Drugs: It's Time for a Health Approach

By Margaret Dooley-Sammuli

The healthcare legislation President Obama signed earlier this year promises to bring sweeping changes to alcohol and drug treatment systems across the country. Not only will more people have access to insurance; heath insurers will be required to cover alcohol and drug treatment as they do any other chronic health condition (aka “parity”). Drug treatment – which currently exists largely outside the mainstream healthcare and insurance systems – may finally be allowed to come in from the cold.

As we work to make that treatment access a reality, however, we need to address the country’s existing contradictory policy responses to drug use. Even before the recent hard-won healthcare legislation, the U.S. Congress and a previous administration was on record as supporting parity. Two years ago, Congress passed – and President Bush signed – the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. At the same time, an overwhelming majority of the American electorate reports in national surveys that they believe that drug addiction is a treatable medical problem.

On both the political and personal levels, Americans understand that drug use is fundamentally a health matter. And yet, our laws continue to require the arrest, prosecution and incarceration of people who use drugs.

Since President Reagan called for a war on drugs in 1982, annual drug arrests had tripled to 1.8 million by 2008. Of those, 1.4 million were arrested for possession – not sales, manufacturing or trafficking. Nearly half of all drug arrests in 2008 were for marijuana. The number of people incarcerated for drug law violations has increased 1,100% since 1980. Today, nearly 6 in 10 people in a state prison for such violations have no history of violence or high-level drug sales.

About 30,000 people are in a California prison for a nonviolent drug offense; they make up over 15% of the prison population and cost $1.5 billion per year to incarcerate (or $49,000 each). A whopping 28.4% of new felony admissions to prison and 32.7% of parolees returning to prison with a new term in 2008 were for drug offenses. That doesn’t include drug-related technical parole revocations. The vast majority of these commitments were for drug possession, not sales, manufacturing or transport.

In 2008, over 200,000 Californians were arrested for a drug offense. In contrast, only 174,000 people accessed treatment that year – just a fraction of the estimated 3.3 million Californians with an alcohol or drug use disorder. Over half of those in treatment in the state came through the criminal justice system, giving rise to the belief that you have to get arrested to get treatment. Unfortunately, fewer and fewer people arrested for a drug offense actually receive such help.

In the last three years alone, state funding for Proposition 36, California’s landmark voter-approved, treatment-instead-of-incarceration law, has been cut by 90% – from $145 million in 2007/8 to just $18 million this year. It’s a simple equation: the less funding available, the less treatment offered and the longer the waiting lists (months long in some cases).

Ten years after voters overwhelmingly passed Prop. 36, calling for treatment rather than incarceration, the governor has proposed eliminating funding for the program. Never mind that, according to UCLA, Prop. 36 saves $2.5-4 for every dollar invested, diverts over 30,000 people into treatment a year (when adequately funded), has helped reduce the number of people incarcerated for personal drug possession by 40% (or 8,000 people), and has had no negative impact on crime trends.

At the same time, the governor has proposed nearly eliminating funding for access to methadone maintenance therapy through Medi-Cal. By destabilizing the state's methadone treatment system, this could end treatment for up to 35,000 addicted individuals, pushing them to the streets, emergency rooms, jails and even death. Cutting treatment won't save. One year of methadone maintenance costs about $5,000 per patient; one year of incarceration in California costs nearly $50,000.

As access to community-based treatment is gutted, behind-bars treatment is also becoming unavailable. Under new California Department of Corrections and Rehabilitation (CDCR) regulations, moderate- to high-risk offenders will have priority placement in drug treatment in the state’s prisons. Ironically, people behind bars for a drug offense – most of whom are deemed low risk to public safety – will not receive treatment behind bars or on parole, even if they have a serious drug problem.

The passage of federal healthcare legislation, the repeated passage of parity legislation in this state and even the state’s corrections bureaucracy have all come to the same conclusion: drug use is primarily a health issue, not a high risk to public safety. And yet the state’s penal code continues to criminalize drug use.

Until California can reconcile the discrepancy between health statute and penal code, the Democratic majority in the State Legislature has a responsibility to reduce – in every way that it can – the criminalization and incarceration of people for drug use and addiction. This year that means rejecting the governor’s proposal to defund Proposition 36 and refusing to cut Drug Medi-Cal's coverage of methadone maintenance.

Margaret Dooley-Sammuli is Deputy State Director, Southern California, for the Drug Policy Alliance, the nation’s leading organization working to end the war on drugs and the proponent of Proposition 36 in 2000.