In this part of the conversation about addiction, Morgan Dandie Hannah and I talk a bit about the legal system and how well the war on drugs works. As I point out below, we squander a huge amount of money and do a terrible job. Clearly, we could do much, much better.
Morgan says that a good treatment facility costs about $20,000/month. I have no reason to doubt this figure, so let's use it as a baseline and compare it to how much it costs to incarcerate someone. I dug up a copy of a 2018 Parliamentary Budget Office report titled Update on Costs of Incarceration and found the following chart.
Operating Expenses Associated with Custody, 2016-17
Total Spending Average cost per Inmate % of Total
Salaries and employee benefits 1,102,774,000 78,188.74 70%
Utilities, materials and supplies 136,852,00 9,703.06 9%
Amortization of tangible capital assets 127,889,000 9,067.57 8%
Professional and special services 96,746,000 6,859.47 6%
Payment in lieu of taxes 35,063,000 2,486.03 2%
Machinery and equipment 28,779,000 2,040.48 2%
Repairs and maintenance 27,693,000 1,963.49 2%
All other expenses 17,891,000 1,268.51 1%Total $1,573,687,000 $109,971
Notes: Correctional interventions and internal services are not included. Cost per inmate based on total spending divided by average custodial population (14,310). Source: Correctional Service of Canada, 2016-2017 Financial Statements, s 16.
First of all, it's important to remember that there are huge variations in the cost of incarceration based on the level of security, which ranges from a high of $463,000/inmate in segregation, $139,000 for a "regional treatment centre", and, $123,000 in a "healing lodge"; to the lower end of $47,400 for a male in minimum security.
Secondly, these figures are just for the federal prison system. There are also provincial ones. The dividing line is the length of sentence, with the provinces being responsible for people serving sentences of two years or less. The 2015 average cost of incarceration per Ontario inmate was $78,475.
Third, look at the way the expenses of the prison system break down. The overwhelming cost is staffing: $78,200 or 70%. This is something that we find over and over again whenever you look at the cost of any social program. Human-to-human interactions are the most expensive part. I'd suggest, therefore, that any program that is aimed at ending a behaviour through a cure is going to be a lot cheaper than simply warehousing individuals for long periods of time.
Also, it's important to understand that while the largest cost per individual is that of keeping someone in prison, there are other costs involved in the criminal justice system. For example, the Department of Justice published a report that provides some idea of the numbers: Costs of Crime in Canada, 2009.
- average $1420 in court costs/person
- $1110 in prosecution costs/person
- totals of $8.59 billion in policing (that's only spent in criminal cases)
- $373 million for legal aid
Don't forget that there is a lot more money flying around. Consider, for example, the cost of safe injection sites, methadone clinics, paramedics and hospital emergency departments for overdoses, the enormous amount of training that goes into teaching front line staff at many different institutions (schools, arenas, businesses, universities, etc) about how to identify and deal with both overdoses and addiction, the cost to individuals and communities who have to deal with street people and the petty crime associated with the drug pandemic, and, probably other things I haven't thought of. In that context it certainly seems to me that it would make sense for society to fund drug treatment programs!
Of course---like so many other issues that the government deals with---because each of these expenses comes from one department's budget as opposed to another, people tend to be oblivious to the aggregate costs of supporting a drug addict. The result is that emotionally-driven, simplistic solutions tend to dominate political discourse. People want the guy who stole their bicycle stolen arrested and often have little patience for the argument that money would be better spent on a drug treatment centre or housing for the homeless.
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It takes a lot of time and effort to bring together all these facts and figures into what I hope is an easy-to-read package. If you can afford it (and Dao knows lots of people are suffering right now), why not subscribe? I can use the extra money and it's easy to do through Patreon and Pay Pal.
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Hannah also says that it's very easy to get drugs in prison. According to a 2007 survey of federal prisoners, it appears that is an exaggeration---although only a bit.
