Punishing Drug Use in Prison: Balancing Health Risks and Concerns

Purpose: The purpose of this presentation is to examine the issue of how disciplinary policies designed to combat drug and alcohol use in prison can place prisoners' health at risk and undermine existing substance abuse programming. The presentation will discuss alternative approaches that reasonably balance security interests and prison health. Findings: In a report released in March 2009, Human Rights Watch found that the disciplinary policies for drug and alcohol use in the New York State prisons unnecessarily placed prisoners' health at risk by denying substance abuse treatment as part of the disciplinary sanction; by punishing prisoners and removing them from treatment for the symptoms of addiction, a chronic, relapsing disease; and utilizing an aggressive urinalysis testing program that evidence has shown moves some prisoners toward use of opiates and other injection drugs that are less detectable, thereby increasing risk of HIV and Hepatitis C transmission. These policies, combined with a failure to screen repeated substance users for addiction before imposing harsher and harsher punishment, poses significant health risks by denying treatment to those who may need it most. Methods: Human Rights Watch's research was based on extensive interviews with prisoners, drug treatment personnel and corrections staff in New York State; a comprehensive review of data related to disciplinary sanctions for drug use and policies related to substance abuse treatment programming; and review of evidence-based practices for substance abuse treatment in a correctional setting. Conclusions: Prisons in New York State and other jurisdictions with similar policies must reform disciplinary procedures for substance use to ensure that measures designed to detect and punish do not compromise the health of prisoners and by extension, the community. Value: Much research has focused on the need for substance abuse treatment programs in prison. The benefits to prisoners' health and to society of providing evidence-based treatment, including medication-assisted therapy such as methadone or buprenorphine, as well as implementing harm reduction measures in prison have been well documented in public health research. Missing from the discourse, however, is an examination of how in many prisons, disciplinary policies designed to deter and punish drug use compromise prisoners' health and undermine the effectiveness of substance abuse programs that do exist in the correctional setting. The presentation will highlight the current debate concerning the health risks posed by prison urinalysis testing programs and discuss areas where further research is necessary regarding substance abuse and correctional health.