How Structural Change Can Help Incarcerated People with Addiction Thrive—and Survive

July 24, 2019

Why This Matters is a series from Roosevelt staff connecting our individual work—from papers to reports and everything in between—to our broader vision of creating a better, more equitable economic and political system. This series will give readers the top takeaways from our latest writing and thinking, with a focus on why they matter as we redefine the rules that guide our social and economic realities.

At least a quarter of the 2.3 million incarcerated people in US are addicted to opioids. The fact that our criminal justice system does not routinely provide treatment for opioid withdrawal or treat addiction as a disease is at best wasteful and counterproductive. Harsh drug laws ensure that we continue to see addiction as a crime rather than a public health problem, leading to a vicious cycle where addicted men and women cycle in and out of prison without getting the emotional, psychological, and physical recovery supports they need.

In Georgia, the situation is particularly dire. The rate of overdose deaths involving opioids has significantly increased in the past five years, reaching nearly 10 deaths per 100,000 Georgians in 2017 alone. Our broken health care system and predatory pharmaceutical industry are responsible for much of this increase; in 2017, doctors in Georgia wrote almost 71 opioid prescriptions for every 100 people. While it’s crucial to rein in our pharmaceutical industry that  prioritizes profiting off of sick people at the expense of affordable medicines and public health, it is also critical that we put in place targeted solutions at the local level to break the cycle of addiction and recidivism—solutions that can lead the way to more robust structural change.

Georgia’s incarceration rate ranks among the highest in the US—970 per 100,000 people in 2018, far surpassing the national average of 698. Uncoincidentally, the state also has one of the most severe drug policies in the country. In 2018, almost 20 percent of inmates admitted to Georgia’s correctional facilities were arrested due to drug offenses. With an estimated two-thirds of incarcerated people in the US addicted to opioids and other substances, it is likely that much of Georgia’s prison population is struggling with addiction.

Virtually all people who leave correctional facilities with untreated addictions return to drug abuse, and more than 65 percent of people incarcerated due to drug offenses get rearrested within three years of their release. As opposed to those whose medications treat or relieve other health conditions (e.g., insulin for diabetes), people who use medications like methadone for opioid abuse treatment cannot continue using them in the correctional system. In part for this reason, incarcerated people with an addiction are 13 times more likely than the general population to die due to an overdose in the two weeks following their release.

When incarcerated, many opioid users go into withdrawal; and upon release, reentering society with untreated addictions, many of these people quickly relapse into drug abuse—the offense that got them into jail in the first place. Successfully reintegrating former inmates into society means addressing the cause of their incarceration and providing them with the means to survive and thrive in their post-incarceration lives. With promising programs across the country, many facilities have succeeded in reducing recidivism and overdose rates by providing incarcerated people medicated-assisted treatments.

It is time for Georgia to join this fight. As explored in a new paper by Roosevelt Network Emerging Fellow Tarun Ramesh, the Athens-Clarke County Jail—backed by key stakeholders, including the county jail commissioner and a local health care provider—is an opportune pilot location to work toward better conditions and health care for incarcerated Georgians struggling with opioid addiction. As advocates build better systems and institutions that support those in need, they should also set their sights on reining in Big Pharma and corporate decision-making that, in the pursuit of profit, endangers the American public with the stroke of a pen.