President Trump may have a reputation for toughness, but the White House is taking a different approach with its newest plan to counteract crime and address the opioid crisis: Reduce punitive policies and emphasize treatment.
This is a smart plan, one that needs to be expanded throughout the criminal justice system. More than half of all prison and jail inmates suffer from a substance use disorder, and opioid overdose is a leading cause of death for people recently released from incarceration.
Unfortunately, only about 25% of incarcerated people with opioid use disorder receive any treatment, and only about 5% receive the most effective treatment — medications. Government regulations and inaccurate notions about drug addiction work to keep scientifically proven solutions out of jails and prisons. Instead, we lock people up, allow their opioid use disorder to fester, then release them with a very high likelihood they will relapse and wind up back in jail.
Responding to opioid addiction by putting people behind bars doesn’t reduce crime, and it doesn’t help fight a public health crisis that, according to the Council of Economic Advisers, costs our country more than $500 billion each year.
A new study by the National Academies of Science, Engineering and Medicine points policymakers in a more effective direction. The report draws upon 50 years of scientific studies to conclude that pharmacological treatments for opioid use disorder, such as methadone, buprenorphine and naltrexone, have positive, life-saving outcomes.
And when we provide these treatments to people who are arrested and under criminal justice control, rates of crime and drug use fall substantially.
The Trump administration is putting this treatment-first attitude into action with the HEALing Communities Study, which sets out to address opioid use disorder at a local level. This $353 million plan has the ambitious goal of reducing opioid-related deaths by 40% over three years in some of our nation’s hardest hit communities by bringing best practices into hospitals, schools, churches, and housing facilities.
This effort has the potential to change everything. It’s a recognition at the highest ranks of government that being tough on opioids isn’t enough — you also have to be smart.
But if policymakers are truly serious about addressing opioid use disorder, then this treatment-first attitude needs to be brought into our jails and prisons, too.
While access to methadone, buprenorphine and naltrexone should be expanded at all levels, the criminal justice system presents a prime opportunity to connect an at-risk population with effective medical care. For 20 years, the two of us have dedicated our careers to chipping away at a mistaken mentality that insists our law enforcement institutions should exist only to punish the incarcerated rather than help reintegrate them.
However, the people on the front lines of the opioid crisis often stand as the greatest barrier to reform.
The problem stems from misinformation and stigma. Too many who work in drug courts, prison systems and even medical fields mistakenly view scientifically proven treatments for opioid addiction as merely substituting one drug for another. Or they’re worried these medications will be misused. Or they think opioid use disorder is a moral failing instead of a medical condition.
Meanwhile, unnecessary government regulations restrict where doctors can provide these treatments and how many patients they can see.
It is time to face the facts: Opioid use disorder is a treatable chronic brain disease. FDA-approved medications to treat opioid use disorder are effective and save lives. As the National Academies’ report says, refusing treatment to people in jails and prisons is medically unethical.
The status quo isn’t working: More than 2 million Americans suffer from opioid use disorder and more than 400,000 Americans have died from overdose since 1999.
This fatal epidemic won’t be solved by locking people in jail — a fact that key leaders in law enforcement are starting to recognize.
It is time to take a different approach — one that appropriately frames opioid use disorder as a public health challenge that can be solved with public health solutions. Change will require bold leadership and a willingness to confront a broken criminal justice bureaucracy. We are up to the challenge and ready to welcome anyone who wants to join.
Jeremy Travis is executive vice president of criminal justice at Arnold Ventures, a philanthropy dedicated to evidence-based policy. Alan Leshner is chief executive officer emeritus at the American Association for the Advancement of Science.
