Executive Summary
For decades, the United States has relied on arrest and incarceration to address drug use. These strategies have failed to achieve their intended aims and have coincided with an increase in harm and overdoses related to a contaminated, unregulated drug supply. Drug-related offenses remain the leading cause of arrest nationwide, with hundreds of thousands of people arrested each year for possession alone. These policies have not improved health outcomes and have instead contributed to an increase in preventable illness, death, and social instability.This statement focuses on substance use involving illegal drugs and the associated health impacts of drug criminalization. Clinicians routinely observe that fear of arrest delays care, disrupts treatment, and worsens health outcomes for people who use drugs. Correctional settings are associated with worse health outcomes for people with drug use disorders than in community-based care. Limited access to effective treatments—particularly medications for opioid use disorder—contributes to elevated overdose risk during incarceration and following release. The consequences of drug criminalization extend beyond incarceration, as criminal records create lasting barriers to healthcare, housing, employment, and other essential supports.Health outcomes related to drug use are not evenly distributed across the United States. Overdose, untreated substance use disorders, and preventable morbidity disproportionately affect Black, Latino, Indigenous, and low-income communities, despite similar rates of drug use across all populations. Differential enforcement of drug laws and resulting criminal justice involvement disrupt access to treatment and function as structural drivers of health inequities.A public health-centered, evidence-based approach to drug use prioritizes access to care over punishment. Strategies such as overdose prevention services, naloxone distribution, and access to medications for opioid use disorder reduce overdose risk, save lives, and support engagement with care. Lawmakers should invest in health-centered approaches that reduce preventable harm, including health-based alternatives to arrest and the removal of criminal penalties for personal possession of drugs. Public policy should not contradict public health recommendations but work to bolster them.Full StatementWe, the undersigned medical and public health organizations and individual health professionals and scientists, support an evidence-based, public health-centered approach to substance use that prioritizes health, safety, and access to care. In this statement, references to substance use and substance use disorders pertain to illegal drugs and do not include alcohol or tobacco. A health-centered approach ensures people who use drugs have ready access to treatment, overdose prevention services, primary health care, and supportive services like housing and job training. A public health approach to drug use includes ending criminal penalties for the personal possession of drugs and meaningfully investing in health services for people who use drugs (1). Decriminalization can decrease stigma associated with drug use, is associated with increased engagement with health services, and creates conditions that facilitate access to care (2).For decades, the United States has attempted to address drug use through arrest and incarceration. Drug-related offenses are the leading cause of arrest in the United States, with more than 800,000 arrests made per year for possession alone (3). Despite over 50 years of arresting and incarcerating people for drugs, the drug supply has become more dangerous, overdose deaths have skyrocketed, and drug use rates have not decreased. Punitive drug policies have failed to improve public health outcomes and have instead heightened the risks associated with drug use (4).As physicians, health practitioners, and public health and public policy experts, our foremost responsibility is to protect the health and well-being of our patients and communities – including people who use drugs. As clinicians, we routinely see how fear of arrest delays care, interrupts treatment, and worsens health outcomes (5, 6). Punishing people who use drugs (including those who use drugs during pregnancy) - rather than providing evidence-based care - contradicts the well-established medical consensus that substance use disorders are health conditions, not criminal problems (7, 8). Drug criminalization and aggressive enforcement alsodiscourage clinicians from prescribing evidence-based treatments, like methadone and buprenorphine, out of fear of surveillance, investigation, or even prosecution (9).Correctional facilities are not healthcare settings, and their punitive environments often exacerbate existing medical and psychiatric conditions (10). Rates of fatal overdose in jails and prisons are alarmingly high, with deaths from drug or alcohol intoxication in state prisons increasing more than six-fold between 2001 and 2018 (11). Despite strong evidence that medications for opioid use disorder, like methadone and buprenorphine, reduce overdose risk, cravings, and withdrawal (12), these treatments remain largely unavailable in most carceral settings (13). People living with substance use disorders should receive timely, evidence-basedtreatment from qualified health professionals in their community, not be subjected to a criminal legal system that exacerbates illness and increases the risk of death.Drug criminalization delays access to care and disrupts the path to recovery (14). Too often, a drug arrest traps people in a cycle of arrest and release—without ever addressing the root causes, like lack of housing, employment, mental