understandable terms: I thought up an example of having an eternally-valid “free car wash” card. If such a thing existed, would the bearer take great care in keeping his car clean?

If only of the price of a car wash were involved, this might not be so great an issue or problem, but, in reality, each individual detox-effort costs (the rest of us) a price more in line with a top-shelf, luxury paint-job on that same car. To continue the example, he’s not just getting a car muddy, he’s graffiti-spray-painting it (70 times over!) with the rest of us (via a leaden state-apparatus) giving “free refills,” on multi-thousand dollar paint jobs.

This free refill policy, aside from not helping beleaguered taxpayers, doesn’t even help this man’s addiction, by avoiding teaching any personal responsibility. The longest he has been free and entirely clean from narcotics, in the last 18 years, has been during a three-year episode in prison. Invariably, within a few days after any detox (or release from prison), he will restart narcotics,most often because he is “bored”.

A carrot-and-stick approach would be eminently sensible. Certainly, make attempts to help someone get clean, but at a certain point if people are showing up addicted to illegal drugs, there should be repercussions. Implicit in heroin-usage and obtaining drug-money are criminal activity.

In pursuing and prosecuting such criminal activity, remember that this man’s most effective “detox” occurred during his prison-days. While walking “free,” our cost in detoxes alone has been close to $1 million.

This dollar price doesn’t begin to reflect a price incurred through the diminution of others’ lives he has “touched” adversely in pursuit of his own drug-money: aiding and abetting drug dealers’ “outreach” for new customers, as yet virgin to drug-addiction.

Randall S. Bock is a primary care physician who blogs at Withdraw to Freedom.

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