The Case for Decriminalization: Public Health Implications of Prison Systems
Highlighting the global overview of incarceration rates and the negative impact of current drug policies leading to high concentrations of infectious diseases within prisons. It emphasizes the need for decriminalization to address public health crises linked to incarceration.
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Presentation Transcript
Public Health and Prisons Making a Case for Decriminalization Frederick L. Altice, M.D. Professor of Medicine, Epidemiology and Public Health Yale University S L I D E 0
The Regulatory Continuum Criminalization Decriminalization Legalization Non-criminalized penalties Tailored and combined by context Jesseman & Payer, Canadian Centre on Substance Use and Addiction, 2018 S L I D E 1
Overview of Incarceration Globally 10.2 million people in closed settings Pre-trial detention (2.5-3.0 million) high turnover Sentenced prisoners (7.0-7.5 million) Compulsory drug detention centers (Asia, 650,000) 40-70 million people transition through a closed setting each year In the past 15 years, prisoners have increased 30% while the world population increased 20% Incarceration rates vary markedly depending on the country and region (median 165 / 100,000) S L I D E 2
Incarceration Rates Globally (2022) (Median 165/100,000) 345326 140 161 7091 629 119 510 445 35 560 46 259 381 205 167 World Population Review, 2022 S L I D E 3
Contributors to Incarceration Concentration of people who use alcohol and drugs Drug policies that favor incarceration 10-48% of male and 30-60% of female inmates used illicit drugs in the month before incarceration Alcohol use is even higher! Are more likely to be re-incarcerated The concentration of PWUDs (injectors), alcohol use disorders and/or mental illness all contribute to the concentration of HIV within prisons, which 3-50 times greater than in the community Though women are 5-10% of prisoners, HIV is several fold higher among them S L I D E 4
Prevalence of Infectious Diseases in Prisons Dolan, K et al, Lancet 2016 S L I D E 5
Incarceration is Dangerous! S L I D E 6
2 1 Within prison Transmission Suboptimal Services Amplification Deterioration Concentration Prison Environment 3 Laws and policing selects members with poor health status and/or at risk for HIV, TB, or viral hepatitis High risk behaviors, new social networks, transmission to new community members In Dissemination Community Post-Release Morbidity and Mortality Relapse Dropout from Care 4 5 Kamarulzaman, Lancet, 2016 S L I D E 7
The Regulatory Continuum Criminalization Decriminalization Legalization Parole Planned Release Probation Non-criminalized penalties Tailored and combined by context Jesseman & Payer, Canadian Centre on Substance Use and Addiction, 2018 S L I D E 8
Probation as a De-carceration Strategy in Ukraine (Screening-Brief Intervention-Referral to Treatment) 100 208 (100%) Ukraine Incarceration 445 140 / 100K OUD: 16% HIV: 44% 1,298 (100%) 90 59% 80 70 60 Percentage 83% 127 77% 50 (58.7%) 106 28% 98 (51.0%) 40 (47.1%) Brief Intervention HIV+ (44%) 30 20 No Dx (26%) 208 (16.0%) 30 10 (14.4%) 0 Screened Opioid Dependent Opioid Dependent Provided Consent Interested in OAT PRE-BI Interested in OAT POST-BI Started OAT Bromberg DJ et al, under review S L I D E 9
Summary Criminalization strategies concentrate people from within communities with or at high risk for HIV, HCV and TB and often related to substance use disorders Incarceration is dangerous for individual and public health and strategies to de-carcerate are urgently needed, including decriminalization strategies Strategies that have moved toward decriminalization have resulted in substantially lower levels of incarceration and decreased costs Such de-carceration strategies, however, require a commitment to ensuring access to prevention and treatment services in the community, including those that align public safety with public health S L I D E 10