health support, or other basic needs. A criminal record can then block access to housing, education, jobs, treatment, and public benefits—all of which are essential for stability and healing (15). Thus, the harm of a drug arrest often lingers long after the sentence ends.Marked disparities in drug-related health outcomes persist across the United States. Rates of overdose, untreated substance use disorder, and preventable morbidity are disproportionately high in Black, Latino, Indigenous, and low-income communities, despite similar rates of drug use across racial and ethnic groups (16, 17). These disparities are driven in part by the differential enforcement of drug laws. Higher rates of arrest and criminal justice involvement in these communities are associated with disrupted access to healthcare, reduced availability of treatment and overdose prevention services, and increased barriers to housing, employment, and public benefits—each a well-established determinant of health (6). Structural racism embedded in drug policy and enforcement thus functions as a population-level health risk. Reducing these inequities requires limiting criminal justice exposure and investing in accessible, community-based health services in the communities most affected.Decades of research and frontline experience demonstrate the benefits of a health-focused approach to drug use (18). Strategies such as naloxone distribution and access to medications for opioid use disorder are effective because they meet people where they are and provide access points to needed services (19). Despite recent decreases in overdose death rates, overdose deaths remain unacceptably high.Lawmakers should prioritize investment in health-centered approaches that improve access to care and reduce preventable harm, including health-based alternatives to arrest and the removal of criminal penalties for personal possession of drugs.References1. The Lancet (2023). Drug decriminalisation: grounding policy in evidence. Lancet (London, England), 402(10416), 1941. https://doi.org/10.1016/S0140-6736(23)02617-X2. Volkow N. D. (2021). Addiction should be treated, not penalized.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 46(12), 2048–2050.3. Federal Bureau of Investigation. (2023). Crime Data Explorer. CJIS.4. O'Dowd A. (2024). Drug policy: Time to change punitive approach, says global report. BMJ (Clinical research ed.), 387, q2753. https://doi.org/10.1136/bmj.q27535. Ostrach, B., Hixon, V., & Bryce, A. (2024). "When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies. Health & justice, 12(1), 3. https://doi.org/10.1186/s40352-023-00256-36. Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system. Annals of Medicine, 54(1), 2024–2038. https://doi.org/10.1080/07853890.2022.21009267. Shah, S. K., Perez-Cardona, L., Helner, K., Massey, S. H., Premkumar, A., Edwards, R., Norton, E. S., Rogers, C. E., Miller, E. S., Smyser, C. D., Davis, M. M., & Wakschlag, L. S. (2023). How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers' perspectives. Journal of law and the biosciences, 10(2), lsad019. https://doi.org/10.1093/jlb/lsad0198. Volkow, N. D., Poznyak, V., Saxena, S., Gerra, G., & UNODC-WHO Informal International Scientific Network (2017). Drug use disorders: impact of a public health rather than a criminal justice approach. World psychiatry : official journal of the World Psychiatric Association (WPA), 16(2), 213–214. https://doi.org/10.1002/wps.204289. Madras, B. K., Ahmad, N. J., Wen, J., & Sharfstein, J. S. (2020). Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM perspectives, 2020, 10.31478/202004b. https://doi.org/10.31478/202004b10. Committee on Causes and Consequences of High Rates of Incarceration, Committee on Law and Justice, Division of Behavioral and Social Sciences and Education, National Research Council, Board on the Health of Select Populations, & Institute of Medicine. (2013). Impact of Incarceration on Health. In National Academies Press (US), Health and Incarceration: A Workshop Summary. https://www.ncbi.nlm.nih.gov/books/NBK201966/11. Carson, E. A. (2021). Mortality in State and Federal Prisons, 2001-2018 – Statistical Tables. Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/msfp0118st.pdf12. NIDA. (2025). Medications for Opioid Use Disorder. NIH.13. NORC at the University of Chicago. (2023). JCOIN’s National Survey of Substance Use Services in Jails: Describing U.S. Jails and Their Screening, Treatment, Recovery, and Re-entry Practices. JCOIN. https://jcoinctc.org/MAT-results-from-JCOIN-national.../14. Drug Policy Alliance. (2025). From Crisis to Care. Drug Policy Alliance.15. Jones, A., & Sawyer, W. (2019). Arrest, Release, Repeat: How police and jails are misused to respond to social problems. Prison Policy Initiative.16. Kariisa, M., Davis, N. L., Kumar, S., Seth, P., Mattson, C. L., Chowdhury, F., & Jones, C. M. (2022). Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics - 25 States and the District of Columbia, 2019-2020. MMWR. Morbidity and mortality weekly report, 71(29), 940–947. https://doi.org/10.15585/mmwr.mm7129e217. National Survey on Drug Use and Health. (2023). Behavioral Health by Race and Ethnicity: Results from the 2021-2023 National Surveys on Drug Use and Health. SAMHSA. https://www.samhsa.gov/.../2023-nsduh-race-eth-companion.pdf 18. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). (2016). Vision for the Future: A Public Health Approach. In US Department of Health and Human Services, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health.19. Salisbury-Afshar, E., Gale, B., & Mossburg, S. (2024). Harm Reduction Strategies to Improve Safety for People Who Use Substances. PSNet. https://psnet.ahrq.gov/.../harm-reduction-strategies...
