In 2016, more than 42,000 people died from opioid overdoses in the U.S., representing 66 percent of all drug fatalities — and it has been on the rise since. As the opioid crisis rages on, the issue of how to treat the epidemic is a source of heated and continual debate.
While the scale of the problem is undeniable, public officials and private treatment centers are still searching for the solution to curb not only the fatalities but the financial impact on communities as well. This epidemic is costing us money — and lots of it.
The Council of Economic Advisors estimates that the economic cost of the opioid crisis was $504 billion in 2015. Seventy-three percent of that figure was spent on expenses related to treating addiction and incarcerating drug offenders. Yet, even if only 1 percent of the total prison population received treatment for addiction instead of jail time, we could save $2.2 billion per year.
By offering addicts a chance at recovery—not criminalizing them and placing them in prison—communities will save money, and addicts have an opportunity at a new start in life.
Tackling Addiction Through Legislation
Earlier this year, President Trump unveiled the White House Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand – aimed at increasing access to addiction treatment, particularly “medication-assisted” options, and providing additional funding for drug courts (specialized programs that work to keep criminal offenders with drug dependencies out of prison).
The initiative has been met with mixed reviews — in part, because drug court programs aren’t always the easiest or most effective option, particularly for the abuse of drugs like opioids. Drug courts are a public initiative paid for by tax dollars. The often black-and-white policies upon which they operate don’t allow for the nuances required to treat addiction as a disease, nor do they provide the individualized care needed to support long-term recovery.
“Opioid overdoses are resulting in staggering death rates like we’ve never seen,” says former New Jersey governor Chris Christie, who chaired the commission on opioid abuse responsible for the initiative. Christie is continuing his work in the fight against the opioid crisis as the new Executive Chairman of Beach House Center for Recovery in Juno Beach, Florida. “It’s a different kind of drug crisis, which means we need to take different, more progressive measures to tackle it. For one, we need to reduce the stigma and criminality of it, so we can first focus on treatment that reduces the addiction itself.”
At the city and state government levels, the concept of offering alternatives to incarceration isn’t a new one. The national problem-solving court movement started back in 1989, when Florida established the country’s first drug court in Miami-Dade County. Today, the state remains a leader when it comes to finding alternative solutions to drug addiction challenges. In fact, Florida Attorney General Pam Bondi is suing five of the largest manufacturers and distributors of opioids, blaming them for creating the opioid crisis.
Private inpatient rehabs and outpatient treatment centers also struggle because of this. Addicts who are facing legal issues often feel like they can’t seek treatment. Or, if they do go to rehab, they’re preoccupied with their impending sentences rather than focused on getting better.
Disrupting the Link Between Crime and Addiction
It might be easy to dismiss the opioid crisis as not applicable to you, your family, or even your community depending on your personal situation or where you live. But make no mistake — it’s taking an increasing toll on entire communities, families, and individuals coast to coast.
Breaking Down the Types of Drug-Related Crimes
Nationwide, 80 percent of crimes involve some type of drug or mind-altering substance, according to the most recent study conducted by the Center on Addiction. This includes 83 percent of property crimes, 78 percent of violent crimes, and 77 percent of other crimes including public order, immigration, and weapons offenses.
On a national scale, drug crimes make up the majority of offenses at 31.6 percent, according to data from the United State Sentencing Commission. Comparatively, violent crimes like murder and assault only account for 0.1 and 1.2 percent of offenses, respectively.
This trend also follows suit on a local level, according to recent data from Florida courts. In Florida, for example, 67 percent of offenses are drug or property crimes (including drug possession, burglary, forgery, and fraud) rather than violent crimes. In the first half of 2017, Florida saw 26,407 defendants facing charges for drug-related crimes — more so than any other category of offenses.
Yet, our laws often still fail to distinguish between general criminal activity and crimes motivated by or directly related to drug and alcohol abuse — especially non-violent crimes such as possession and DWI. These laws treat violent criminals and people who use drugs exactly the same way. It’s not surprising that we’re seeing soaring incarceration rates for addicts (who have less than a 25 percent chance of getting proper treatment in prison) and little effort to combat the underlying challenges fueling the core addiction that leads to these illicit behaviors.
Legal issues are a common barrier to treatment and a primary cause of “against medical advice” (AMA) discharges from private rehabs. The result is an unstable patient population that resists commitment to long-term treatment due to the fear of legal repercussions.
The Scope of the Burden on Courts and Taxpayers
According to research studies, higher rates of drug imprisonment do not translate to lower rates of drug use, arrests, or overdose deaths. Despite that reality, the volume of opioid-related and other drug-related criminal cases is overwhelming our already-strapped court system.
