How Obamacare May Lower the Prison Population More Than Any Reform in a Generation

healthcare reform 2“While many have focused on the individual mandate, and the online (and glitchy) insurance exchanges, one of the most potentially impactful elements of the Patient Protection and Affordable Care Act (ACA) has flown more or less under the radar. It may be the biggest piece of prison reform the U.S. will see in this generation.

The Justice Department estimates suggest that with the expansion of Medicaid, 5.4 million ex-offenders currently on parole or probation could get the health care they need. (It’s important to note that 25 states plus Washington, D.C. have implemented the Medicaid expansion as of 2014. However, many policy experts expect the remaining states to fall in line, citing the historical example of how CHIP was initially rejected by many states when it rolled out in 1997, but is now utilized in every state in the country.)

Even with coverage, those ex-offenders will still need to actually utilize those health benefits, and the key will be making the connection at the time of release. The biggest challenge will be getting state justice systems and health systems – not exactly happy bedfellows in past years – to work together to create coordinated discharge planning between jails and community healthcare.”

http://www.newsweek.com/how-obamacare-may-lower-prison-population-more-any-reform-generation-230695

See related article from the George Washington University Milken School of Public Health –  Affordable Care Act Brings Crucial Health Coverage to Jail Population available at: http://sphhs.gwu.edu/content/affordable-care-act-brings-crucial-health-coverage-jail-population

See related article from the Fix – Obamacare Rolls Out, Transforming Addiction Coverage available at: http://www.thefix.com/content/obamacare-rolls-out-addiction-coverage-transforms

Source: Newsweek.com – March 10, 2014

Crime Does Not Increase Around Methadone Clinics in Baltimore

crime purchased shutterstock_78337543“Citizens’ concerns that methadone treatment centers (MTCs) might be focal points for serious crime are unwarranted, a recent NIDA-supported study suggests. Dr. Susan Boyd and colleagues at the University of Maryland School of Medicine in Baltimore found that crime rates in the immediate vicinities of that city’s MTCs were level with the rates in the surrounding neighborhoods.

The researchers used Baltimore City Police Department records from 1999‒2001 and global positioning data to plot the distribution of FBI Part I crimes (homicide, forcible rape, robbery, aggravated assault, burglary, larceny theft, motor vehicle theft, and arson) within a 100-meter (328-foot) radius of 15 MTCs. A statistical analysis of the plots showed that the crimes were no more frequent within 25 meters of the MTCs than they were 75 to 100 meters away.

In contrast to the case with MTCs, the likelihood of Part I crimes rose with closer proximity to convenience stores. The researchers suggest that the high volume of foot traffic around these stores provides opportunities for criminals to find victims. Consistent with this surmise, the frequency of crime declined near mid-block residences, where foot traffic is relatively sparse.

The study MTCs included all but one of the 16 centers located in Baltimore. They were situated in diverse communities, including inner-city, working-class, and middle-class neighborhoods, according to Dr. Boyd. The convenience stores and residences were located in neighborhoods that closely resembled those of the MTCs in demographic and social features that influence crime rates.

“There’s no evidence from our study of increased reports of crime around the methadone clinics,” says Dr. Boyd. She and colleagues are now analyzing data on actual arrests around the study sites to see whether drug sales and possession increase with proximity to methadone treatment centers. The researchers hope that demonstrating that MTCs are not hot spots for crime will reduce public resistance to the building of new centers, and thus remove an impediment to making methadone treatment more widely available.”

See graphs available at: http://www.drugabuse.gov/news-events/nida-notes/2012/12/crime-does-not-increase-around-methadone-clinics-in-baltimore

See related blog available from the Institute on Research, Education and Training in Addictions (IRETA) available at: http://iretablog.org/

Source: National Institute on Drug Abuse (NIDA) Notes – January 2014, IRETA – February 13, 2014

Supreme Court: Heroin Dealer Can’t be Given Longer Sentence Because Client Died

Pg8_law“The U.S. Supreme Court unanimously ruled a heroin dealer cannot be held liable for a client’s death and given a longer sentence if heroin only contributed to the death, and was not necessarily the only cause.

