Politics
Top Federal Drug Official Wants U.S. To Move ‘Away From Criminalization’ And Focus On Treatment
A top federal drug official is calling for the government to move “away from criminalization” under the drug war, saying that the country’s failure to offer drug treatment to incarcerated people only exacerbates the ongoing opioid overdose crisis.
“It remains a common belief that simply stopping people from taking drugs while in jail or prison is an effective approach to treatment,” Nora Volkow, director of the National Institute on Drug Abuse (NIDA) wrote in a new opinion article. “But that belief is inaccurate and dangerous.”
In fact, drug overdose “is the leading cause of death among people returning to their communities after being in jail or prison,” Volkow continued. “Providing addiction treatment in these settings could change that.”
In addition to calling for wider access to medication-assisted treatment—using the Food and Drug Administration (FDA)-approved drugs methadone, buprenorphine and naltrexone—the NIDA leader also said a shift away from the criminal drug war could help improve outcomes and help families.
“Fundamentally, an individual’s best or only option to receive addiction treatment should not have to be during incarceration,” Volkow wrote in the piece, which appeared last week in the life sciences publication STAT and was republished Monday on NIDA’s website. “In an ideal world, treatment and prevention systems in the U.S. would proactively address social drivers of health and mental health needs to stop the cycle between addiction and incarceration.”
“Moving away from criminalization of substance use disorders toward a public-health approach would remove a key structural practice that perpetuates equalities,” she said. “It would improve lives for people and their families.”
🆕 @statnews op-ed in Nora's Blog: #NIDA Director Dr. Nora Volkow & colleague Dr. Tisha Wiley discuss how the overdose crisis impacts people in jails or prisons, 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
As for medication-assisted treatment for incarcerated people with opioid use disorders, Volkow argues in the piece that it “benefits public health and public safety. It’s cost-effective. It can help break the cycle of recidivism. It can reduce the burden on the wider health care system, including emergency departments.”
“Programs across the country are underway to offer naloxone and medications for opioid use disorder in jails and prisons, paired with instruction, training, and social support,” she wrote. “Federal agencies have launched programs to help people manage withdrawal in jails and provide financial health care support for people who are about to reenter the community. A recently published revised methadone rule now allows any jail or prison registered as a hospital or clinic to dispense medications for opioid use disorder in certain circumstances.”
A study in Rhode Island estimating that deaths could be reduced by 30 percent in the state if incarcerated people had access to all three FDA-approved medications, Volkow noted. But nationwide, fewer than half of jails and a tenth of state prisons offer all three medications.
“All three are effective, safe, and lifesaving. But they are woefully underused, particularly in criminal justice settings,” she wrote. “Studies also show that people who receive these medications while in jail or prison are less likely to return to substance use and more likely to continue with treatment in the community afterward.”
Roughly 60 percent of people who are incarcerated have a substance use disorder, Volkow added, citing a 2017 Department of Justice report.
Even those charged with enforcing drug laws are “starting to see how addiction treatment increases safety for everyone,” the article says, referencing a Massachusetts sheriff, Chris Donelan, whose jail is one of a small number with a licensed opioid-treatment program:
“When someone is booked into our facility, often we are the first treatment provider the person has seen in years,” Donelan told his University of Massachusetts research partners. “These treatments save lives and help people enter into recovery. Treatment makes the work of our facility much easier. We have less fights, less contraband, and a much safer facility.”
While there’s still a long way to go, Volkow wrote, she drew attention to the National Institutes of Health’s work funding partnerships “to figure out how to link people with addiction to care during and after their time in the corrections system. These researchers are poised to share new evidence as it emerges that will help other communities make data-driven changes so they can implement what is most efficient in justice settings.”
Despite the federal government’s apparent stubbornness to drug reform, Volkow, director of NIDA since 2003, has been a frequent critic of the status quo and a voice in favor of rethinking the country’s criminal approach to substances.
Late last year, for example, she said that taking an abstinence-only approach to drug treatment was “magical” thinking that “costs a lot of lives.”
She’s also said that drug criminalization has “created a structurally racist system” in which Black people are treated “worse” than others.
As for marijuana, Volkow has said there’s “no evidence” that occasional marijuana use is harmful for adults. And at a 2022 D.A.R.E.-sponsored event hosted by an anti-marijuana advocacy group, she reiterated that data showed youth marijuana use had remained stable “despite the legalization in many states.”
Volkow said at a congressional hearing in May, meanwhile, that there’s “tremendous excitement” about the therapeutic potential of psychedelics. However, she cautioned that while the treatment option is “very promising,” people should understand that “it’s not magic” and needs more rigorous research.
The federal official has repeatedly discussed her interest in psychedelics therapy, acknowledging not only the potential but the societal impact of local and state reform potentially encouraging more people to use substances such as psilocybin outside of a clinical context.
She said in 2022 that the “train has left the station” on psychedelics amid the policy reform movement. Volkow discussed the issue in an earlier interview with Marijuana Moment as well.
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