Micah Robbins, a community substance use prevention leader with the Palm Beach County Substance Awareness Coalition (PBCSAC), points out that in the first half of 2017, there were 3,850 drug-related arrests in Florida’s Palm Beach County alone. “That’s 7,700 for the year,” says Robbins. “When you extrapolate those numbers on a state- and nationwide scale, the number of people entering the legal system for drug-related offenses is staggering.”
Of those drug-related Palm Beach County cases, the majority were due to drug use, not distribution. Most people dealing with the disease of addiction are not violent. However, these non-violent offenders end up in the same system as violent criminals, which costs the U.S. $182 billion, according to a 2017 Prison Policy Initiative report.
The same report estimates a population of 2.3 million incarcerated offenders, meaning each prisoner costs about $79,130. Imagine if only a fraction, say 10 percent (about 230,000), of those offenders received rehabilitation instead of jail time — the criminal justice system could potentially save $18 billion a year.
In addition, the reduced healthcare costs that come from supporting long-term recovery could further lower the overall financial burden. For instance, the National Institute on Drug Abuse estimates that a year of methadone maintenance is $19,300 cheaper than a year of incarceration. If addicted offenders received drug treatment instead of being criminally prosecuted, that could save the system another $4 billion each year, for a total savings of $22 billion.
Alternatives to Incarceration: Benefits & Challenges of Current Models
Alternative solutions to incarceration have been developed and tested — some with significantly improved success rates — both in public arenas as well as privately-funded recovery centers.
Publicly Funded Drug Courts: A Step in the Right Direction, But an Incomplete Solution
In drug courts – which all states have adopted in some form or another as of 2018 – police, judges and prosecutors work with attorneys and treatment specialists to help addicts facing criminal charges get help, rather than a criminal charge and prison time. The model removes addicts from the criminal court system and instead requires them to complete group counseling and undergo mandatory drug testing. Drug courts are generally a more effective option for people with drug-related criminal issues than standard criminal prosecution.
As an example, in 2016, Florida saw 6,590 admissions to its drug court programs, and nearly 60 percent of participants graduated. Nationally, 75 percent of drug court grads remain arrest-free (compared to 30 percent of those released from prisons). Drug courts also reduce crime by 45 percent, compared to traditional sentencing. Additionally, sending offenders to drug courts rather than state prison is estimated to save up to $13,000 per person. When looking at the 6,590 participants the Florida drug courts saw in 2016, that’s a total of $85.7 million saved.
While this is a notable improvement, drugs courts can still be expensive programs for the government to operate. They also remain challenging to navigate for many of those in recovery. It’s not unusual for an addict who is having a hard time staying sober to be stressed to the point of relapse by the process required to abide by drug court guidelines. Additionally, some feel drug addiction is best treated by health professionals, rather than the court system.
Medically Assisted Treatment: Effective But Requires Medical Professionals
Due to the intense way the human body reacts to opioids, successfully treating opioid addiction often requires medically assisted treatment, or MAT. MAT involves administering FDA-approved medications that alleviate withdrawal symptoms — such as methadone, buprenorphine (more commonly known by the brand name Suboxone), and naltrexone — alongside holistic treatment such as counseling and behavioral therapies.
Gaining access to proper treatment through publicly funded options is particularly tricky for opioid addicts. Drug courts aren’t required to administer MAT to opioid addicts. One of the most significant issues with MAT clinics is that they emphasize the “medical” aspect over the “treatment” aspect. With limited resources, these clinics are more likely to hand out medication to alleviate addicts’ withdrawal symptoms than provide addicts with the counseling and support that increase the chances of addiction recovery.
But expecting heavily addicted opioid users to quit cold turkey creates a potentially deadly cycle of relapse into both drug use and criminal behavior. The stakes are only heightened if probation terms require addicts to get and stay clean. In Massachusetts, for example, addicts can be sent to jail if they test positive for drug use while on probation—marking them a criminal just for struggling with their disease. Yet those same people are not guaranteed access to adequate addiction treatment.
The consequences of administering MAT without proper support can be severe. Ideally, the decision to use any type of MAT should be made by a medical professional who has direct knowledge of and interaction with the individual patient.
Private Court Liaison Programs: More Holistic Approach, But Not Accessible to All
While public options may lean too heavily on the court system, private treatment centers often have the opposite problem. Even when addicts make it into treatment programs, their pending legal problems can quickly derail their recovery while they are in treatment or once they’re back in the real world.
“Imagine spending 60 to 90 days in a treatment facility, getting sober and well, only to get arrested the second you arrive home because you didn’t address your legal issues,” says Anna Ciulla, Beach House’s Vice President of Clinical and Medical Services. “It’s a total setup for relapse.”
