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Drug Policy Alliance: Treatment centers that rely on arrests to get clients seek to profit from pain | COMMENTARY

Women participate in a morning meeting at one of Gaudenzia's addiction treatment centers on Oct. 22, 2020.
Women participate in a morning meeting at one of Gaudenzia's addiction treatment centers on Oct. 22, 2020. (Karl Merton Ferron/The Baltimore Sun)

As the coronavirus bore down on our country in March, those of us working on criminal justice reform saw the potential for a real crisis that many were either ignoring or had not yet considered. Correctional facilities, unsanitary at the best of times, were set to be hotbeds of disease due to the challenges of social distancing in such close quarters, as well as the already-limited access to the most basic personal hygiene products. Unlike the majority of prosecutors who failed to act early and decisively to protect the health of their communities, Baltimore State’s Attorney Marilyn Mosby took swift action to reduce jail and prison capacity by treating drug use as a public health issue rather than a criminal justice one.

It is therefore disturbing to read recent comments in The Sun by drug treatment providers in Baltimore who complain that their finances have been negatively impacted by Ms. Mosby’s lifesaving decision to stop prosecuting people who use drugs during the pandemic. The complaints from these facilities are not only out of touch with trends in this country; they are also concerning.

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We should all be suspicious of any industry whose business model is predicated on getting clients solely by threats of jail or other punishment. In 2017, nearly one third of all drug treatment admissions in the United States involved a referral or mandate from the criminal justice system.

In fact, far too many drug treatment programs in Baltimore appear to have built a very lucrative business model on the backs of people who use drugs and have been unjustly criminalized. The Sun’s article highlights complaints from drug treatment provider Gaudenzia about the non-prosecution of drug users, with a spokesperson lamenting that “We only get paid if there’s someone in a bed. Without people in the bed, we have to subsidize that revenue with whatever we can come up with.” With that statement, Gaudenzia — a nonprofit that generated $94 million in revenue in FY19 — is shining a light on the flaws of the treatment industrial complex. Like private prisons, a multibillion-dollar industry has sprung up to profit from the pain and misery of those caught up in the criminal justice system.

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Instead of criticizing Ms. Mosby’s decision to stop prosecuting drug users, treatment providers should use this opportunity to revisit their approach to treatment. They should ask themselves why, in the midst of a historic overdose crisis where deaths continue to rise and many struggle to access health resources, is no one voluntarily seeking their services?

There are some possible explanations. Treatment facilities often have strict requirements for treatment compliance around abstinence and attendance that can often be challenging for people in the early phases of recovery. A 2019 national study found that 90% of people with substance use disorders did not receive treatment in the past year and the top reason was that they were unwilling to quit. Treatment should be low-barrier and low-threshold, which means we must use a harm reduction approach and meet people where they are until they are ready to make a change. Gold-standard treatments like methadone and buprenorphine are essential options for people with opioid use disorder, yet we know that they are not available at most facilities, forcing people to undergo dangerous withdrawal and increasing overdose risk.

Ms. Mosby’s approach makes Baltimore a leader, not a pariah or outlier. She is doing the right thing because drug decriminalization is an inevitability in this country and has already proven to work in other parts of the world. The ACLU, Human Rights Watch, World Health Organization, American Public Health Association, Organization of American States and NAACP are among many major public health and civil society organizations that have called for drug decriminalization. And prosecutors in Philadelphia, Boston, San Francisco and Seattle, among other cities, have stopped prosecuting drug possession and the sky has not fallen.

We must always remember that when we talk about criminalizing drugs, especially in Baltimore, we are talking about criminalizing Black and brown people. As we march in protest in response to the horrific murders of George Floyd and Breonna Taylor, we must underscore that many police killings often start with an interaction involving a minor offense like drug possession. We must push prosecutors and police to end the persecution of Black communities for “quality of life” offenses like broken windows, drug use, sex work, or selling a loose cigarette.

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Drug users are not dollar signs, and must not be viewed as such by those who claim they want to help. The drug war has failed, decimating communities of color. Baltimore appears ready to shift to a health-based approach to drugs. Treatment providers must do the same.

Kassandra Frederique (media@drugpolicy.org) is executive director of the Drug Policy Alliance.

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