America's Opioid Epidemic and Mass Incarceration Crisis Are Inextricably Linked | Opinion

A man uses heroin under a bridge where he lives with other addicts in the Kensington section which has become a hub for heroin use on January 24, 2018 in Philadelphia, Pennsylvania. Spencer Platt/Getty Images

Late last year, the Centers for Disease Control and Prevention released the sobering news that American life expectancy had fallen in 2017, continuing a dismal trend not seen since the heights of World War I, when hundreds of thousands of Americans died on the battlefields of Europe and from a global flu pandemic.

The CDC pointed to two culprits: the nation's skyrocketing suicide epidemic and the ongoing opioid crisis, which is ravaging the entire country. More than 49,000 Americans died from opioid-related overdoses in 2017, setting a grim new record. The number of deaths caused by legally-prescribed opioid medications and substances sold illegally, such as heroin and fentanyl, was nearly six times higher in 2017 than in 1999. The Council of Economic Advisers estimates that opioid abuse, addiction, and overdose cost the country $504 billion in 2015, the most recent year available, a number equivalent to 2.8 percent of GDP.

But the opioid epidemic isn't taking place in a vacuum, and is best understood as one of three interconnected national crises: substance abuse, mental illness, and mass incarceration. We can begin to curb all of them if we provide inmates with the types of medical care and support programs that they need to break their addictions and bring their mental illness under control. That's what the Constitution demands, it's what human compassion dictates, and it's one of the only things that can begin to reduce the costs of incarcerating people with addiction or diseases like schizophrenia.

The raw numbers are staggering. Nearly 2.2 million Americans are incarcerated in federal or state prisons (which hold people convicted of serious crimes for long periods of time) and local jails (which hold people awaiting trial or serving shorter sentences). According to data from the Bureau of Prison Statistics, more than 1.5 million of them are estimated to have drug or alcohol problems, and nearly 380,000 are thought to have regularly used opiates or heroin before they were incarcerated. More than 400,000 are thought to have a mental-health disorder.

People find themselves behind bars for different reasons, but they have one thing in common: a constitutional right to getting treatment for their addictions or mental illness while incarcerated.
In a landmark 1976 decision, the Supreme Court ruled that deliberate indifference to prisoners' legitimate medical needs constituted cruel and unusual punishment and violated the Eighth Amendment to the US Constitution.

The sad truth, though, is that most inmates aren't getting the care they deserve – or that the government is legally required to give them.

Instead, newly-incarcerated inmates with opioid addictions are given little to no medical assistance when they're forced to stop their use of the drug, leaving them vulnerable to painful withdrawal symptoms that range from nausea to vomiting and muscle spasms.

Inmates with mental-health disorders like schizophrenia, meanwhile, are often confined in isolation, where their conditions can quickly worsen. The contrast with the civilian world couldn't be starker: outside of jails and prisons, people facing similar challenges can receive medication, counseling, and other support designed to keep them from backsliding.

It isn't cruelty that drives our national failure to give inmates relief from opioid withdrawal symptoms or adequate mental health treatment: it's money. Most correctional health systems simply don't have the funds necessary to provide treatment to their inmates with addiction or diseases like schizophrenia.

The sad irony is that giving inmates the treatment they need while they're incarcerated saves significant amounts of money by sharply reducing the odds that they will wind up back behind bars.

Fully three-quarters of the inmates with opioid addictions, for instance, relapse within three months of their release if they're not given help while in jail or prison. And keeping them there isn't cheap: the average annual cost of federal imprisonment is $36,300 per prisoner . By contrast, the average annual cost of providing opioid-addicted individuals with medication is just $4,000 a year. Giving inmates that help – and keeping them out of jail or prison – would save taxpayers money.

It's the same with mental illness. People with schizophrenia can go to their doctor and get injected with a medication that helps control their symptoms and costs $83 per day. Putting them in prison costs taxpayers at least $99 per day, or $16 more per day than would be necessary if the patients had gotten treated before their run-ins with the law.

The benefits of proper treatment can also be a literal matter of life-and-death differences for many inmates. Rhode Island once had the nation's seventh highest opioid overdose death rate. In 2016, it began investing in better treatment programs for people with opioid addictions during and after their time in prison. The program includes medication, therapy, and assistance in finding jobs and housing – and it's worked wonders. State officials say the initiative has cut the number of post-incarceration overdose deaths by an eye-opening 61 percent.

Rhode Island's success story helps illustrate an important point: we already have effective and relatively low-cost tools for helping inmates who have opioid addiction or mental illness prepare for their post-release lives. Programs like this will pay for themselves over time; the question is whether there's the political will to make sure they're used more widely.

The Trump administration, led by presidential adviser Jared Kushner, recently pushed a prison reform bill through Congress that should result in more inmates getting help with their opioid addictions while they're incarcerated. Changing how the nation treats the hundreds of thousands of inmates who have substance abuse problems or mental illness won't be easy, but it's what the country needs to do legally and financially. We've stuck with a broken system for far too long. It's time to build a new one.

Michael C. Barnes is chairman of the not-for-profit Center for U.S. Policy. He served as confidential counsel in the White House drug policy office under President George W. Bush.
