Addressing opioid addiction: treatment, not jail

Drug addiction should be treated as a public health issue, not a criminal justice one.

From 2000 to 2012, the number of unintentional fatal opioid overdoses in Massachusetts increased by 90%. Efforts to reduce addiction through tougher criminal penalties have failed. Instead of reducing addiction, these policies hurt individuals, families and communities by creating criminal records that often prevent offenders from obtaining work, housing or professional licensure.

There are about 4,000 treatment beds in the state, and only 868 are for detox—where patients go to break the cycle of addiction. These resources fall far short for the over 40,000 Massachusetts residents who need, but are not receiving, clinical treatment for addiction. Compounding the problem, long-term inpatient substance abuse treatment is not covered by health insurance, so many cannot afford to get the help they need.

It currently costs the state about $53,000 to incarcerate an individual for one year, while an outpatient substance abuse treatment episode can cost less than $2,500, although costs vary when treatment services are tailored to individual needs. We must implement reforms to transfer funds spent on arresting, prosecuting and incarcerating drug users to substance abuse treatment and supporting social services.

There is not one substance abuse treatment program that works for everyone because the roots of addiction vary between individuals. For treatment to be successful, services beyond detox must be available, including job training, anger management, parenting classes and other skill building opportunities.

Many studies have concluded that treatment is far more cost effective than jail. For example, the National Institute of Drug Abuse notes:

According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1.

Diversion to treatment is the practice of allowing eligible defendants to have their criminal charges dismissed if they successfully complete a court-recognized drug treatment program and participate in surrounding social services. The policy simultaneously reduces addiction and recidivism while saving taxpayer money.

• California implemented diversion to treatment in 2000. A University of California, Los Angeles study found that the program saved the state $2,681 per offender over 30 months, representing a net savings to government of $173.3 million. Within five years of the law's passage, the number of people incarcerated in state prisons for drug possession fell by 32% (over 6,000 people) while treatment beds increased by 66% (700 new beds).
• The Massachusetts Bar Association estimated that implementing diversion to treatment in Massachusetts would save the state over $8 million annually by transferring more than 1,400 low-level drug offenders out of jail and into substance abuse treatment. This estimate only includes savings that would result from a reduction in incarceration costs after substance abuse treatment is paid for. Additional savings would accrue from reductions in crime and health care costs as a result of more people getting the treatment they need.

Carol Rose, executive director of the ACLU of Massachusetts, and Cheryl Zoll, chief executive officer of Tapestry Health, in Boston Globe: State's opioid crisis needs a public health approach

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