Four people will die today from an opioid overdose in Massachusetts. Tomorrow, if the average from 2015 remains unchanged, another four souls - who may at this very moment be reading this article - will also lose their lives with the push of a plunger.

For the new year to look any different from the last, it has become clear that uncomfortable measures will need to be taken in order to end the overdose crisis. Gloucester Police Chief Leonard Campanello has shown a willingness to do just that by taking on Big Pharma and offering treatment instead of jail time, as has Governor Charlie Baker in his willingness to go up against the medical establishment to curb the overprescription of opioids.

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A man who was busted for hiding heroin in his prosthetic leg has sparked the latest battle between judges and prosecutors - two powerful factions who are fighting over mandatory minimum sentences.

Imran Laltaprasad was convicted of possession with intent to distribute heroin and two counts of possession with intent to distribute cocaine in July. He hid the heroin in his artificial leg. He had been convicted of the same offenses in the past.

Under state law, sentencing should have been easy. The mandatory minimum sentence for the crimes is 3 1/2 years. Prosecutors asked for concurrent sentences of 3 1/2 to five years in state prison.

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As a lifelong high school health teacher, I was dismayed to read some of the analogies that Thomas Levenson used in his article "Drugs, fleas, race, and disease" (Ideas, Dec. 13). Any person knowledgeable of the facts of addiction should be aware that it is a brain disease, and that shaming the addict is useless and wrong. But calling addiction "an accident of nature" or "bad luck" is misleading. This rhetoric is exactly what teenagers experimenting with drugs should not be hearing.

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This fall,a new kind of court session came to order in Massachusetts, one that holds enormous promise for a region coping with an exploding opioid epidemic by offering integrated treatment for low-level drug defendants rather than costly long-term incarceration.

The program, called RISE - for Repair, Invest, Succeed, Emerge - is part of a broader shift nationally away from rigid sentencing guidelines to a more humane view: dealing with the complex social causes that can lead to drug abuse and drug-related crime in an effort to break the addiction cycle and keep people from re-offending.

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Contrary to the Herald editorial, it wouldn'=C2=80=C2=99t hurt Massachuse tts state senators to visit Colorado and sample legal marijuana ("=C2=80=C2=9CRethink this road trip,"=C2=80=C2=9D Dec. 7). The legislato rs would learn that marijuana is not nearly as dangerous (or exciting) as federal government propaganda suggests.

Marijuana prohibition is indefensible. If the goal is to subsidize violent drug cartels, marijuana prohibition is a grand success. The drug war distorts supply and demand dynamics so that big money grows on little trees.

And the criminalization of Americans who prefer marijuana to martinis has no scientific basis. In sum, the war on marijuana consumers is a failed cultural inquisition, not an evidence-based public health campaign =2E

Robert Sharpe, policy analyst, Common Sense for Drug Policy, Washington, D.C.

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As sheriff of one of the largest urban jail systems in the country, I see the devastating impact that the lack of substance abuse and mental health resources has on the women and men in our custody. The hallmark of a great society is how we care for our most compromised, and, as our current treatment policies stand, we are grossly negligent.

County sheriff departments serve as the de facto health and addiction service providers for residents who do not seek, or have access to, care in the community. We deliver detoxification, recovery treatment, and long-term case management for addiction. Individuals in our custody who are struggling with mental illness have access to care and treatment that they could not obtain, much less afford, outside of our walls. But our fellow citizens should not have to go to jail in order to receive treatment.

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While I agree that the upcoming trip by state legislators to Colorado to explore the impact of marijuana legalization is likely unnecessary, I don't think the Herald should be so quick to highlight the alleged shortcomings of legalization there ("Rethink this road trip," Dec. 7). Teen use has not risen at a faster rate in Colorado when compared to states that have not yet legalized. A Colorado survey showed that, if anything, teen use of marijuana went down in 2013, the first year of legalization.

Furthermore, it is not Massachusetts' problem if our border states have increased enforcement costs assuming the commonwealth legalizes marijuana in 2016. If these states want to cling to the misguided and unrealistic policy that is pot prohibition, let them pay for it.

- - Eric Casey, Marlboro

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It is highly unlikely that the Legislature will vote to "legalize" the recreational use of marijuana in Massachusetts anytime soon. Come January lawmakers will have six months to wrap up the work of this session and they struggle to get their acts together even on far less controversial bills.

But that won't stop a group of state senators from embarking on a week-long field trip to Colorado in January, to research that state's experience with legalizing the recreational use of pot.

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Governor Baker's plan to increase opioid education, which he announced on Nov. 9 with the deans of the state's four medical schools, gets it only half right.

It's wonderful to teach future doctors how to prescribe opioids safely to reduce abuse and addiction. But the United States is actually caught in the middle of two colliding epidemics, not just one: the well-publicized problem of opioid abuse, and the under-publicized epidemic of chronic pain, which affects 100 million American adults, according to the Institute of Medicine.

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I'm sure that Barnstable County Sheriff James M. Cummings means well ("Cops: Legal pot 'makes no sense'," Nov. 16). However, the cannabis (marijuana) "gateway theory" was discredited over a decade ago, and even the prohibitionist federal government stopped making that claim.

Cannabis is no more likely to lead to heroin addiction than beer or milk. The prohibition of cannabis, on the other hand, has been associated with increased hard-drug addiction rates - by, among other things, putting cannabis users in contact with people who may also sell hard drugs including heroin.

Caging responsible adults who choose to use the relatively safe cannabis is what "makes no sense."

- - Stan White, Dillon, Colo.

