The State of Opioids and Substance Use

The Crisis Continues

The opioid crisis continued to dominate 2018 headlines—and impact the criminal justice system. Sixty-five percent of all incarcerated individuals meet the criteria for a substance use disorder, but only 11 percent of incarcerated people who need treatment are receiving it.[]National Institute on Drug Abuse (NIDA), “Treating Opioid Addiction in Criminal Justice Settings,” NIDA, December 14, 2017.

The federal government is split on a solution to the crisis: while the National Institutes of Health continued to study public health approaches, launching the Helping to End Addiction Long-term (HEAL) Initiative in April, and the Centers for Disease Control and Prevention mobilized resources for the counties in greatest need, the Department of Justice promoted a return to “war on drugs”-era policies like stricter punishments for drug offenses.[]For the National Institutes of Health (NIH) approach, see NIH, “About the NIH HEAL Initiative.” See also Centers for Disease Control and Prevention (CDC), “Understanding the Epidemic.” For Sessions’ position, see Memorandum from Attorney General Jeff Sessions to United States Attorneys, “Guidance Regarding Use of Capital Punishment in Drug-Related Prosecutions,” (Washington, DC: Office of the Attorney General, March 20, 2018); and Kevin Breuninger, “Attorney General Jeff Sessions Outlines When to Use Death Penalty on Drug Traffickers,” CNBC, March 21, 2018.

Outside the walls of jail and prison, overdoses are taking a toll on public health generally: the average life expectancy in the United States decreased in 2018, a trend “largely driven by deaths from drug overdose and suicide,” according to the Centers for Disease Control and Prevention.[]Robert M. Redfield, “CDC Director’s Media Statement on U.S. Life Expectancy,” press release (Atlanta, GA: CDC, November 29, 2018); and Sherry L. Murphy, Jiaquan Xu, Kenneth Kochanek, and Elizabeth Arias, Mortality in the United States, 2017 (Atlanta, GA: CDC, 2018). Local activists are fighting for alternatives to incarceration for people with substance use issues, as well as for safe injection facilities: places where people who choose to consume drugs can do so with clean, safe equipment, and in the presence of medical personnel who can assist in case of an accidental overdose.[]Elana Gordon, “What's the Evidence that Supervised Drug Injection Sites Save Lives?” NPR, September 7, 2018. State governments are finding themselves caught in the middle: California Governor Jerry Brown recently vetoed a bill passed by the California legislature legalizing safe injection facilities—just one month after Deputy Attorney General Rod Rosenstein made it clear the federal government would aggressively prosecute those involved with such operations.[]German Lopez, “The Trump Administration’s Threat against Safe Injection Sites Is Working,” Vox, October 2, 2018. But it’s clear that something must be done, and soon. On an average day in 2018, 115 people in the United States died from a drug overdose involving opioids.[]National Institute on Drug Abuse, “Opioid Overdose Crisis,” revised March 2018.

Top Things to Know

  1. Legislators focus on punishing overprescription—with a nod to prevention.
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  2. The feds favor enforcement.
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  3. Syringe exchange programs open in some jurisdictions, close in others.
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  4. Efforts to establish safe injection facilities face pushback.
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  5. Good Samaritan laws protect some, miss others.
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Facts and Figures

On Our Radar

  • Courts consider state, county, and city lawsuits against opioid manufacturers and distributors.
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  • Medication-assisted treatment in corrections facilities shows promising results—and some are suing to obtain it.
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  • Federal programs focus on putting resources where they’re needed most.
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Best of 2018


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