The ruling is likely to result in a shorter sentence for Marcus Burrage, who received 20 extra years in prison because of his client’s death, according to USA Today. The decision is also likely to make it more difficult in the future for prosecutors to extend drug sentences, the article notes.”

New Mexico Jail Methadone Program Shows Mixed Results

jail croppedjailjail cropped
jail cropped“A recent study conducted by the University of New Mexico found that inmates in the methadone maintenance program, which provides a daily dose of methadone to inmates already enrolled in a community-based methadone program, spent almost 40 days longer out of jail than their opiate-addicted counterparts not enrolled in a methadone program. That amounts to per-inmate savings to taxpayers of almost $2,700, according to the study, as taxpayers shell out around $69 to house an inmate per day.

The study published in early December, however, contains another finding that erases the savings: Inmates enrolled in the methadone program tended to stay in jail 36 days longer than other inmates. It’s unclear what causes methadone inmates to stay longer, though the program’s directors and others have a couple guesses – that methadone-receiving inmates are more comfortable in jail than those addicted to heroin, and that inmates getting methadone tend to prefer serving their full sentences and leaving jail without probation.”

http://www.abqjournal.com/331644/news/methadone-program-shows-mixed-results.html

Source:  ABQJournal.com – January 6, 2014

Blog: What Health Care Reform Could Mean for Drug Policy and Mass Incarceration

healthcare reform 2“What does the Affordable Care Act (ACA) mean for drug policy?. A new issue brief – From Handcuffs to Healthcare — published by the Drug Policy Alliance (DPA) and the American Civil Liberties Union(ACLU) outlines how the ACA could help our country end the war on drugs and move toward a health-based approach to drug policy

This paper is intended as a starting framework for criminal justice and drug policy advocates to navigate the ACA, and to take advantage of the conceptual and practical opportunities it offers shifting the conversation and the landscape.

Part One of this paper describes some of the major provisions of the ACA relevant to our work: the health insurance requirement; the places many people will buy insurance, called health exchanges; Medicaid expansion; insurance coverage requirements for substance use and mental health disorders; and opportunities for improved models of coordinated care.

Part Two of this paper outlines a series of practical recommendations, including program and policy examples and suggested action steps, across three broad categories:

  • Ensuring access to care for people most likely to be steered into the criminal justice system under the current framework
  • Leveraging the ACA to reduce incarceration and criminal justice involvement
  •  Moving from a criminalization-based drug policy approach to one rooted in health

The Brief can be accessed at: http://www.drugpolicy.org/sites/default/files/Healthcare_Not_Handcuffs_12.17.pdf

Source: HuffingtonPost.com - December 3, 2013 and DrugPolicy.org – December 2013

Locked Up in America Infographic

jail croppedThe Criminal Justice Degree Hub has developed an infographic that shows that 46.8% of federal prisoners are incarcerated for drug offenses. Other statistics include yearly correctional spending by state and the number of prisoners by year.

http://www.criminaljusticedegreehub.com/locked-up-in-america/

Source: CriminalJusticeDegreeHub.com – October 2013

Eric Holder Unveils New Reforms Aimed At Curbing US Prison Population

“The US government took the first tentative steps toward tackling its 1.5m-strong prison population on Monday by announcing that minor drug dealers would be spared the mandatory minimum sentences that have previously locked up many for a decade or more.

Reversing years of toughening political rhetoric in Washington, attorney general Eric Holder declared that levels of incarceration at federal, state and local levels had become both “ineffective and unsustainable.”

The Department of Justice will now instruct prosecutors to side-step federal sentencing rules by not recording the amount of drugs found on non-violent dealers not associated with larger gangs or cartels.”

http://www.theguardian.com/world/2013/aug/12/eric-holder-smart-crime-reform-us-prisons

Source: The Guardian.com – August 12, 2013

Study: Many Arrested Men Use Illegal Drugs But Don’t Receive Treatment

jail“More than 60% of men arrested in five U.S. cities used at least one illegal drug, but fewer than 15% received drug treatment, a government report found.

