Fear COVID-19? Current US Drug Policy Spreads It

[ID] orange photo of a person touching their two hands together outside of a jail cell with the title, Harm Reduction Coalition and Drug Policy Alliance logos and the byline: By Kassandra Frederique and Dr. Kim Sue.

The rapid escalation of COVID-19 across the US is exposing many of the systemic vulnerabilities within our society while also revealing the many policy and criminal justice decisions that have made us more vulnerable. There are over 400,000 people in jail or prison for drug-related offenses, over a third of whom haven’t even been convicted. This is not only fueled by the laws we have in place criminalizing drug use, but by the way people who wield power over the freedom of people who use drugs have consistently dehumanized them.

This week saw the COVID-19 related deaths of multiple people incarcerated in federal custody on a drug offenses. Despite the impending public health crisis and their underlying conditions that made them more vulnerable to COVID-19 — and direction to the Federal Bureau of Prisons last week to consider early release for prisoners particularly at risk to the virus — the lack of swift, decisive action led to their loss of life and inexcusable disregard for their lives.

This disregard is reflected in harmful views vocalized by judges like Louisiana’s David Ritchie who said recently, “drug addicts who have the worst hygiene of anyone in the community” as a reason to not release people with drug charges in the midst of the COVID-19 pandemic. He would lead you to believe they belong in prison, undoubtedly a potential death sentence as cases of coronavirus spread like wildfire within them. His reasoning is nothing more than a personal bias, assuming their release will lead to more crime rather than an opportunity to access the services they need. It is imperative we address this directly and immediately.

It’s clear the judge fails to realize that on a daily basis, people in jail and prison are being subjected to neglectful and inhumane conditions that threaten their immediate safety. While our government leadership struggles to manage a pandemic in the community, we must reckon with the vulnerability of our loved ones who are incarcerated and who do not have the choice to implement most, if any, of the preventative measures that have been recommended. Social distancing is virtually impossible for these individuals. Even if family visitation is paused, corrections officers can be carriers. Soap is in limited supply, and hand sanitizer is contraband in most correctional settings due to alcohol content. People with pre-existing health conditions will remain at highest risk.

Advocacy groups should be applauded for pushing policymakers in Ohio and California to release people from correctional facilities, recognizing that they would be safer and healthier in our communities. But it shouldn’t require a pandemic for decision makers to realize that jails and prisons are bad for public health. Correctional facilities in New York have the fifth-highest death rate due to overdose in the country. This moment makes it clear that decriminalization is an issue of life and death for many.

Our healthcare system’s limited ability to respond to COVID-19 is paralleled by the longstanding problems of our country’s addiction treatment system — rigid policies, lengthy waiting lists, and limited use of evidence-based treatments — which has fueled the overdose crisis and will only take more lives. Access to life-saving medications like methadone and buprenorphine are restricted due to inflexible policies for prescribing and dispensing. Meanwhile, ill-equipped treatment systems place people with opioid use disorders at risk, either for returning to the illicit drug supply or for COVID exposure as they seek daily on-site treatment. Potential transit closures and curfew announcements could add to these concerns. How will people who need these medications access them under citywide and potentially national closures?

During the current crisis, we need open and compassionate lines of communication between health professionals and people with increased risk of contracting COVID-19, not less. We know from experience that people who use drugs can be discouraged from engaging with systems that have discriminated against and stigmatized them in the past. Their symptoms can be disbelieved, which can lead to them being disengaged or not seeking healthcare. They may also live with chronic physical or mental health issues that go unaddressed. This burden of comorbidities (diabetes, hypertension, heart and lung disease, kidney disease, for example), can increase COVID-19 risk factors substantially. The drug war has made the health care system largely a responder that our loved ones can’t trust, and trust is an essential component in managing a crisis.

Housing is a stabilizing, protective factor against acquiring infections like COVID-19, yet, similar to the lack of preparation to address the needs of people who are incarcerated, decision makers have failed to adequately plan for the needs of people who are insecurely housed. People who use drugs encounter daily structural violence, including chronic homelessness or housing insecurity. This can lead many individuals to congregate in small spaces, often in dormitory-style living, where social distancing is not feasible. Our drug war disproportionately harms poor people by leading to housing policies and practices that have kicked people out of homeless shelters, domestic violence centers, and treatment facilities. Police raids aimed at disrupting encampments has led to further dislocation and lack of access to services.

As COVID-19 reveals how precarious our public health and broader social systems are, let’s intentionally focus on how to rebuild health and community infrastructure and prioritize the most vulnerable people in our policies and practices.

Our efforts must do more than illustrate the world we want; they must also address the dynamics of the world we don’t want. In order for us to do that, we need to upend the status quo and existing power structure. Thankfully, there are immediate steps local and state governments and agencies can take. First, continued access to syringe services and naloxone distribution must be kept as essential public health programs. Strict regulations around drugs like buprenorphine and methadone should be loosened to increase accessibility to these life-saving medications. Low-level drug enforcement needs to be deprioritized so less people are even entering the justice system. Investments to expand housing and shelters options must be paired with supportive policies to ensure residents are able to remain housed.

Racism and xenophobia have fueled decades of War on Drugs policies, disproportionately harming communities of color; fear of Chinese railroad workers and opium/heroin, Mexicans and cannabis, and Southern blacks with cannabis fueled the first drug laws in this country. The drug war codified how to use race to blame communities. In this moment we relive the anti-Chinese sentiment, from fentanyl to COVID-19, with subsequent fear and violence against Asian people around the world.

The drug war has weakened our society — not only through criminalization and stigma, but by eroding the social safety net, making us all less safe. We must overhaul these systems and change our policies if we truly want to save lives. Drug policy and harm reduction is the work at the intersection of health, justice, equity, and autonomy. It is freedom — and we are constantly reminded that it is life and death. May we protect each other and learn to fight with the strength and the urgency that the state has displayed in harming us.

Kassandra Frederique is the Managing Director of Policy Advocacy and Campaigns of Drug Policy Alliance
Dr. Kim Sue is the Medical Director of Harm Reduction Coalition



National Harm Reduction Coalition

National Harm Reduction Coalition is a nationwide advocate and ally for people who use drugs. harmreduction.org