Some private recovery programs have found an effective solution by providing their clients with legal assistance. This allows clients to focus entirely on their recovery while a licensed attorney oversees their legal issue resolution.
“By having this outside entity to assist, particularly an attorney, we can manage the legal issues, so the client can focus on skills for sobriety and coping,” Ciulla explains. For example, as part of Beach House’s Court Liaison Program, a client can travel to treatment despite pending legal restrictions.
At Beach House, about 50 percent of the clients take advantage of the program as part of their recovery, but this option is not available in all private treatment centers. That said, the high usage at Beach House suggests that this type of program is in high demand and is of high value. The cost of private treatment is also a significant barrier to entry for lower-income addicts. Generally, court liaison programs at treatment facilities are currently only available to those who have private insurance or those who can afford to pay out of pocket for a private treatment center with a similar program.
The attorney who supervises Beach House’s Court Liaison program helps clients get into treatment and identifies legal issues during the admissions process. With the opioid crisis affecting an entire generation of people and draining billions of dollars out of the economy, the Court Liaison program and other similar programs may just be a key to helping end this cycle. Treating the client’s addiction and offering them legal support is a holistic solution that addresses the realities.
A Patient’s Story
John (whose name has been changed) struggled with alcoholism and opiate addiction for years and was facing felony charges after being arrested for a DUI and possession. He finally sought treatment, but his legal issues prevented him from completing the program.
John traveled from his native New Jersey to Florida to undergo recovery treatment. “[In treatment], all I could think about was that I was going to jail,” John says. “I had a court date two weeks in. My therapist tried to move my court date, but the court refused. The pressure was too much. I picked up some drugs from a friend the minute I got back to New Jersey, and I was high on the way to court that day. I continued using while that case went on,” he adds.
He was eventually convicted and sentenced to time served — and that felony status shifted his mindset. “I lost all hope for having any kind of a future, and that started the serious spiral.” By the time of his second arrest several years later, John was moving from house to house, with no job, and stealing to support his habit. And after submitting a dirty urine sample during his last probation visit, he knew a warrant would be issued for his arrest. It was time to get serious about treatment again, but he thought his probation status limited him to public in-state treatment options.
After calling multiple out-of-state rehabs hoping for a solution, he eventually found one that could help address both his addiction and related legal problems. “They put me on the phone with their Court Liaison program, and they helped me make a plan to deal with my warrants and probation,” he says. “The court liaison took care of all the details: getting a public defender, getting warrants recalled, letting probation know everything they needed to know, and getting documentation to my attorney.”
John has remained sober for eight months, and he credits the holistic support approach he received, in addition to regularly attending 12-step meetings.
The Ideal Path: Harnessing Combined Public and Private Solutions
Fortunately, public and private programs are increasingly working together to solve the complex problems associated with the addiction epidemic, but there’s still a long way to go.
“Right now, first responders drop overdose victims at the emergency room and hope for the best, and many still treat in the street,” says Robbins. “Public beds fill up quickly, and the system is overwhelmed mentally, physically, and financially.”
Local police and legal systems also have limited funds, which makes undertaking new initiatives a challenge, especially as the number of arrests and incarcerations continues to grow. What most people well-informed on the topic agree on is this: It’s a vicious cycle and drain on public resources to re-arrest and reincarcerate drug users. By creating a partnership between law enforcement and private treatment centers, addicts receive better treatment, and the burden on public services could potentially be reduced by billions of dollars each year.
“We’ve tried the short-term fixes and discovered a pill won’t cure pills,” Robbins says. “So, we’ve developed a long-term solution — continued support, sobriety, and less incumbrance of legal issues, all at the same time.”
In its efforts to convey the severity of the epidemic and promote effective solutions, Beach House partnered with former New Jersey Governor Chris Christie. By gaining Christie’s expertise in the public sector, Beach House intends to fully develop its relationship with publicly-funded options and make treatment more widely accessible.
“Jail time is not the answer to the opioid crisis,” says Christie. “Without access to proper treatment and a solid support network, those struggling with addiction don’t have a chance at real recovery. Public and private sectors need to start working together to expand the resources available to addicts and get them the help they need.”
When rehabilitation works, it brings people back into their previous life, before their addiction. It may even give them a sense of purpose that they’d never had. History has shown that better citizens are rarely created by spending a year sitting in jail. The alternative — committing to treatment and sobriety and to evaluating and practicing the life skills needed to be productive — has the potential to dramatically improve the lives of individuals, their families, and our communities.
Additional background sourced from: Federal Alternative-to-Incarceration Court Programs