Data from the Bureau of Justice Statistics indicate that 68% of jail inmates, 53% of state prison inmates and 46% of federal prison inmates abuse or are addicted to drugs and alcohol.”

http://www.usatoday.com/story/news/nation/2013/05/23/half-of-men-arrested-used-drugs/2356033/

Source: USAToday.com – May 23, 2013

Study: Sending Nonviolent Drug Offenders to Treatment Instead of Prison Saves Money

“When it comes to nonviolent drug offenses, systems that favor treatment over incarceration not only produce better health outcomes, they save money, too. It’s yet another example of how investing in public health and prevention yields valuable returns on investment.

In a new study published in the June issue of the American Journal of Public Health (AJPH), researchers found that California’s Substance Abuse and Crime Prevention Act, which diverts nonviolent drug offenders from the correctional system and into treatment, saved a little more than $2,300 per offender over a 30-month post-conviction period. In fact, researchers estimated more than $97 million in savings for the 42,000 offenders affected during the first year of the law’s implementation. And even though the law resulted in spending more on treatment, health care services and community service supervision, bypassing incarceration still yielded overall savings, said study co-author M. Douglas Anglin, founding director of the UCLA Drug Abuse Research Center and associate director of the university’s Integrated Substance Abuse Programs.

According to a 2009 report from California’s Legislative Analyst’s Office, incarcerating a single offender costs California approximately $49,000 per year.”

http://scienceblogs.com/thepumphandle/2013/05/24/study-sending-nonviolent-drugs-offenders-to-treatment-instead-of-prison-saves-money/

Source: Scienceblogs.com - May 24, 2013

How to Make Drug Courts Work

Pg8_law“Drug courts have made a surprisingly small contribution to the crime reduction that has occurred over the past twenty years. They process only a small fraction of drug-involved offenders within the criminal justice system, and an even smaller fraction of offenders who commit serious crimes. Most chronic cocaine, heroin and methamphetamine users who reach court will end up in jail or prison, often for minor crimes.

Drug courts could be more helpful in reducing crime and incarceration, but only if they become more ambitious and less risk-averse by taking in populations likely to serve real time.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/26/how-to-make-drug-courts-work/

Source: WashingtonPost.com – April 26, 2013

Forced Methadone Withdrawal in Jails Creates Barrier to Treatment in Community

jail croppedMethadone treatment for opioid dependence remains widely unavailable behind bars in the United States, and many inmates are forced to discontinue this evidence-based therapy, which lessens painful withdrawal symptoms. Now a new study by researchers from the Center for Prisoner Health and Human Rights, a collaboration of The Miriam Hospital and Brown University, offers some insight on the consequences of these mandatory withdrawal policies.

According to their research, published online by the Journal of Substance Abuse Treatment and appearing in the May/June issue, nearly half of the opioid-dependent individuals who participated in the study say concerns with forced methadone withdrawal discouraged them from seeking methadone therapy in the community after their release.

“Inmates are aware of these correctional methadone withdrawal policies and know they’ll be forced to undergo this painful process again if they are re-arrested. It’s not surprising that many reported that if they were incarcerated and forced into withdrawal, they would rather withdraw from heroin than from methadone, because it is over in days rather than weeks or longer,” said senior author Josiah D. Rich, M.D., M.P.H., director of the Center for Prisoner Health and Human Rights, which is based at The Miriam Hospital.

He points out that methadone is one of the only medications that is routinely stopped upon incarceration. “This research highlights that what happens behind bars with methadone termination impacts our ability to give methadone, a proven treatment, to people in the community,” he added. “Given that opioid dependence causes major health and social issues, these correctional policies have serious implications.”

For the past four decades, methadone has been the treatment of choice for opioid dependence, including heroin, and is on the World Health Organization’s list of “Essential Medicines” that should be made available at all times by health systems to patients. This “anti-addictive” medication prevents withdrawal symptoms and drug cravings and blocks the euphoric effects of illicit opioids. Additionally, methadone therapy has been shown to reduce the risk of criminal activity, relapse, infectious disease transmission (including HIV and hepatitis) and overdose death.

However, in the United States, a significant proportion of people who are opioid dependent are not engaged in methadone replacement therapy. Rich says the majority of patients terminate treatment prematurely, often within the first year.

