Legal And Policy Approaches To Address Opioid Use Disorder In The Criminal Justice And Child Welfare Settings

Approximately 130 people in the united states die every day from opioid related drug overdoses, accounting for 47,000 deaths in 2017. Increased national and international attention to this crisis has led to an influx of resources and policy solutions in recent years; however, the problem is much larger than opioids. Addiction is not a new phenomenon and does not occur in a vacuum, but instead occurs at the intersection of public health, criminal justice and social services. Solutions must reflect this reality. 

This report focuses on access to treatment in the criminal justice and child welfare settings for several reasons.

1. These systems, rather than the health care system, have traditionally been involved in the response to addiction and its related consequences, particularly for members of marginalized communities. People recently released from correctional facilities and postpartum women are two groups that are at a significantly higher risk for overdose death than the general population.Ensuring access to evidence-based treatment and medication in corrections, courts and child welfare systems is one immediate measure that will save lives.
2. Solutions must recognize that there are enormous racial and economic disparities in access to care for substance use disorders. People with greater social and economic capital often have greater access to treatment and other needed resources to support recovery, whereas those who are less resourced are more likely to be impacted by the criminalization and punishment of addiction. Implementing strategic reforms in the criminal justice and child welfare systems presents a crucial opportunity to address these disparities and connect people to life-saving care, which will in turn contribute to lower recidivism and promote healthier and safer communities.

In our current system, jails, prisons, courts and child welfare are often the intervention points for people with substance use disorders. A public health approach to addiction would create a system where people have barrier-free access to a range of services and supports that promote well-being for individuals, families and communities to deflect people from entering the criminal justice and child welfare systems. As we work to transform our systems of care, we must simultaneously improve access to treatment for the people most at risk for overdose to save lives and improve health outcomes for people with substance use disorders and their families.

This report provides recommendations for actions that state and local leaders can take immediately to increase evidence-based practices, decrease arbitrary determinations, and prevent overdose deaths. The report also provides concrete steps that will, in the longterm, help dismantle a siloed system of unequal access and disparities and move towards an integrated system that promotes restorative justice, where people and families are treated with dignity, and where addiction is treated as a health and wellness matter rather than one of moral failing or criminality.