If President Trump and Congress want to tackle America’s opioid epidemic, accepting the recommendations of his opioid commission to expand addiction treatments would be a good start. However, to address this public emergency with the serious intent that it deserves, the Trump administration also needs a consistent, coordinated approach to both criminal justice and health care.
Commentators weighing in on this issue have neglected the administration’s inconsistency. On the one hand, the Trump-appointed commission headed by Governor Chris Christie (R) recommends removing onerous barriers to medication-assisted treatments for addiction.
On the other, Trump’s Attorney General Jeff SessionsJefferson (Jeff) Beauregard SessionsTrump criticizes Justice for restoring McCabe's benefits McCabe wins back full FBI pension after being fired under Trump Overnight Hillicon Valley — Apple issues security update against spyware vulnerability MORE, wants to revive one of the worst policies of the failed war on drugs: Mandatory prison sentences for people convicted of nonviolent crimes, including minor drug offenses.
The administration simply can’t have it both ways. These positions are completely contradictory.
Sessions recently said, “We don’t have a sentencing problem.” He is wrong. We have a sentencing problem that has long been a powerful contributor to America’s drug problem, because it locks people up and denies them the treatment that they need.
About two thirds of incarcerated Americans have substance use disorders, yet only about one in ten who are clinically addicted get professional treatment while in jails and prison. More than half of those on probation and parole are also untreated.
This staggering treatment gap reflects our longstanding deeply defective national drug policies, which have prioritized a criminal justice response over a public health approach.
To its credit, the opioid commission’s final report identifies the problem of addiction in the criminal justice population and the need to treat people before and after they’re released from prison.
Here are two additional recommendations that will go right to the heart of this health emergency:
1. While expanding treatment before and after incarceration, the administration should complete the cycle and provide treatment while people are incarcerated.
The commission didn’t address one of the most important barriers to addiction treatment for those under criminal justice supervision: federal law prohibits the use of Medicaid dollars to provide healthcare to incarcerated people. And because they must apply or re-apply to Medicaid when they’re released and navigate the health care system to find treatment providers, the same law contributes to a high rate of drug overdoses, relapses and other serious health problems in the first few weeks after they leave prison.
If the administration is serious about stemming the tide of addiction, waiving this Medicaid prohibition must be part of the strategy, just as the opioid commission has called for waiving a similar prohibition on Medicaid funding for many residential treatment programs.
Galvanizing Congress to amend Medicaid statutes can also help to address this challenge. That is the goal of a bill introduced by Rep. Paul Tonko (D-N.Y.) which would enable states to provide Medicaid coverage to eligible people in prison during the 30 days prior to their release. The administration should throw its weight behind this bill.
2. Undertaking widespread sentencing reform is another critical step. We already know that hauling people into prison for minor drug offenses and keeping them there for years will not work, and we have the data to prove it. When New York dismantled the worst parts of the draconian “Rockefeller Drug Laws”, instituting sentencing reforms and expanded access to treatment, the rates of crime and recidivism dropped.
Last year, while still a senator, Sessions voted against a sensible bipartisan bill sponsored by Sens. Charles GrassleyChuck GrassleyAnother voice of reason retires Overnight Health Care — Presented by Carequest — FDA moves to sell hearing aids over-the-counter McConnell: GOP should focus on future, not 'rehash' 2020 MORE (R-Iowa) and Dick DurbinDick DurbinManchin: Negotiators to miss Friday target for deal on reconciliation bill Democrats look for plan B on filibuster The Memo: Cuts to big bill vex Democrats MORE (D-Ill. ) that barred mandatory minimum sentencing for nonviolent crimes, including drug crimes.
This year, the Trump administration should actively support the same bill, which has been introduced again.
These steps would get widespread public support in both red and blue states. According to a survey in 2016 by the Legal Action Center, 78 percent of Americans believe that we need to treat drug and alcohol addiction more as a health problem and less as a criminal problem.
As the epidemic of addiction continues to escalate at alarming rates, a return to the kinds of policies advocated by Sessions would be devastating.
Instead, Trump should launch an ambitious initiative that uses health care to transform our criminal justice system, treats addiction as a disease instead of a crime, and goes a long way toward healing a country that has been ravaged by the opioid epidemic and decades of punitive and ineffective drug policies.
Tracie Gardner is the Associate Director of the Legal Action Center, a national non-profit legal and advocacy organization that works to protect the rights of people with addiction, criminal justice involvement, and HIV or AIDS. Formerly, she served as the Assistant Secretary of Health for New York State.
Retired Lt. Commander Diane Goldstein was the first female lieutenant for the Redondo Beach Police Department. She's now an executive board member for the Law Enforcement Action Partnership (LEAP), a nonprofit group of police, judges, and other law enforcement professionals who advance drug policy and criminal justice solutions that improve public safety.