Decriminalizing a Disease

By: Tarun Ramesh

The current opioid crisis has sparked a debate over ethical and effective solutions to decrease addiction rates and reduce overdose statistics. However, possession of scheduled drugs like prescription opiates and heroin remains a federal crime, which warrants extended jail time as a felony charge. Unfortunately, those incarcerated for an opiate related issue tend to remain addicted during their tenure in prison and without safe rehabilitation programs, often resort to risky sexual activities, gang involvement, or black market dealings to finance their addiction. When prisoners are released, they often remain addicts; the lack of a sustainable treatment program ensures that recidivism rates for opiate related offenses remain high.

Considering an influx of HIV and Hepatitis C cases are strongly correlated with areas most impacted by the opioid crisis, both addicts and the greater community are severely affected by such alarming trends. The overprescription of opioids, stigmatization of mental health issues, lack of normalized substance abuse treatment programs, and lack of medication assisted treatment programs (MAT) in prisons have all contributed to the influx of prisoners addicted to opiates. 

Over the last twenty years, death by opioid overdose has steadily increased with little media attention dedicated to the issue until the last few years. However, the strength of the pharmaceutical lobby and the lack of federal oversight have escalated the problem. The crisis has increased the market for heroin in the United States, leading to a larger influx of black market drugs along with the development of dangerous synthetic alternatives such as fentanyl and black tar heroin. Furthermore, rising congenital syphilis rates and STI transmissions amongst individuals who currently abuse or have a history of abuse affect the greater community. In prison, inmates deal with greater violence and riskier behavior in order to obtain drugs, while a lack of MAT ensures that little support exists to actually rehabilitate prisoners for their addiction. This creates an environment where individuals continue to abuse drugs to greater and greater capacities until they either overdose or are transferred to a different ward. Prison gangs are thus given an increasingly more important role as a supplier of black market drugs, which can further endanger inmates.

While in prison, individuals who decide to completely cut off usage of drugs tend to have severe withdrawal effects, which leads to a further deterioration of both physical and mental health. Without proper supervision, withdrawal poses a severe if not deadly effect on an individual. Abstinence-only programs actually increase an individual's risk of death. Opiate tolerance decreases in the several months after completing an abstinence only program, leading to a 130 times increased risk of overdosing after release (1). MAT programs utilize a combination of methadone, suboxone, and Vivitrol. While the first two help withdrawal symptoms and decrease cravings, the third works as a neurotransmitter blocker, preventing neurons from activating pleasure complexes with the introduction of a drug. This ensures that the individual cannot get ‘high.’ Prisons, methadone clinics, drug courts, prisoner rights groups, and inmates are all immediately affected by the lack of sustainable rehabilitation programs for addicts in prison. While prison wardens have the ultimate decision on whether MAT can be implemented, several states including Rhode Island, West Virginia, and Pennsylvania can highlight specific ways that programs can be implemented and supervised with minimal interference to daily running of the prison and lowered costs. In order to combat the negative effect of abstinence-only programs in prisons for individuals with substance abuse problems, prisons should implement medication assisted treatment programs through either a referral system or in house treatment system to help inmates receive the proper resources to combat their addiction.

Other states and counties show that MAT programs can decrease both drug related recidivism and addiction rates. A 2012 study shows that of the 75% of inmates with a history of heroin dependence, who did not receive MAT during or after their prison term had a 55% chance of recidivism for a similar crime. These are startling especially since the recidivism rate for an individual convicted for a first time drug related offense tends to be around 20% (2). Furthermore, in his 2018 study, Linden argues that a prisons not providing MAT is a constitution violation of the 8th amendment. In the Journal of Law, Medicine and Ethics, Linden establishes that if prisoners have the right to healthcare, then by extension MAT, which helps to treats a mental disorder should be held under the same light (3). With more states creating sustainable support systems for inmates affected by substance abuse problems, it has become imperative for the federal government to normalize MAT and offer it as an option in any federal prison. Only by understanding that prisoners are patients too can policy better combat the current opioid crisis.

Tarun Ramesh is a first-year at the University of Georgia pursuing a B.S. in Economics and a B.S. in Genetics. He currently serves as Roosevelt @ UGA Communications Director. Tarun intends to enter into the medical field, but is engaged in a wide range of policy studies.

Roosevelt Issues Forum: Hurricane Irma and Hurricane Harvey

On September 14, Roosevelt @ UGA hosted a Roosevelt Issues Forum to discuss disaster management techniques.  Undergraduate students Aditya Krishnaswamy and Elizbeth Hardister led a policy workshop that challenged students to analyze current and potential policy situations that address healthcare and shelter management in the wake of natural disasters. In the following post, Elizabeth Hardister discusses the impact of hurricanes and her involvement at the Georgia State Operations Center.