What comes next for the war on drugs? The beginning of the end.
By The Editorial Board
There are three bills floating through Congress right now that could not only save lives and money but also help to finally dismantle the nation’s failed war on drugs. The Medicaid Re-entry Act, EQUAL (Eliminating a Quantifiably Unjust Application of the Law) Act and the MAT (Mainstreaming Addiction Treatment) Act all have bipartisan support and could be passed during the lame duck session of Congress. Lawmakers should act on them without delay.
The MAT Act would eliminate the special Drug Enforcement Administration waiver that doctors must apply for in order to prescribe buprenorphine (a medication that helps reduce the craving for opioids). It would enable community health aides to dispense this medication as long as it’s prescribed by a doctor through telemedicine. And it would give the Substance Abuse and Mental Health Services Administration responsibility to start a national campaign to educate health care practitioners about medications for opioid use disorder. Reams of data have shown and addiction specialists agree that these medications offer some of the best options for preventing overdoses and helping people into recovery. But a 2019 report from the National Academies of Sciences, Engineering and Medicine found that fewer than 20% of people who could benefit have access to them.
There are several reasons for that, including stigma and a lack of understanding about how medications for opioid use disorder work. The biggest problem is that so few doctors are willing to treat addiction in the first place. Dropping the DEA waiver will not be enough to alleviate that shortage; lawmakers will also have to find ways to ensure that addiction treatment enjoys the same robust reimbursement rates as other chronic conditions. But eliminating the waiver would still be a crucial step in the right direction. The prescription drugs that caused the current epidemic should not be easier to access than the medications that could help alleviate it.
The MAT Act, which was written by Rep. Paul Tonko of New York, boasts some 248 co-sponsors and has already passed the House as part of a broader mental health package.
The Medicaid Re-entry Act would allow states to reactivate Medicaid for inmates up to one month before their scheduled release from prison. Those benefits are normally suspended (or in some states terminated) during incarceration because current law prohibits jail and prison inmates from receiving federal health insurance. Reinstating them after incarceration takes time and resources that people who have just been released from jail or prison don’t necessarily have. The resulting disruptions in medical care can be dire: America’s prison population suffers disproportionately from a range of serious ailments, including mental illness, heart disease and opioid use disorder. Among other risks, they are 50 to 150 times as likely to die of an overdose in the first two weeks after their release.
Closing the post-incarceration treatment gap would go a long way toward reducing such deaths. The Rhode Island Department of Corrections reduced its post-incarceration overdose fatalities by 60% by ensuring that inmates could access methadone and buprenorphine both during incarceration and after release, without disruption. “It was basically a slam dunk,” says Keith Humphreys, an addiction expert at Stanford University and a former senior adviser to President Barack Obama on drug policy. “Instead of sending them off with a brochure, you connect them to treatment.”
Reinstating Medicaid before release would be another, even more robust way to accomplish the same goal. Several states have already applied for federal waivers that would allow them to do so on a trial basis. The Biden administration should approve those waivers without delay. But Congress should also pass the Medicaid Re-entry Act so that the benefit of seamless care isn’t determined by where an inmate is incarcerated.
The bill, which was also written by Tonko, has bipartisan backing in both chambers and support from a wide range of groups, including the National Alliance on Mental Illness and the National Sheriffs Association. Experts on addiction believe it could save both lives and money. “It would open up a world of possibilities for taking care of people who are newly released,” Humphreys says. “There is really no reason not to do it.”
The EQUAL Act would eliminate the federal sentencing disparity between drug offenses involving crack cocaine and powder cocaine. That disparity was created by a 1986 law that equated 50 grams of crack with 5,000 grams of powder cocaine and subjected possession of either to a minimum sentence of 10 years in prison.
The law was based on the now disproved idea that crack cocaine is far more addictive than powder cocaine. It resulted in disproportionately harsher penalties and far more prison time for drug offenders in communities of color: While two-thirds of people who smoke crack are white, 80% of people who have been convicted of crack offenses are Black.
In 2010, Congress reduced the crack-to-powder ratio from 100:1 to 18:1. The EQUAL Act would finally eliminate it altogether. If passed, approximately 7,600 people who are serving excessive crack-related sentences could be released an average of six years earlier, according to an estimate from the U.S. Sentencing Commission. That comes out to some 46,500 fewer prison years.
EQUAL, which was written by Rep. Hakeem Jeffries of New York, who was recently elected leader of the House Democrats, passed the House last year with overwhelming bipartisan support. We urge the Senate to pass it. Lawmakers should get this long overdue bill across the finish line now, before House investigations and other political battles take priority in the next session.
The nation’s five-decade war on drugs has been a dismal failure. Overdose deaths have reached — and then surpassed — extreme levels in recent years, and the number of people who are still in prison for drug offenses remains stubbornly and egregiously high. Still, it is hard to agree on what comes next. What has been shown to work is not always politically feasible, and what’s politically popular often doesn’t make for sound public health. MAT, EQUAL and the Medicaid Re-entry Acts meet both requirements. Congress should pass all three now.