For decades, the United States has relied on arrest and incarceration to address drug use. These strategies have failed to achieve their intended aims and have coincided with an increase in harm and overdoses related to a contaminated, unregulated drug supply. Drug-related offenses remain the leading cause of arrest nationwide, with hundreds of thousands of people arrested each year for possession alone. These policies have not improved health outcomes and have instead contributed to an increase in preventable illness, death, and social instability.
This statement focuses on substance use involving illegal drugs and the associated health impacts of drug criminalization. Clinicians routinely observe that fear of arrest delays care, disrupts treatment, and worsens health outcomes for people who use drugs. Correctional settings are associated with worse health outcomes for people with drug use disorders than in community-based care. Limited access to effective treatments—particularly medications for opioid use disorder—contributes to elevated overdose risk during incarceration and following release. The consequences of drug criminalization extend beyond incarceration, as criminal records create lasting barriers to healthcare, housing, employment, and other essential supports.
Health outcomes related to drug use are not evenly distributed across the United States. Overdose, untreated substance use disorders, and preventable morbidity disproportionately affect Black, Latino, Indigenous, and low-income communities, despite similar rates of drug use across all populations. Differential enforcement of drug laws and resulting criminal justice involvement disrupt access to treatment and function as structural drivers of health inequities.
A public health-centered, evidence-based approach to drug use prioritizes access to care over punishment. Strategies such as overdose prevention services, naloxone distribution, and access to medications for opioid use disorder reduce overdose risk, save lives, and support engagement with care. Lawmakers should invest in health-centered approaches that reduce preventable harm, including health-based alternatives to arrest and the removal of criminal penalties for personal possession of drugs. Public policy should not contradict public health recommendations but work to bolster them.
Full Statement
We, the undersigned medical and public health organizations and individual health professionals and scientists, support an evidence-based, public health-centered approach to substance use that prioritizes health, safety, and access to care. In this statement, references to substance use and substance use disorders pertain to illegal drugs and do not include alcohol or tobacco. A health-centered approach ensures people who use drugs have ready access to treatment, overdose prevention services, primary health care, and supportive services like housing and job training. A public health approach to drug use includes ending criminal penalties for the personal possession of drugs and meaningfully investing in health services for people who use drugs (1). Decriminalization can decrease stigma associated with drug use, is associated with increased engagement with health services, and creates conditions that facilitate access to care (2).
For decades, the United States has attempted to address drug use through arrest and incarceration. Drug-related offenses are the leading cause of arrest in the United States, with more than 800,000 arrests made per year for possession alone (3). Despite over 50 years of arresting and incarcerating people for drugs, the drug supply has become more dangerous, overdose deaths have skyrocketed, and drug use rates have not decreased. Punitive drug policies have failed to improve public health outcomes and have instead heightened the risks associated with drug use (4).
As physicians, health practitioners, and public health and public policy experts, our foremost responsibility is to protect the health and well-being of our patients and communities – including people who use drugs. As clinicians, we routinely see how fear of arrest delays care, interrupts treatment, and worsens health outcomes (5, 6). Punishing people who use drugs (including those who use drugs during pregnancy) - rather than providing evidence-based care - contradicts the well-established medical consensus that substance use disorders are health conditions, not criminal problems (7, 8). Drug criminalization and aggressive enforcement also
discourage clinicians from prescribing evidence-based treatments, like methadone and buprenorphine, out of fear of surveillance, investigation, or even prosecution (9).
Correctional facilities are not healthcare settings, and their punitive environments often exacerbate existing medical and psychiatric conditions (10). Rates of fatal overdose in jails and prisons are alarmingly high, with deaths from drug or alcohol intoxication in state prisons increasing more than six-fold between 2001 and 2018 (11). Despite strong evidence that medications for opioid use disorder, like methadone and buprenorphine, reduce overdose risk, cravings, and withdrawal (12), these treatments remain largely unavailable in most carceral settings (13). People living with substance use disorders should receive timely, evidence-based
treatment from qualified health professionals in their community, not be subjected to a criminal legal system that exacerbates illness and increases the risk of death.
Drug criminalization delays access to care and disrupts the path to recovery (14). Too often, a drug arrest traps people in a cycle of arrest and release—without ever addressing the root causes, like lack of housing, employment, mental health support, or other basic needs. A criminal record can then block access to housing, education, jobs, treatment, and public benefits—all of which are essential for stability and healing (15). Thus, the harm of a drug arrest often lingers long after the sentence ends.
Marked disparities in drug-related health outcomes persist across the United States. Rates of overdose, untreated substance use disorder, and preventable morbidity are disproportionately high in Black, Latino, Indigenous, and low-income communities, despite similar rates of drug use across racial and ethnic groups (16, 17). These disparities are driven in part by the differential enforcement of drug laws. Higher rates of arrest and criminal justice involvement in these communities are associated with disrupted access to healthcare, reduced availability of treatment and overdose prevention services, and increased barriers to housing, employment, and public benefits—each a well-established determinant of health (6). Structural racism embedded in drug policy and enforcement thus functions as a population-level health risk. Reducing these inequities requires limiting criminal justice exposure and investing in accessible, community-based health services in the communities most affected.