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REGARDING YOUR Nov. 13 editorial in support of the Bay State Repeal model for legalizing marijuana, I agree that having the Department of Agriculture regulate marijuana makes sense. The Campaign to Regulate Marijuana Like Alcohol seems to believe that regulating marijuana like Kryptonite will appeal to voters.

It's a plant. In a few years, farmers will cultivate legal marijuana under natural sunlight. Right now, illegal marijuana is cultivated in environmentally destructive wilderness "grows" and in suburban basements under artificial lights, with massive carbon footprints. When legal marijuana is grown by farmers, it will be virtually worthless. This is important. Financial incentives drive destructive cultivation practices.

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Undermines State's Opioid Crackdown

Several Bay State sheriffs are blasting an ongoing push to legalize marijuana amid a raging opiate epidemic - accusing some lawmakers and those behind pot legalization ballot initiatives of undercutting Gov. Charlie Baker's bipartisan opioid crackdown.

"It makes no sense," said Barnstable County Sheriff James M. Cummings. "We're here fighting opiates and now we're going to legalize another mindaltering substance?"

Baker is set to testify in support of his legislation on Beacon Hill today. The bill, which would limit prescriptions and give doctors the ability to send patients to addiction treatment, has high-profile backers like Mayor Martin J. Walsh and eight of the state's sheriffs.

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Faced with a statewide opioid epidemic, Governor Charlie Baker seems determined to disrupt the treatment rules for the medical community. Perhaps the most provocative proposal in his wide-ranging legislative package is a three-day commitment provision for addicts, allowing doctors to decide to hold them against their will, locked in a hospital, for 72 hours.

As the state Legislature prepares to hold a public hearing on Baker's proposals on Tuesday, lawmakers must take special care in expanding the civil commitment law.

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Voters shouldn't let the similar rhetoric of the state's two marijuana legalization efforts fool them: The groups are pursuing very different goals.

One, Bay State Repeal, would remove almost all restrictions on cannabis cultivation, possession, and use for adults. The other, pushing a more complicated proposal, would create a cumbersome regulatory framework that seems as concerned with creating a hospitable environment for the nascent marijuana industry as extending rights to citizens.

Both have their flaws, but for voters who favor marijuana legalization, the choice should be clear: Sign Bay State Repeal's petition to get its question on the 2016 ballot.

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The continued criminalization of marijuana and other drugs has not worked ("Ohio snuffs out Big Pot's risky push for legalization," Nov. 9).

Those punitive policies, over many years, have led to serious consequences including mandatory sentencing, expensive prison overcrowding and a lack of judicial discretion. And it has entrenched the underground business of delivering and selling illegal drugs.

It is common knowledge that cigarettes kill more people in the U.S. than any other drug. And alcohol use destroys more lives and destabilizes society to a far greater extent than marijuana and other drugs.

The United States should apply the far more rational policies we use to control cigarettes and alcohol use to all potential addiction problems, rather than continuing the failed "War on Drugs."

- - Tom Larkin, Bedford

The writer is a licensed psychologist.

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Backers of a proposed ballot question to legalize the recreational use of marijuana in Massachusetts say they've collected more than 100,000 signatures in support of the initiative.

If certified, those would be well above the 64,750 signatures needed to continue the process of putting the question on the 2016 state ballot.

The measure would allow adults 21 and older to possess up to one ounce of marijuana and grow a limited number of marijuana plants in their homes. It would also create a 3.75 percent state excise tax on retail marijuana sales and establish a regulated system of licensed marijuana retail outlets and cultivation and testing facilities overseen by a commission similar to the Alcoholic Beverages Control Commission.

The question is one of two proposed ballot initiatives to legalize marijuana in the state.

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Spurred by an opiate problem that kills three people a day in Massachusetts, Governor Charlie Baker has proposed controversial legislation to give hospitals power to hold addicts against their will if they pose a grave danger to themselves.

Intruding on personal freedom is serious business. But in extreme situations it's necessary.

I remember the frantic parents of my 23-year-old patient, Susan. They tried to get her committed for "grave disability" due to addiction. Susan had dropped out of college three years earlier, chose to live on the streets of New Haven or crash on her friends' filthy couches. Two months before her parents sought forced treatment, their daughter had overdosed twice, suffered a near-rape, and was hospitalized for abscesses from infected injection sites.

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FRED BRASON knew there was an opioid crisis in the making long ago, "when nobody was talking about it." In Wilkes County, N.C., where he lives, the misuse of potent pain-relief drugs like fentanyl, morphine, and oxycodone was rampant. It got so bad that in 2007 the rural county recorded the country's third-highest rate of overdose deaths, according to the Centers for Disease Control and Prevention. "Nobody had any template or practice or solution that we could follow to fix it," said Brason. "We decided it's our house and we're going to have to do it ourselves.

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WASHINGTON - As U.S. Sen. Rand Paul's presidential campaign goes to pot, Vermont Sen. Bernie Sanders stands to roll up some of his supporters - marijuana advocates and weed purveyors.

Sanders, the first presidential candidate to support marijuana legalization, got a bump from the nation's largest pot advocacy group yesterday. The Marijuana Policy Project boosted Sanders' voter guide report card score from a "B" to an "A" after the Democratic Socialist said he'd vote for Nevada's pot legalization initiative if he lived in the state.

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This is how it usually happens, in hospital emergency rooms from Boston to Pittsfield:

Heroin addicts overdose and are brought back from the brink of death by Narcan. The addicts gradually come to their senses and find a compassionate ER doctor standing at their bedside. The doctor asks if they want treatment for their addiction. And most of the time, the addicts say no, because the Narcan has kicked them into the agony of withdrawal. At that point, all most of them want to do is leave the hospital and get high. And so most of them do.

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