A top federal drug enforcement official is calling on the government to “move away from criminalization” in the war on drugs, saying the country’s failure to provide drug treatment to incarcerated people is only exacerbating the ongoing opioid overdose crisis.
“There is a widespread belief that simply preventing people from taking drugs while they are incarcerated is an effective approach to treatment,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA), wrote in a new opinion piece. “But this belief is inaccurate and dangerous.”
In fact, drug overdoses “are the leading cause of death among people returning to their communities after prison,” Volkow continued. “Providing drug treatment in these settings could be a game changer.”
In addition to calling for broader access to medication-assisted treatment — using Food and Drug Administration-approved drugs like methadone, buprenorphine and naltrexone — the NIDA chief also said a shift away from the criminal war on drugs could help improve outcomes and help families.
“Fundamentally, the best or only option for an individual to receive treatment for addiction should not be incarceration,” Volkow wrote in the paper, which appeared last week in the life sciences journal STAT and was republished Monday on the NIDA website. “In an ideal world, treatment and prevention systems in the United States would proactively address social determinants of health and mental health needs to end the cycle between addiction and incarceration.”
“Moving away from the criminalization of substance use disorders to a public health approach would eliminate a key structural practice that perpetuates inequalities,” she said. “It would improve the lives of people and their families.”
🆕 @statnews editorial in Nora’s blog: #NIDA Director Dr. Nora Volkow and colleague Dr. Tisha Wiley discuss the impact of the overdose crisis on incarcerated people and the importance of providing addiction treatment in criminal justice settings. @jcoinctc https://t.co/nlqpzAEvKd pic.twitter.com/muUAXr2Hog
– NIDAnews (@NIDAnews) July 15, 2024
When it comes to medication-assisted treatment for incarcerated people with opioid use disorder, Volkow argues in his paper that it “is beneficial to public health and safety. It is cost-effective. It can help break the cycle of recidivism. It can reduce the burden on the health care system as a whole, including emergency departments.”
“Programs are underway across the country to provide naloxone and medications for opioid use disorder in prisons, along with instruction, training, and social support,” she wrote. “Federal agencies have launched programs to help people manage withdrawal in prison and to provide financial support for health care for people who are about to re-enter the community. A recently released revised methadone rule now allows any prison registered as a hospital or clinic to dispense medications for opioid use disorder in certain circumstances.”
A Rhode Island study found that deaths could be reduced by 30 percent if incarcerated people had access to all three FDA-approved drugs, Volkow noted. But nationally, fewer than half of prisons and one-tenth of state jails offer all three drugs.
“These three medications are effective, safe, and can save lives. But they are woefully underutilized, particularly in criminal justice settings,” she wrote. “Studies also show that people who receive these medications while incarcerated are less likely to return to substance use and more likely to remain in treatment in the community afterward.”
About 60 percent of incarcerated people have a substance use disorder, Volkow added, citing a 2017 Justice Department report.
Even those charged with enforcing drug laws are “beginning to see how drug treatment increases safety for everyone,” the article says, referring to a Massachusetts sheriff, Chris Donelan, whose jail is one of the few with an accredited opioid treatment program:
“When someone comes into our facility, we are often the first health care provider that person has seen in years,” Donelan told his research partners at the University of Massachusetts. “These treatments save lives and help people recover. The treatment makes our facility much easier to do. We have fewer fights, less contraband, and a much safer facility.”
While much work remains to be done, Volkow wrote, she pointed to the work of the National Institutes of Health, which is funding partnerships “to determine how to connect people with addiction to care during and after their time in the correctional system. These researchers are ready to share new evidence as it emerges, which will help other communities make data-driven changes so they can implement what is most effective in justice settings.”
Despite the federal government’s apparent stubbornness in reforming the drug system, Volkow, NIDA’s director since 2003, has often criticized the status quo and advocated for an overhaul of the country’s criminal justice approach to drugs.
Late last year, for example, she said that adopting an abstinence-only approach to drug treatment was “magical” thinking that “costs a lot of lives.”
She also said that drug criminalization has “created a structurally racist system” in which black people are treated “worse” than others.
When it comes to marijuana, Volkow said there is “no evidence” that casual marijuana use is harmful to adults. And at a 2022 DARE-sponsored event hosted by an anti-marijuana advocacy group, she reiterated that data shows that youth marijuana use has remained stable “despite legalization in many states.”
In May, during a congressional hearing, Volkow said there was “tremendous excitement” about the therapeutic potential of psychedelics. But she cautioned that while the treatment option was “very promising,” people should understand that “it’s not magic” and that more rigorous research was needed.
The federal official has repeatedly spoken of her interest in psychedelic therapy, acknowledging not only the potential but also the societal impact of local and state reform that could potentially encourage more people to use substances like psilocybin outside of a clinical setting.
In 2022, she said the “train has left the station” when it comes to psychedelics as part of the policy reform movement. Volkow also addressed the issue in a previous interview with Marijuana Moment.
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