Prisoners to Addiction: The Forgotten Victims of the 21st Century Opioid Crisis

Abstract

The current opioid crisis in the United States is a topic of significant interest and importance to both policy-makers and the general public. Having been covered in great detail, it is nearly impossible to be unaware of the scope of the epidemic as it currently exists. While one cannot say with certainty, it is well within reason to assert that every American has been affected, either directly or indirectly, by the current crisis of opioid addiction. The degree of bewilderment regarding exactly how things got to be this bad is trumped only by the confusion and discord concerning how to solve the problem. In addition to its unprecedented scope, the high level of attention paid to the opioid crisis, and the treatment-focused response, is a function of the effect it has had on the white, upper-class population. This response, endorsed by addiction scientists and politicians alike, has been the development and promotion of evidence-based techniques utilizing medications to aid in treatment. However, as a result of lingering effects from “War on Drugs” policies, a substantial population has realized almost no benefits from this new perspective and science-based approach to opioid addiction. Using a historical framework, this paper explains how the evolution of drug enforcement and substance abuse treatment in the United States has led to a scenario in which a large percentage of individuals suffering from Opioid Use Disorder (OUD), those within the criminal justice system, are receiving little to no treatment. Having established the context for the current landscape, I then use results from several studies, both international and domestic, to argue that the criminal justice population represents the group whose access to evidence-based programs, namely medication-assisted treatment (MAT), would have the highest incremental impact on every relevant metric in the effort to reverse the economic, societal, and health and mortality trends of the crisis. Furthermore, I contend that the current approach represents a misallocation of funds that not only fails to appropriately address the needs of a crucial population, but also contributes to the continued escalation of negative outcomes with respect to those three metrics. Finally, I argue that the high correlation between OUD and criminal justice involvement provides an opportunity for a number of targeted policy interventions. These interventions, specifically focused on improved screening, data-collection, and pre- and post-release treatment practices, would yield significant and comparatively high marginal results