US – Treating Drug Addicts in Prison
For the last 16 years, Dr. Josiah Rich has gone weekly to prisons in or near Providence, R.I., to treat people being held there for drug-related offenses. Each time, he has wrestled with an ethical conundrum: not the issue of whether the offenders have done something wrong, but whether the American prison system is doing something worse. “What I see is not bad people,” he says. “Predominantly, I see people with a disease.” Complete story, with charts and photo galleries, in Newsweek.
Of the 2.3 million inmates in the U.S., more than half have a history of substance abuse and addiction. Not all those inmates are imprisoned on drug-related charges (although drug arrests have been rising steadily since the early 1990s; there were 195,700 arrests in 2007). But in many cases, their crimes, such as burglary, have been committed in the service of feeding their addictions. Rich, a professor of medicine and community health at Brown University, is worried that, by refusing or neglecting to provide treatment to these addicts, many U.S. prisons are missing the best chance to cure them—and in the process to cut down on future crime. Treatment can reduce recidivism rates from 50 percent to something more like 20 percent, according to the DEA. Yet it is not widely provided. “Our system has taken the highest-risk and most ill people and put them in a place where they have constitutionally mandated health care,“ Rich says. “What a great opportunity to make a difference. Are we just trying to punish people? Or are we trying to rehabilitate people? What do we want out of this?”
Looking at the way prisons currently deal with drug addiction, the answer to Rich’s question is unclear. Over the last few years, some in the justice system have warmed to the idea of treating drug addicts in addition to (or instead of) incarcerating them. In some states, most notably Ohio, almost all first-time drug offenders and many second-timers are offered treatment. That is by no means the case nationally. According to a report released last year by the National Institute on Drug Abuse, just one fifth of inmates get some form of treatment. That number may be lower in the near future: tight budgets are forcing many states to cut back or close down their existing treatment programs. Kansas and Pennsylvania have already done so; California and Texas may follow suit in the next few months.
The irony here is that by lowering recidivism, the programs themselves save money in the long run. The NIDA report released last year cited a remarkable statistic: heroin addicts who received no treatment in jail were seven times as likely as treated inmates to become re-addicted, and three times as likely to end up in prison again. For every dollar spent, the programs save $2 to $6 by reducing the costs of re-incarceration, according to Human Rights Watch. Looked at another way, the programs can save the justice system about $47,000 per inmate.
So why would prisons target their own treatment programs in an effort to cut costs? Part of the reason is that pharmacological treatment—such as giving heroin addicts methadone to help them through withdrawal—requires a lot of regulation, and thus it’s expensive in the short run. Pharmacological treatment isn’t the only way of helping addicts—the White House’s drug-policy arm has a good list of other options—but in many cases it’s the most effective. Unfortunately, it’s also very tricky. It can be undermined by the fact that addicts can easily relapse behind bars; a Human Rights Watch report last year claimed that “drugs are as available in prison as in the street,” often getting to inmates via the mail. (Reliable statistics on inmate drug use are understandably hard to come by, since prisoners have no reason to fess up to using.) There are other challenges, too, particularly in treating addicts with methadone. “People are loath to provide methadone because it poses some security risk,” says Dr. Amy Nunn, also a professor of medicine at Brown. “It could be diverted or sold on the black market, or someone might rob the dispensary.” When methadone is given, it’s usually with strict oversight at a medical center, not as a matter of course in the correctional facility. That takes money. Buprenorphine, which is used to treat opioid addicts, is a little easier for prisons to deal with because it’s “harder to divert,” Nunn adds. The medication has an additive that prevents it from being crushed up and inhaled. But it is not widely used either. Only half of all states and prisons provide any form of methadone or buprenorphine treatment, and those that do make use of the drugs do so in a limited fashion, even though the WHO has both medications on a list of drugs that should be available to all prisoners at any time.
But Nunn says the real problem is an ideological one, not a practical one. “In spite of all of the proven clinical and social and economic benefits of pharmacological treatment, people really have a moral opposition to it,” she says. “They think if you’re providing people with treatment, you’re not addressing their addiction in an appropriate way. They think people who have addictions deserve what they get, and that the only way to treat addiction is abstinence, when nothing could be further from the truth.”
Further reading, with charts and photo galleries, in Newsweek.
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