Reviews | What’s next in the war on drugs? The beginning of the end.
There are three bills before Congress that could not only save lives and money, but also help finally dismantle the nation’s failed war on drugs. The Medicaid Re-entry Act, the Eliminating a Quantifiably Unjust Application of the Law (EQUAL) Act, and the Mainstreaming Addiction Treatment (MAT) Act all enjoy bipartisan support and could pass in the lame session of Congress. Legislators should act without delay.
The MAT law would eliminate the Drug Enforcement Administration’s special waiver that physicians must seek in order to prescribe buprenorphine (a drug that helps reduce the craving for opioids). This would allow community health aides to dispense this drug as long as it is prescribed by a doctor via telemedicine. And it would give the Substance Abuse and Mental Health Services Administration responsibility for launching a nationwide campaign to educate healthcare professionals about medications for opioid use disorders. A lot of data has shown, and addiction experts agree, that these drugs offer some of the best options for preventing overdoses and helping people recover. But a 2019 report from the National Academies of Sciences, Engineering and Medicine found that less than 20% of people who could benefit have access to it.
There are several reasons for this, including stigma and a lack of understanding of how drugs for opioid use disorder work. The biggest problem is that so few doctors are willing to treat addiction in the first place. Abandoning the DEA waiver will not be enough to alleviate this shortage; lawmakers will also need to find ways to ensure that drug treatment enjoys the same strong reimbursement rates as other chronic conditions. But eliminating the waiver would still be a crucial step in the right direction. The prescription drugs that caused the current outbreak should be no easier to access than the drugs that could help alleviate it.
The MAT law, which was drafted by Rep. Paul Tonko of New York, has some 248 co-sponsors and has already passed the House as part of a broader mental health package.
The Medicaid Reinstatement Act would allow states to reactivate Medicaid for inmates up to a month before their scheduled release from prison. These benefits are normally suspended (or, in some states, terminated) during incarceration, as current law prohibits prison and jail inmates from receiving federal health insurance. Their reintegration after incarceration requires time and resources that people who have just been released from prison or prison do not necessarily have. The resulting disruptions in medical care can be severe: America’s prison population suffers disproportionately from a range of serious illnesses, including mental illness, heart disease and opioid use disorders. Among other risks, they are between 50 and 150 times more likely to die of an overdose in the first two weeks after their release.
Closing the treatment gap after incarceration would go a long way to reducing these deaths. The Rhode Island Department of Corrections has reduced post-incarceration overdose deaths by 60% by ensuring inmates can access methadone and buprenorphine while incarcerated and after release, without interruption. “It was basically a slam dunk,” says Keith Humphreys, an addiction expert at Stanford University and former senior adviser to President Barack Obama on drug policy. “Instead of sending them off with a brochure, you connect them to treatment.”
Restoring Medicaid before its release would be another, even more robust way to accomplish the same goal. Several states have already applied for federal waivers that would allow them to do this on a trial basis. The Biden administration should approve these waivers without delay. But Congress should also pass the Medicaid Re-entry Act so that the benefit of continuing care is not determined by where an inmate is incarcerated.
The bill, which was also drafted by Mr Tonko, has bipartisan support in both houses and support from a wide range of groups, including the National Alliance on Mental Illness and the National Sheriffs Association. . Addiction experts think it could save lives and money. “It would open up a world of possibilities for caring for newly released people,” Humphreys says. “There’s really no reason not to.”
The EQUAL law would eliminate the federal sentencing disparity between drug offenses involving crack cocaine and powder cocaine. This disparity was created by a 1986 law that equated 50 grams of crack cocaine to 5,000 grams of powdered cocaine and made possession of either subject to a minimum 10-year prison sentence.
The law was based on the now disproven idea that crack is much more addictive than powder cocaine. This has resulted in disproportionately harsher sentences and significantly longer prison time for drug offenders in communities of color: while two-thirds of people who smoke crack are white, 80% of people convicted of crack offenses are black.
In 2010, Congress reduced the crack-to-powder ratio from 100:1 to 18:1. The EQUAL law would eliminate it definitively. If passed, about 7,600 people serving excessive crack-related sentences could be released an average of six years earlier, according to an estimate by the US Sentencing Commission. That amounts to some 46,500 fewer prison years.
EQUAL, which was penned by Rep. Hakeem Jeffries of New York, who was recently elected leader of the House Democrats, passed the House last year with overwhelming bipartisan support. We urge the Senate to pass it. Lawmakers should now get this long-awaited bill across the finish line, before House investigations and other political battles take priority in the next session.
The five-decade national war on drugs has been a dismal failure. Overdose deaths have reached — and then surpassed — extreme levels in recent years, and the number of people still in prison for drug-related offenses remains stubbornly and extremely high. However, it is difficult to agree on the continuation. What works is not always politically feasible, and what is politically popular often does not contribute to good public health. MAT, EQUAL, and the Medicaid Re-entry Acts meet both requirements. Congress should pass all three now.