ACTIVISTS AND TREATMENT PROFESSIONALS NOTE THAT EFFORTS TO ADDRESS THE HARMS OF POLICE VIOLENCE AND INCARCERATION MUST CONSIDER THE DRUG WAR, INCLUDING THE PUNITIVE MODELS OF TREATMENT.
As jurisdictions across the nation begin to examine and redress the harms of police violence and incarceration, activists and professionals in addiction treatment and harm reduction urge that these actions also take into account the drug war, including the punitive treatment models that are rooted in the carceral system.
Dinah Ortiz, a harm reduction activist and member of the North Carolina Urban Survivors Union’s leadership committee, stated that from the moment [substance addiction] was recognized as a public health issue, it should have been discussed that drug users should not be met with punitive measures; should not be arrested; and should not even be forced to enter a treatment program.
One-fifth of those incarcerated in the United States are there on a drug charge, including 120,000 who are not convicted each year. In addition, more than a million drug offenders remain under correctional supervision through probation or parole. Even though billions of dollars are being invested in expanding access to treatment and halting the flow of illegal drugs into the country, the number of drug overdose deaths continues to rise. Even the police brutality that resulted in the deaths of George Floyd and Breonna Taylor this year and prompted calls for systemic reform across the nation was at least partially fueled by the drug war.
But, cautioned Sheila Vakharia, deputy director of research and academic engagement at Drug Policy Alliance, we must be cautious when implying that treatment will solve all problems, given that not all treatments are created equal, not all agencies or programs offer the best possible services, and our current delivery system has many flaws.
Substance abuse and the criminal justice system are inextricably linked, and when a drug user comes into contact with the police, coercive treatment is frequently suggested as a solution. In the United States, there are over 3,000 adult and juvenile drug courts. In lieu of incarceration, these programs provide substance abuse treatment for a variety of substance problems, from cannabis use to severe opioid or stimulant addiction.
Rehab and detox have not been shown to save lives, according to Justine Waldman, medical director of the REACH Project, a harm reduction-focused treatment provider in New York State. Furthermore, I do not believe that forcing people to speak with someone influences their decision-making because they do not feel they can have honest conversations in that environment. These programs frequently rely on unproven methods of addiction treatment, such as 12-step programs and talk therapy. Approximately half of physicians prescribe medication for opioid use disorder. 9 percent of these individuals rely solely on naltrexone, an opioid blocker with a weaker evidence base than opioid agonist medications such as methadone and buprenorphine.
We know without a doubt that the use of [buprenorphine] and methadone alone significantly reduces substance abuse and saves many lives. I don’t understand why we are spending so much time and effort on this premise when other measures, such as mandatory counseling, have not been shown to have such an effect, Waldman said.
Even for those who can engage in a method supported by evidence, drug court programs are notoriously punitive. After his mandatory treatment provider kicked him out for eating a cookie without permission, a participant in a drug court in San Francisco ultimately chose six months in jail over drug court. It is common for participants to be compelled to engage in humiliating activities, such as urinating while being observed. Failure to comply or adhere to a regimen of total abstinence frequently results in incarceration periods that are sometimes longer than the defendant’s original sentence.
Waldman stated that there should not be mandatory treatment for substance use disorders. There are no statistics indicating that mandatory substance abuse treatment is effective.
Nicole Reynolds, a member of the North Carolina Urban Survivors Union and a street-based harm reduction outreach specialist in Raleigh, North Carolina, asserts that drug decriminalization is essential for reducing negative outcomes for drug users. She stated that [decriminalization] significantly reduces the number of individuals arrested, incarcerated, or otherwise involved with the justice system. It reduces racial and ethnic disparities in the criminal justice system and enhances the efficiency of scarce public health resources.
Blacks are 5.9 times more likely to be incarcerated than whites in the United States, while Latinxs are 3.1 times more likely. Blacks and Latinos are more likely than whites to be booked into jail rather than issued a citation for nonviolent drug-related arrests, and are also more likely to serve time for the charges. Yet Black and Latino individuals are referred to treatment diversion programs less frequently. In 2018, while overall opioid overdose deaths decreased, overdose deaths among African Americans and Latinos increased.
Shilo Jama, executive director of the Peoples Harm Reduction Alliance, a Seattle-based harm reduction program led by substance users, remarked that the treatment system generates punitive systems that do not benefit patients. If the ultimate objective is for the individual to live a healthy and successful life, as defined by the individual, we must sit down with patients and ask, “What do you want to get out of this? What is your end goal?”
Vakharia of the Drug Policy Alliance stated that increasing access to treatment and ensuring that treatment is evidence-based are part of the solution.
She noted that we must consider how to make it as easy as possible for people to [begin treatment], citing the lengthy wait times that patients frequently encounter when attempting to enter treatment. We know from a national survey of drug users and health that abstinence expectations and inability to afford treatment are the two leading reasons people do not begin treatment when they believe they need it. When we discuss expanding access to treatment, we should do so in a way that is financially feasible for those in need of assistance.
Ortiz also emphasized the importance of trauma treatment services that are easily accessible. There is always a reason why people use drugs, and she believes that [treatment providers] are focusing too much on the drugs and not enough on the underlying cause. I believe that offering therapy to all drug users that is focused on harm reduction and non-coercive is the best way to begin.
Kevin Moore, a clinical psychologist and administrator at the interstate substance abuse agency Crossroads Treatment Centers, added that there is a significant need for ongoing training and education. We need a significant increase in professional training. Currently, we say, “Go to school for X years and learn stuff, and then continue your education for three or four more decades.” In lieu of this, you must continually reevaluate, grow, and expand.
Jama stated that building people’s self-worth is a topic that is not discussed enough. If you lack self-confidence and self-love, it will be difficult to make positive decisions.
Or, as stated in the Drug Policy Alliance’s treatment principles for substance use disorders, treatment must be accessible on demand. It should be inexpensive, accessible, and appealing.
Efforts to address the harms of police violence and incarceration must consider the drug war, activists and treatment professionals note, including the punitive models of treatment.