Arrested on heroin: A national opportunity

Amy E. Boutwell, MD, MPP; Ank Nijhawan, MD; Nickolas Zaller, PhD; Josiah D. Rich, MD, MPH

doi:10.5055/jom.2007.0021

Authors

Amy E. Boutwell, MD, MPP
Ank Nijhawan, MD
Nickolas Zaller, PhD
Josiah D. Rich, MD, MPH

DOI:

https://doi.org/10.5055/jom.2007.0021

Keywords:

heroin, addiction, prison, public health

Abstract

Objectives: Heroin addiction in the United States exacts significant social, economic, medical, and public health costs, estimated at almost $22 billion in 1996. The national drug control strategy of arrest and mandatory sentencing of drug offenders over the past two decades has resulted in ever greater numbers of drug users who encounter the criminal justice system each year. No estimate of heroin use among the US incarcerated population exists. The authors attempted to estimate the proportion of heroin-using individuals who pass through the corrections system annually to determine the potential impact of interventions designed to link heroin-using individuals to addiction treatment.
Methods: The authors constructed an estimate by employing the following elements: arrestee drug-testing data, total number of arrests, an estimate of the mean annual number of arrests in a drug-using population, estimates of arrestees incarcerated, and estimates of heroin use and addiction in the US population. The authors present each component of the estimate and how it was derived, and conclude by discussing the degree of uncertainty in the estimates and the implications of our results for policy makers.
Results: Using a conservative estimate, the authors found that 24 percent to 36 percent of all heroin addicts pass through the corrections system each year, representing more than 200,000 individuals.
Conclusions: Viewed as a public health opportunity, effective linkage to addiction treatment could ultimately reduce the costs associated with poor health, disease transmission, criminality, and recidivism that heroin use exacts on individuals and communities.

Author Biographies

Amy E. Boutwell, MD, MPP

Director, Institute for Healthcare Improvement, Cambridge, Massachusetts.

Ank Nijhawan, MD

Brown University, Providence, Rhode Island; Clinical Research Fellow, Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island; The Center for Prisoner Health and Human Rights, Providence, Rhode Island.

Nickolas Zaller, PhD

Assistant Professor of Medicine (Research), Brown University, Providence, Rhode Island; Clinical Research Fellow, The Miriam Hospital, Providence, Rhode Island; The Center for Prisoner Health and Human Rights, Providence, Rhode Island.

Josiah D. Rich, MD, MPH

Professor of Medicine and Community Health, Brown University, Providence, Rhode Island; Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island; The Center for Prisoner Health and Human Rights, Providence, Rhode Island.

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