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JAMA: Drug War Mandatory Sentences May Be Driving Major Resurgence of Tuberculosis


January 1993

The overzealous prosecution of the war on drugs may be responsible for a major resurgence of tuberculosis, a disease that public health officials once thought on the verge of elimination [Andrew A. Skolnick, Medical News and Perspectives, "Some Experts Suggest the Nation's 'War on Drugs' is Helping Tuberculosis Stage a Deadly Comeback," Journal of the American Medical Association (JAMA), 12/9/92, Vol. 268, No. 22, p. 3177].

Referring to statistics in another JAMA (Vol. 268, 1992, pp. 174-175), the editorial observes that soaring drug-related incarceration rates have spurred tremendous prison overcrowding with inmates often infected with both HIV and tuberculosis. Since nearly all are returned to the community, this creates a vector for greatly increased disease transmission. Author Andrew Skolnick notes that approximately five in every 1000 Americans are behind bars on any given day, the highest incarceration rate of any nation in the world.

Skolnick suggests an end to mandatory minimums, a reorientation towards more humane, health oriented policies, and consideration of decriminalization of illicit drugs. He cites a number of recent policy statements from major national health and correctional organizations.

A joint position paper by the American College of Physicians, the National Commission of Correctional Health Care, and the American Correctional Health Services Association concluded that:

"Clearly, mandatory sentencing practices and the National Drug Control Strategy have overwhelmed correctional facilities to the point of crisis, without substantially alleviating the national problem of drug abuse or drug-related crime."

A recent report from the American Bar Association Ad Hoc Committee on Drugs concluded that mandatory minimums incur costs "disproportionate to any deterrent or rehabilitative effect they might have" (American Bar Association, "Responding to the Problem of Drug Abuse: Strategies for the Criminal Justice System: The Report of the Ad Hoc Committee of the Criminal Justice Section,Washington, D.C., ABA, 1992).

Skolnick also quotes Robert L. Cohen, M.D., a federal court-appointed monitor of correctional health care facilities, now an attending physician at New York's St. Vincent's Hospital and former director of health services for inmates of New York's Rikers Island jail:

"Court ordered inmate population caps have been the only thing that has kept correctional institutions in many jurisdictions from collapsing into total chaos. I hope the Clinton administration will develop a more reasonable, more humane, and certainly much cheaper approach to this problem.

"Prisons are terrible institutions. Prisons deform everyone who spends time in that environment, whether they are inmates, guards, or medical professionals. The problem of drug abuse is much better approached with a medical model than with a crime-and-punishment model. The medical model provides much greater benefit and much less cost to society than incarceration."