The proportion of inmates who reported injecting drugs in prison compared to the community declined by about 30% for men (16% vs. 22%) and 50% for women (15% vs. 29%) (see Figure 2). Furthermore, the proportion injecting at least once per week and "often or always" binge-injecting (i.e., injecting many times over a short period) significantly declined by at least 70% in prison compared to the community.
I suppose it only stands to reason that it is harder to get drugs in a prison, both because they have to be smuggled in, and, because it's harder to get the money required. Having said that, it is pretty remarkable that so many inmates are able to get their hands on injectable narcotics given the barriers.
Morgan also says that there is precious little drug treatment for people in prison. It is very difficult to find information about what happens in prisons, but there are some indications that might allow a person to draw conclusions.
First of all, I found a 2018 story in the CBC about a person arrested in Guelph for breaking the terms of his probation---a provision about not using narcotics---after being treated for an overdose. He later died of a fentanyl overdose in the Maplehurst prison near Milton. According to that story, part of his problem was that doctors in prisons are forbidden to prescribe methadone to inmates who have not already been prescribed before incarceration.
CBC sources familiar with health care in the Ontario correctional system, who requested anonymity because they are not authorized to speak publicly, blame a provincial policy that says methadone should not be started with "inmates who have not been previously enrolled in [methadone treatment], except under special circumstances." The policy is in place in spite of a 2016 report by the provincial Methadone Treatment and Services Advisory Committee that recommended to the health minister that prisoners have access to methadone therapy.
Blair Bigham: 'A human rights issue': Lack of treatment for drug users means deaths behind bars
I suspect that a big part of the problem is how you define "addiction treatment". Hannah repeatedly says that you have to treat the underlying psychological issues---what the Centre for Addiction and Mental Health (CAMH) identifies as "the concurrent mental health problem"---or else you won't be successful. Moreover, she says that people have to be at the point where they really want to stop their addiction. That means that simply putting people in jail and taking away their source of drugs---which is only partially done anyway---isn't enough to get the monkey off their backs.
And from what I could see while researching this subject, there are precious few resources for people with mental illness in prison.
The results speak for themselves. I came across a study from the Canadian Medical Association Journal titled Mortality over 12 years of follow-up in people admitted to provincial custody in Ontario: a retrospective cohort study. It contained the following graph that illustrates the grim reality.
As you can see, there are dramatically higher rates of overdoses in the first four weeks after release from Ontario prisons. Primarily, this tells me that lots of people come out still addicted. What probably fuels the overdoses is the fact that when someone goes through a physical detox (ie: "cold turkey" in a prison cell) without dealing with the underlying reasons they are addicted, they often naively take the same amount that they were used to taking before---but which is now a fatal overdose.
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Hannah mentioned a figure of $20,000/month. It's important to remember that that's just a one-shot cost. After that, the price tag should decline pretty dramatically. For example, how much would it cost per person per month to house someone in supportive housing? Probably a whole lot less than prison! Or to pay for some sort of psychological counselling to deal with the underlying problem that fuelled the addiction in the first place? Again, a whole lot less than prison!
People often complain that such and such a program would be a good idea, but we just can't afford it. I hope the numbers I've cited above would put that canard to rest---at least with regard to helping addicts. We are already spending a lot of money---just in a tremendously wasteful way.
Looking at the issue from "on high", it appears that the real problem is one of perceptions and prejudices. Our society is based upon the myth of "Horatio Alger" that says that people should "pull themselves up by their bootstraps". Instead, I think we would be much better served by the Bantu concept of Ubuntu, which can be translated as "I am because we are" or "humanity towards others". Political scientists say that most people vote on the basis of their values, instead of a deep understanding of policy alternatives. What that suggests to me is that no matter how many numbers and graphs I dredge up to educate readers, what we really need is for people stop fixating on self-reliance and instead develop a little more ability to "walk a mile in another person's moccasins".
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Furthermore I say unto you, we have to deal with the Climate Emergency!
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