Racial Justice and MOUD in Corrections

Resources for people involved in the criminal-justice system, and caring community members, to advocate for access MOUD, navigate medication choice and find providers in the community.

The recent opioid epidemic was triggered by physicians overprescribing opioids to patients who were predominantly white, rural and suburban. Lately, the epidemic has increased among people of color and those living in urban areas. These individuals are incarcerated for opioid related charges at disproportionately high rates.1

In order to implement effective medication for opioid use disorder programs for people with opioid use disorder in the community and in correctional settings, an acknowledgment of the current racial discrepancies and commitment to racial and social justice is necessary to adequately address the opioid crisis and mass incarceration. 

We believe…

  • Everyone deserves access to top quality, life-saving health care regardless of their race or criminal legal status
  • People should not be incarcerated for substance use disorder
  • People of color have been disproportionately deprived of access to addiction treatment, and incarcerated at higher rates

References

  1. Drake J, Charles C, Bourgeois JW, et al. Exploring the impact of the opioid epidemic in Black and Hispanic communities in the United States. Drug Science, Policy, and Law. 2020; 6: 1-11. doi: 10.1177/2050324520940428

Context on Racial Disparities and MOUD

While studies have shown that people across racial lines use drugs at similar rates, Black and Latino people are far more likely to be criminalized and incarcerated for their drug use.1 The “War on Drugs” and the criminalization of people who use drugs, beginning in the early 1970s, has led to the excessive rate of incarceration of people of color that we see in the United States today.2 Minimum mandatory sentencing laws, implemented in the 80s and 90s, have remained a major contributing factor to the mass incarceration of people of color in prisons and jails. Prosecutors are nearly twice as likely to pursue a mandatory minimum sentence for black than for white people who are charged for the same crime.3

While there is an urgent need for dramatic criminal justice change to dismantle racial inequity in incarceration, the reality remains that the majority of people who are incarcerated are there due to drug related behavior and are disproportionately people of color. More so, due to the lack of access to quality healthcare and substance use disorder treatment in correctional settings, our current criminal legal system prevents people of color from accessing lifesaving treatment available in the community. Additionally, as noted by the Robert Wood Johnson Foundation, “Incarceration exposes people to a wide range of conditions, such as poor sanitation and ventilation and solitary confinement, that are detrimental to long-term physical and mental health.”4

References

  1. DPA. The Drug War, Mass Incarceration and Race (English/Spanish). Drug Policy Alliance website. Published January 25, 2018. Accessed June 11, 2021. https://drugpolicy.org/resource/drug-war-mass-incarceration-and-race-englishspanish
  2. DPA. A Brief History of the Drug War. Drug Policy Alliance website. Updated 2021. Accessed June 11, 2021. https://drugpolicy.org/issues/brief-history-drug-war
  3. Starr SB, Rehavi MM. Mandatory Sentencing and Racial Disparity: Assessing the Role of Prosecutors and the Effects of Booker. Yale Law Journal. 2013-2014; 123(1):1-265. Accessed June 11, 2021. https://www.yalelawjournal.org/article/mandatory-sentencing-and-racial-disparity-assessing-the-role-of-prosecutors-and-the-effects-of-booker
  4. Acker J, Braveman P, Arkin E, Leviton L, Parsons J, Hobor G. Mass Incarceration Threatens Health Equity in America. Robert Wood Johnson Foundation website. Published December 1, 2018. Accessed June 11, 2021. https://www.rwjf.org/en/library/research/2019/01/mass-incarceration-threatens-health-equity-in-america.html

Godel et al., – Association of Racial/Ethnic Segregation With Treatment Capacity for Opioid Use Disorder in Counties in the United States (April 2020)

In this cross-sectional study of all 3142 counties or county-equivalent units in the US in 2016, counties with highly segregated African American and Hispanic/Latino communities had more facilities to provide methadone per capita, while counties with highly segregated white communities had more facilities to provide buprenorphine per capita.

Hadland et al., – Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001)

Disparities based on sex, age, and race/ethnicity were observed.

Schiff et al., – Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts (May 2020)

In this cohort study of 5247 women with opioid use disorder who delivered a live infant, black non-Hispanic and Hispanic women with opioid use disorder were significantly less likely to use any medication for treatment and were less likely to consistently use medication for treatment during pregnancy compared with white non-Hispanic women with opioid use disorder.

Tiako 2021 – Addressing racial & socioeconomic disparities in access to medications for opioid use disorder amid COVID-19

Pre-COVID-19, stark racial disparities characterized the landscape of access to medications for opioid use disorder, especially buprenorphine

COVID may worsen existing racial/ethnic and socioeconomic disparities in access to treatment for opioid use disorder (OUD). Pre-COVID-19, research overlooked, and the media excluded from its coverage the racial disparities in access to medications for OUD (MOUD) and the increasing rates of opioid overdoses in Black communities surrounding the opioid epidemic

Yet the “medicalization” of OUD treatment is situated in a long history of differential marketing and access along racial lines. Methadone was wielded as a disciplining mechanism: one of the measures of success was that it reduced crime. This approach, in addition to protests from neighborhood associations at the time of the creation of methadone clinics, led to today’s prevalence of OTPs in majority Black and Hispanic communities.

Guiding questions for equitable MOUD implementation

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