Decades of research and frontline experience demonstrate the benefits of a health-focused approach to drug use (18). Strategies such as naloxone distribution and access to medications for opioid use disorder are effective because they meet people where they are and provide access points to needed services (19). Despite recent decreases in overdose death rates, overdose deaths remain unacceptably high.
Lawmakers should prioritize investment in health-centered approaches that improve access to care and reduce preventable harm, including health-based alternatives to arrest and the removal of criminal penalties for personal possession of drugs.
References
1. The Lancet (2023). Drug decriminalisation: grounding policy in evidence. Lancet (London, England), 402(10416), 1941. https://doi.org/10.1016/S0140-6736(23)02617-X
2. Volkow N. D. (2021). Addiction should be treated, not penalized.
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 46(12), 2048–2050.
3. Federal Bureau of Investigation. (2023). Crime Data Explorer. CJIS.
4. O'Dowd A. (2024). Drug policy: Time to change punitive approach, says global report. BMJ (Clinical research ed.), 387, q2753. https://doi.org/10.1136/bmj.q2753
5. Ostrach, B., Hixon, V., & Bryce, A. (2024). "When people who use drugs can't differentiate between medical care and cops, it's a problem." Compounding risks of law Enforcement Harassment & Punitive Healthcare Policies. Health & justice, 12(1), 3. https://doi.org/10.1186/s40352-023-00256-3
6. Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system. Annals of Medicine, 54(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926
7. Shah, S. K., Perez-Cardona, L., Helner, K., Massey, S. H., Premkumar, A., Edwards, R., Norton, E. S., Rogers, C. E., Miller, E. S., Smyser, C. D., Davis, M. M., & Wakschlag, L. S. (2023). How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers' perspectives. Journal of law and the biosciences, 10(2), lsad019. https://doi.org/10.1093/jlb/lsad019
8. Volkow, N. D., Poznyak, V., Saxena, S., Gerra, G., & UNODC-WHO Informal International Scientific Network (2017). Drug use disorders: impact of a public health rather than a criminal justice approach. World psychiatry : official journal of the World Psychiatric Association (WPA), 16(2), 213–214. https://doi.org/10.1002/wps.20428
9. Madras, B. K., Ahmad, N. J., Wen, J., & Sharfstein, J. S. (2020). Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System. NAM perspectives, 2020, 10.31478/202004b. https://doi.org/10.31478/202004b
10. Committee on Causes and Consequences of High Rates of Incarceration, Committee on Law and Justice, Division of Behavioral and Social Sciences and Education, National Research Council, Board on the Health of Select Populations, & Institute of Medicine. (2013). Impact of Incarceration on Health. In National Academies Press (US), Health and Incarceration: A Workshop Summary. https://www.ncbi.nlm.nih.gov/books/NBK201966/
11. Carson, E. A. (2021). Mortality in State and Federal Prisons, 2001-2018 – Statistical Tables. Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/msfp0118st.pdf
12. NIDA. (2025). Medications for Opioid Use Disorder. NIH.
13. NORC at the University of Chicago. (2023). JCOIN’s National Survey of Substance Use Services in Jails: Describing U.S. Jails and Their Screening, Treatment, Recovery, and Re-entry Practices. JCOIN. https://jcoinctc.org/MAT-results-from-JCOIN-national.../
14. Drug Policy Alliance. (2025). From Crisis to Care. Drug Policy Alliance.
15. Jones, A., & Sawyer, W. (2019). Arrest, Release, Repeat: How police and jails are misused to respond to social problems. Prison Policy Initiative.
16. Kariisa, M., Davis, N. L., Kumar, S., Seth, P., Mattson, C. L., Chowdhury, F., & Jones, C. M. (2022). Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics - 25 States and the District of Columbia, 2019-2020. MMWR. Morbidity and mortality weekly report, 71(29), 940–947. https://doi.org/10.15585/mmwr.mm7129e2
17. National Survey on Drug Use and Health. (2023). Behavioral Health by Race and Ethnicity: Results from the 2021-2023 National Surveys on Drug Use and Health. SAMHSA. https://www.samhsa.gov/.../2023-nsduh-race-eth-companion.pdf
18. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). (2016). Vision for the Future: A Public Health Approach. In US Department of Health and Human Services, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health.
19. Salisbury-Afshar, E., Gale, B., & Mossburg, S. (2024). Harm Reduction Strategies to Improve Safety for People Who Use Substances. PSNet. https://psnet.ahrq.gov/.../harm-reduction-strategies...
