How Jails Contribute to the Opioid Crisis

Jails and the Opioid Epidemic

Jails and the Opioid Epidemic

As we’ve previously discussed on the blog, America’s opioid epidemic is a complex and multifaceted issue. Its origins lie in the deception of physicians by large pharmaceutical companies, and in the years since, countless factors have contributed to its out-of-control growth and devastation. Unsurprisingly, one major contributor to the crisis is America’s system of jails and prisons.


Jails and the American Prison System

The prison-industrial complex has grown exponentially since the 1970s. With President Richard Nixon’s declaration of the “War on Drugs” in 1971 and the 1984 introduction of the Sentencing Reform Act (SRA), the number of incarcerated Americans exploded. Year over year, the correctional population grew from under 500,000 in the 70s to nearly 2.5 million people in 2008. Policies initiated during the War on Drugs have resulted in the number of those awaiting trial or sentencing for a drug offense in prisons or jails jumping from about 40,000 in 1980 to nearly half a million today.

The challenge of punishment for drug crimes is compounded by the concept of the replacement effect. If one drug dealer or user is arrested, others will rise up to fill the gap. There is a constant supply of drugs and dealers, and therefore a consistent number of those who will become incarcerated, without addressing the causes at the heart of the issue.


The Justice System Falls Short

About 58% of those in state prison meet the criteria for drug dependence or misuse, compared with only 5% of the general population, according to the Bureau of Justice Statistics. However, a study by Johns Hopkins found that less than 5% of those who were referred to opioid use disorder treatment through the justice system received all types of treatment available. While many states offer some sort of treatment for those who are addicted to alcohol and drugs, there are two major ways that state policies create an increased risk of relapse for those who are incarcerated.

First, the risk of overdose within prisons or jails. While studies suggest that drug use is lower while incarcerated – due to reduced access to these substances – there is still no doubt that drugs may be smuggled in and consumed by the general population. Because of the immense secrecy surrounding this, it’s unlikely that someone will get help for an overdose, or that the flow of drugs will be stopped after it becomes more problematic.

Beyond this, there is an incredibly high risk of relapse for those who have recently been released from prison. According to a 2007 study from The New England Journal of Medicine, former inmates’ risk of a fatal overdose is 129 times higher than that of the general population during the first two weeks after release. For this reason, it is critical that those who are incarcerated receive comprehensive addiction treatment, as well as referrals to other programs after their sentence has concluded.


Addiction Treatment Behind Bars

One often overlooked fact about local jails is that they are the default response to those with severe mental health and substance use disorders. Those who display worrying behavior are often routed into the prison system, instead of through programs to address their various disorders and diagnoses. In spite of this overwhelming trend, correctional facilities are often ill-equipped to respond to the mental health care needs of those in custody.

Studies point to various explanations for the weak response to the needs of the incarcerated. Citing issues like short lengths of stay and unpredictable release dates, officials claim that delivering treatment is complex and not always possible. Additionally, the wide variations in health care delivery models from state to state contribute to confusion and difficulty surrounding care.

Put simply, jails can never substitute for community-based healthcare services. These should be made affordable and accessible to the general population, especially on a preventative basis, in an effort to stop addiction before it becomes out of control. By funding these services, jails will gradually lose their role as a local health care safety net. According to Vera Institute of Justice, reducing the number of incarcerated people with mental health issues and substance use disorders relies on “developing community capacity to treat these conditions.” Furthermore, quality of services for those who have already been imprisoned should be elevated to match the needs of the population.


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