Conclusion

The knowledge and attitudes of these select criminal justice stakeholders suggest that although the opioid overdose epidemic has created a key moment for shifting the paradigm of how the United States responds to substance use—away from criminalization and toward a public health approach that incorporates principles of harm reduction—there remains a number of significant obstacles to overcome. These obstacles include the still nascent understanding about what harm reduction means and how it can be incorporated into the justice system; a range of opinions about the spectrum of techniques appropriate for integration; deeply held beliefs about the nature of addiction and viable avenues for recovery; and legitimate questions about the appropriate role of the justice system in responding to drug use. To best address these obstacles and help interested jurisdictions introduce harm reduction strategies, it is clear that the justice system requires at least three avenues of work:           

  1.  The launch of a more visible campaign to raise awareness and build a cadre of credible messengers who can attest to the value of a public health approach in the criminal justice system;
  2.  The dissemination of practical guidance for jurisdictions on how to implement evidence-based harm reduction strategies across different criminal justice intercepts (such as toolkits for implementing evidence-based approaches from pre-arrest to post-reentry; case studies from jurisdictions that have implemented strategies with success; and the provision of technical assistance during implementation); and
  3.  The development of a research program evaluating the implementation of harm reduction approaches in criminal justice settings (such as implementation studies that follow jurisdictions as they build the capacity for data collection, tracking, and evaluation of the evidence-based approaches they apply).

Without this work—that is, the creation, testing, and dissemination of concrete models, ideas, and tools for integrating harm reduction across the system and right-sizing the role of the justice system in the lives of people who use drugs—this promising moment could be squandered. But stakeholders interviewed were optimistic that a new model for responding to drug use—one based in principles fundamental to public health—is possible.

As Judge Nash said, “Once you get caught up in the criminal justice system, your ability to lead a normal life—normal being defined as, ‘I have a job, I pay my rent, I have a place to live, and I live my life’—is more and more difficult.” Transforming the criminal justice system from a “life-interruption model” to an avenue for increased recovery options necessitates that the system be capable of proving evidence-based care—a standard that includes embracing harm reduction. And as long as criminal justice stakeholders remain frequent first and second responders to people in crisis, they must develop a robust set of strategies for responding to substance use that goes beyond arrest and incarceration. In the words of Kenneth Burner, West Virginia state coordinator of the Appalachia High Intensity Drug Trafficking Area, they must, “embrace the fact that there’s going to be a new normal in the United States.”