While the recent election has caused many to wonder about the future of healthcare and its impact on substance use disorder (SUD) treatment services, these changes will be quite slow to come. The Affordable Care Act will not be repealed rapidly or haphazardly —especially in its entirety.
A new plan, if one comes into being, will not be ready for a few years at least. However, the Trump administration can have a more immediate impact on SUD policy through another avenue: the Department of Justice.
On the issue of illicit drugs, President Trump ran on a hardline platform. With only a few exceptions, his comments centered around his plans for a border wall, insisting this would halt (or at least impact) the flow of heroin into the United States. Of course, this ignores the massive amounts of fentanyl being shipped in from China via the U.S. Postal Service, as well as drugs smuggled in through other methods.
Regardless of whether President-Elect Trump’s proposed wall will be built—to say nothing of whether it will be effective—his rhetoric brought back images of our “war on drugs” of the 1970s and 1980s, which is widely regarded as unsuccessful, and which forced an explosion in state and federal prison populations. In California, recordkeeping for prisons alone costs the state close to $380 million, and much of this is fueled by those in prison on drug charges.
Trump has appointed Sen. Jeff Sessions (R-Ala.) as his attorney general, and those who favor criminal justice reform—especially as it pertains to populations in need of SUD services—have cause to be concerned. Based on his record as a senator, Sessions has not shown much enthusiasm for criminal justice reform and has made comments that reflect a hardline stance on illicit drugs.
Sessions is on the record as having a hardline stance on marijuana:
“Knowledge that [marijuana] is dangerous, you cannot play with it, it is not funny, it’s not something to laugh about . . . and to send that message with clarity that good people don’t smoke marijuana.”
While he may be right in part—marijuana is not something to laugh about—his words are not encouraging to those who favor an approach of assistance over incarceration. His attitude toward marijuana smokers is that they are inherently bad. We can only imagine what his attitude is towards a heroin abuser, or methamphetamine addict.
Addiction is a disease, yet Sessions sees it as one of morality. We have finally made progress in the last decade, convincing policymakers that morality has little to do with substance use disorders, and our future attorney general does not appear to share this belief. Sessions has been a consistent critic of President Obama’s drug policies, especially in regard to enforcement.
Mandatory minimum sentences
In the most recent session of Congress, Sessions was critical of legislation that would have brought about reforms to mandatory minimum sentences, including those that incarcerate nonviolent offenders for possession of illegal narcotics. A criminal justice reform bill supported by John Cornyn (R-Texas) that had bipartisan backing was opposed by Sessions. Also, Sessions noted the rise in heroin deaths and the sudden increase in violent crime as the reason to oppose the bill.
“The drive and the pressure to move toward sentencing reform is always there. It is a very seductive call. It is a siren song sometimes,” Sessions said. “My experiences are that it is seldom effective.”
When President Obama commuted the long sentences of nonviolent federal drug offenders, Sessions called the move “reckless” and “unprecedented.” The Obama administration halted private prison contracts for the federal penal system, and Sessions is expected to give serious consideration to undoing this effort.
California Consortium of Addiction Program and Professionals and other advocates in Washington have made great progress over the last decade, framing the SUD issue as one that should be the domain of public health, not criminal justice. Progress has included the expansion of drug courts, expanded treatment in prisons, and the Comprehensive Addiction Recovery Act (CARA).
It will be a top priority in the coming years not to regress to a time when our first reaction to those with SUD issues was to incarcerate them.
Andrew Kessler is the federal policy liaison for the California Consortium of Addiction Programs and Professionals.