Let’s try cures, not criminalization, for the opioid epidemic

With each prison sentence, America normalizes the ways incarceration functions as an abyss — a socioeconomic black hole — that swallows public funding, the dignity of substance-dependent individuals, and the moral authority of the nation. The thick overcast of failure in the war on drugs reveals the inability to incarcerate our way out of the opioid crisis. We can elect to spend public money on health care that creates new possibilities for Americans, or incarceration that forecloses futures for people burdened by a curable illness.

From statehouses to the White House, schoolyards to backyards, we must ask ourselves, “What does the American money trail say about the nature of our republic?” Any earnest legislative strategy or morally inspired movement to end the opioid epidemic must include strengthening the benefits of and expanding access to Medicaid, not prisons.


Thanks to the Affordable Care Act’s (ACA) requirement of states to include substance use disorders in health care coverage, Medicaid plays a critical role in combating the opioid emergency. Yet only 12 states fund comprehensive clinical services to treat substance use disorders, including varying gradations of outpatient, inpatient and residential treatment. According to the Center on Budget and Policy Priorities, “The uninsured rate among people with opioid-related hospitalizations fell dramatically in states that adopted the Medicaid expansion, from 13.4 percent in 2013 (the year before expansion took effect) to just 2.9 percent two years later.”

Several governors rejected Medicaid expansion, and conservative legislators have tried to gut existing health care funding, obstructing the path toward healing from this public health crisis. In Ohio, 700,000 residents have Medicaid as a result of expansion under the ACA, but the legislature’s proposal to override Gov. John Kasich’s veto of freezing enrollment to Medicaid could harm 400,000 Ohioans. Likewise, President TrumpDonald TrumpWhite House denies pausing military aid package to Ukraine Poll: 30 percent of GOP voters believe Trump will 'likely' be reinstated this year Black Secret Service agent told Trump it was offensive to hold rally in Tulsa on Juneteenth: report MORE’s endorsement of repealing the ACA and his administration’s increased work requirements for safety net programs deflates his resolve to address opioid addiction.

We appropriate public money to turn people in need of medical care into criminals — those who are addicted. In a news conference before the midterm elections, former Toledo, Ohio, mayor Carty Finkbeiner noted: “Opioid addiction is not a partisan issue — it’s killing people and destroying families in both red and blue states. President Trump himself has declared that the opioid crisis is a public health epidemic — though there has been little concrete policy action to address it in today’s hyper-divided Congress.” Although Ohio has experienced some decline in its opioid epidemic, the state ranked second in the nation (to West Virginia) in fatal overdoses last year.

Alaska, Connecticut, Utah, California and Oklahoma have taken measures toward decriminalization of narcotic use, reclassifying many drug felonies as misdemeanors. But last month, Ohio voters rejected a constitutional amendment aimed at reducing penalties for low-level drug possession and preventing the criminalization of substance use disorders; more than 63 percent of voters opposed Ohio Issue 1.

Of the many anticipated benefits that had excited its supporters, the ballot measure would have changed low-level, nonviolent drug possession charges to misdemeanors and retroactively reclassified past offenses; redirected money saved from not incarcerating people for low-level drug crimes and probation violations into drug treatment, mental health and trauma recovery service; and saved tax dollars by removing those suffering mental health and addiction problems from prison and placing them into treatment.

The criminalization of drug use diverts public funding away from life-giving, humanizing options inherent in health care programs: it is cheaper to treat addiction than to incarcerate people. More than 40 years after President Nixon declared a “war on drugs,” more than 1.25 million arrests occur each year for drug possession. And among those incarcerated, not all inmates who need drug treatment take part in programs offered. The National Institute of Drug Abuse purports that opioid use characteristically resumes after a person is released, intensifying the risk of overdose-related fatalities.  

The opioid crisis in America necessitates curative justice, not retributive justice. In fact, the narrow ways we use the prison system to control the underclasses of Americans pose a danger to public health. One might argue that even short stints in violently dehumanizing prisons and jails, designed to erase one’s agency and value, do more harm to the person with substance use disorder than do drugs.

The moral costs of defaulting to incarceration as the remedy for social crises are too high. Structural poverty and political powerlessness reduce classes of people to invisibility under the moniker of criminal justice. The criminalization of addiction empties homes of parents and breadwinners, leaving children in need. State and federal legislatures should decriminalize simple possession of drugs and pass legislative measures to infuse public resources into treatment programs and the expansion of Medicaid.

Willie D. Francois is senior pastor of Mount Zion Baptist Church in Pleasantville, New Jersey, president of the Black Church Center for Justice and Equality, and a fellow for the Center for Community Change.