A new study published in Lancet Public Health medical journal theorizes that in some areas across the United States, “when incarceration rates rise and household incomes fall, drug-related deaths increase.”  Researchers found “from 1983 to 2014, when there was a significant decrease in average household income, which dipped by nearly a third, there was an associated 12.8% increase in drug-related deaths.”  The study also found in the area observed average “increases of 7,018 jail admissions per 100,000 people and 255 prison admissions per 100,000 people were associated with a 1.5% and a 2.6% increase in the county’s death rate from drug use, respectively.”“We know that most incarceration is only very loosely related to the crime rate,” said Lawrence King, a professor of economics at the University of Massachusetts Amherst and the study’s senior author.  He added, “If we’re incarcerating people because we don’t like the negative effects of drugs, what this study shows is it’s counterproductive…It’s a strong argument for medicalization of hard drugs as opposed to criminalization, which actually makes a lot of sense, given that the definition that we use of addiction is the continued obsessive-compulsive use of drugs despite negative consequences.  So imprisoning people – giving them negative consequences to get them to stop using drugs – is not going to work by the very definition we’re using of addiction.”

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In total, data for 2,640 U.S. counties was analyzed between 1983 and 2014, and the journal study included mortality statistics from the U.S. National Vital Statistics System and Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and incarceration data by county from the Vera Institute of Justice.  The researchers also secured county-level data on retail opioid prescription rates between 2006 and 2014 from the Centers for Disease Control and Prevention (CDC) and found that the incarceration rates correlated with overdose deaths.“On average, 130 people in the United States die every day from an opioid overdose,” according to the CDC.King said, “I think the most surprising thing was that the prescriptions of the opioids do not seem to be the major cause of the opioid crisis.  It’s contributing for sure but once we put in our controls, it had no predictive power.”  Normally, “the national dialogue on opioid addiction is all focused on the behavior of the pharmaceutical companies – and I don’t think they should be left off the hook – but it’s all focused on the supply and no focus on the demand,” he added.King said it’s important to note that the prescription data in the journal study only dated back to 2006.  The findings also only suggest an association between reduced household incomes, high incarceration rates and drug-related deaths, and additional research is needed to determine whether there is correlation between these factors, and to explain why associations exist.“They really started to prescribe opioids a lot from ‘95.  So, there could have been a big effect earlier on and then that carried forward,” he said. “So, we can’t conclusively say they have no effect, and I don’t believe they have no effect.”The new study, however, “demonstrates the powerful potential that better understanding of incarceration could have on public health,” said James LePage, chief of research at the Department of Veterans Affairs’ (VA) North Texas Health Care System in Dallas, who wrote in a commentary paper that coincided with the study.“The impact of incarceration on individuals and families can be devastating leading to an increased incidence of homelessness, unemployment, divorce, and recidivism,” he wrote. “Individuals who have been incarcerated are more likely to be substance users and have a higher risk of premature death…Economic deprivation is also a known risk factor for substance abuse and early death.  It seems plausible, therefore, that both rates of incarceration and impoverishment might contribute to changes in mortality from drug use.  The results highlight the need to evaluate current approaches towards the issues associated with incarceration.”

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Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysisIncarceration, falling incomes may play a role in the US opioid epidemic, study says