In their study, Rich and colleagues surveyed 205 people in drug treatment in two states – Rhode Island and Massachusetts – that routinely enforce methadone withdrawal in correctional facilities. They found nearly half of all participants reported concern regarding forced methadone withdrawal during incarceration. Individuals in Massachusetts, which has more severe methadone withdrawal procedures, were more likely to cite concern.

“If other evidence-based medicines like insulin therapy were routinely terminated or withdrawn from those who were incarcerated, we would hear about these serious lapses in care. They would likely garner some attention. But routine termination of methadone maintenance therapy has been occurring in the criminal justice system for decades and remains a little discussed and highly neglected issue,” says lead author Jeannia J. Fu, Sc.B., a former researcher with The Miriam Hospital who is now affiliated with the Yale University School of Medicine.

Rich adds, “We should examine the impact of incarceration itself, and what happens behind bars, on public health and public safety outcomes, and tailor our policies appropriately. We have methadone, which has been shown to improve public health and public safety, yet we have policies that reduce access to this treatment. The correctional policies on methadone should be re-evaluated in terms of the impact they have on the individual and the community.”

http://www.eurekalert.org/pub_releases/2013-03/l-fmw032713.php

Information on the American Association for the Treatment of Opioid Dependence (AATOD) initiatives to increase access to methadone treatment in the Criminal Justice System is available at: http://www.aatod.org/projectseducational-training/methadone-treatment-in-the-criminal-justice/

Source: Eurekalert.org – March 27, 2013

A Day at the Drug Court

“Developed locally, their operations vary significantly. Defendants are diverted to drug court programs at various stages in the judicial process. And while many people arrested for non-violent offenses are eligible, prosecutors ultimately determine who gets offered the option of treatment. Participants must usually plead guilty as a prerequisite, and they’re drug tested throughout treatment. Judges can reward or punish their behavior: Incentives include certificates, cards and applause from the courtroom. Sanctions include admonishments, assigned essays, increased drug testing and court appearances, and, sometimes, a few days or weeks in jail.”

“Drug courts are one of the most important pieces of evidenced-based drug policy reform we have seen in generations,” US drug czar Gil Kerlikowske says in an email to The Fix. “By providing non-violent drug offenders with a chance to reclaim their lives through treatment rather than wasting away in prison, we save lives, save taxpayer dollars, reunite families, and reduce rates of incarceration. Decades of research and experience reveal that addiction—the underlying cause of too much crime in our communities—is a disease that can be successfully treated. Drug courts are what today’s discussion about drug policy should be about.”

http://www.thefix.com/content/drug-courts91363

Source: The Fix.com – March 5, 2013

Outside Box, Federal Judges Offer Addicts a Free Path

“Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive. The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.”

http://www.nytimes.com/2013/03/02/nyregion/us-judges-offer-addicts-a-way-to-avoid-prison.html?_r=1&

Source: NYTimes.com – March 2, 2013

Drug Abuse Treatment Could Save Billions in Criminal Justice Costs

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community.

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.

The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison.

According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.

The study builds on previous research led by RTI indicating that increased investment in treatment for substance-abusing prisoners can reduce crime rates and cut criminal justice spending. In a study released earlier this year, Zarkin and colleagues found that increasing and improving prison-based drug treatment programs could save up to $17 billion in criminal justice system costs.

http://www.newswise.com/articles/study-replacing-prison-terms-with-drug-abuse-treatment-could-save-billions-in-criminal-justice-costs

Source: RTI International – January 9, 2013

Plan to End Methadone Use at Albuquerque Jail Prompts Alarm

For the last six years, the Metropolitan Detention Center, New Mexico’s largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so.

In November, however, the jail’s warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive.

Moreover, Mr. Rustin, a former warden of the Allegheny County Jail in Pennsylvania and a 32-year veteran of corrections work, said he did not believe that the program truly worked.

http://www.nytimes.com/2013/01/07/us/alarm-in-albuquerque-over-plan-to-end-methadone-for-inmates.html?smid=fb-share&_r=2&

Source: NYTimes.com – January 13, 2013

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