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July 5, 2019

"The rapid expansion of the US prison population since the 1970s might have contributed substantially to the ongoing increase in overdose deaths"

The quote in the title of this post is a line from this notable new Lancet Public Health study titled "Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis."  This new study, authored by Elias Nosrati, Jacob Kang-Brown, Michael Ash, Martin McKee, Michael Marmot and Lawrence King, starts with this summary:

Background Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation.  We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA.

Methods In this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014.  We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention.  We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time.  To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach.

Findings After adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0–14·6; p<0·0001) in drug-related deaths within counties.  Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0–2·0; p<0·0001) and 2·6% (2·1–3·1; p<0·0001) in drug-related mortality, respectively.  The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates.  Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R²=0·975).  Between counties, high rates of incarceration were associated with a more than 50% increase in drug-related deaths.

Interpretation Reduced household income and high incarceration rates are associated with poor health. T he rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders.

UPDATE: I see now that this journal issue also has this related editorial titled "US mass incarceration damages health and shortens lives." Here is an excerpt:

The findings of this study support a plausible case that mass incarceration has added to the damaging effects of economic decline in increasing drug use and mortality. Incarceration can lead to drug addiction and death by feeding feelings of stigmatisation, by entrenching poor economic prospects, by breaking up families and communities, and by worsening individual mental health.

Over the past 40 years, US politicians of all stripes have sought to appear tough on crime, which has led to an over-reliance on incarceration across many types of offences and damaged public health.  Drastic changes to the justice system will be needed to seriously reduce the prison population.  Legislators need to repeal regressive sentencing laws that inflate the use of imprisonment (such as the three strikes law) and allow judges to pass sentences that are proportional to the crime.  Discriminatory policies and those that unfairly pull the poor into incarceration — such as money bail, plea bargaining, and arrests for crimes of poverty — must also be addressed.  Finally, chronic substance abuse should be confronted with treatment, not criminalisation.  As Natasa Gisev and colleagues' study shows, also in this issue, consistent opioid agonist treatment can reduce criminal involvement.  Drug misuse is a public health issue; more than a criminal one, and like many other petty crimes, it would be more effectively addressed by investment in social and community services, and not in steel bars.

July 5, 2019 at 03:07 PM | Permalink

Comments

Fewer Vicitmizations Ignored

Violent and property crimes hit 40-60 year lows in 2014, due to expanding prison cells, better policing and demographics.

Millions of potential crime victims were spared violent crimes.

Criminals are 6-7 times more likely to be drug abusers than are the general population.

It appears much more than likely that drug abuse is, now, less than it otherwise would have been, due to increased incarceration, based upon fewer violent crime victims becoming drug abusers.

Patrick A. Langan, senior statistician at the Justice Department's Bureau of Justice Statistics,calculated that tripling the prison population from 1975 to 1989 may have reduced "violent crime by 10 to 15 percent below what it would have been," thereby preventing a "conservatively estimated 390,000 murders, rapes, robberies and aggravated assaults in 1989 alone." (6).

In 1989, alone. In one year, alone.

From 1985-2015 that would be about 20 million prevented victimizations, by greater incarceration. The incarceration rate rose from about 250 in 1989 (Langan study) to 500 in 2009

Girls and women who have been sexually abused are 2-3 times more likely to have alcohol or drug problems, as those who have not been sexually abused.

Men and women, with sexual or non sexual assaults and murders of loved ones, would have similar if not worse statistics.

All, significantly, prevented crimes,20 million or more, as per Langans review, with huge multiples greater numbers in fewer victinizations, and their attendent drug and alcohol abuse, than those incarcerated.

Posted by: Dudley Sharp | Jul 6, 2019 9:02:32 AM

Little Dudù is as always WRONG.
In Italy, without mass incarceration and without capital punishment, we passed from 2.000 murders in 1991 to the 300 of 2017. Our murder rate is a 0.5 per 100.000: a tenth of the american one.

Posted by: Claudio Giusti | Jul 6, 2019 1:45:58 PM

Claudio:

That was not the topic of the article or the response to it.

Posted by: Dudley Sharp | Jul 7, 2019 8:40:43 AM

hahahahahahahah !!!!!!!!!!!!

Posted by: Claudio Giusti | Jul 8, 2019 12:32:40 PM

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