Two Separate Societies: One in Prison, One Not

Forty years ago, the Kerner Commission concluded in its landmark study of the causes of racial disturbances in the United States in the 1960s: "Our nation is moving toward two societies, one black, one white -- separate and unequal." Today we are still moving toward two societies: one incarcerated and one not. The Pew Center on the States released a study in February showing that for the first time in this country's history, more than one in every 100 adults is in jail or prison. According to the Justice Department, 7 million people -- or one in every 32 adults -- are either incarcerated, on parole or probation or under some other form of state or local supervision.

These figures understate the disproportionate impact that this bold and unprecedented social experiment has had on certain groups in U.S. society. Today one in nine young black men is behind bars. African Americans now comprise more than half of all prisoners, up from a third three decades ago.

Sen. James Webb (D-Va.) held a remarkable set of hearings last October on mass incarceration in the United States. In his opening statement, Webb noted that "the United States has embarked on one of the largest public policy experiments in our history, yet this experiment remains shockingly absent from public debate."

The leading presidential candidates have not identified mass imprisonment as a central issue, even though it is arguably the country's top civil rights concern. Many of today's crime control policies fundamentally impede the economic, political and social advancement of the most disadvantaged blacks and members of other minority groups. Prison leaves them less likely to find gainful employment, vote, participate in other civic activities and maintain ties with their families and communities.

Congress recognized some of these barriers recently when, after years of delay, it approved and sent to the White House the Second Chance Act, which President Bush signed into law last week. This legislation seeks to ease the reentry of prisoners into society by providing modest increases in support for mentoring programs, drug treatment, job training and education.

Bruce Western of Harvard soberly concludes in his landmark book "Punishment and Inequality in America" that mass imprisonment has erased many of the "gains to African American citizenship hard won by the civil rights movement." Sen. Barack Obama glancingly made some similar points in an address at Howard University last September. But he generally has not focused on the perils of mass incarceration. Neither has Sen. Hillary Clinton, though the $4 billion anti-crime package she unveiled last week did call for elimination of the federal mandatory five-year sentence for minor crack cocaine violations. As for Sen. John McCain, civil rights and criminal justice policy are not among the 15 issues the Republican nominee highlights on his Web site. But America's space program did make the top 15.

At the hearings last fall, Webb underscored a basic truth sidelined in most discussions of crime and punishment: The explosion of the prison population wasn't driven so much by an increase in crime as by the way we chose to respond to crime. Even former president Bill Clinton, whose administration was an accomplice in the largest prison buildup in U.S. history, conceded in a keynote address at a University of Pennsylvania symposium in February commemorating the Kerner anniversary: "Most of the people who went to prison should have been let out a long time ago."

A change of heart by Bill Clinton and other public figures will not be enough to reverse the prison boom. In rare instances, public officials have been moved by strong personal beliefs to empty their prisons. During his brief tenure as Britain's home secretary early in the 20th century, Winston Churchill expressed deep skepticism about what could be achieved through incarceration, and he began releasing prisoners. Political leadership has been critical for major reductions in incarceration in other countries. But in many cases, the public and experts on criminal justice had to push politicians to begin emptying their prisons and jails.

It is a national disgrace that the U.S. incarceration rate is five to 12 times that of other industrialized countries as well as being the highest in the world. As Churchill once said, "The mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of the civilization of any country."

Marie Gottschalk, an associate political science professor at the University of Pennsylvania, is author of " The Prison and the Gallows: The Politics of Mass Incarceration in America."

U.S. Senate Passes Second Chance Act

The U.S. Senate passed today the Second Chance Act of 2007. This landmark bill, introduced by Senators Joseph Biden (D-DE), Sam Brownback (R-KS), Patrick Leahy (D-VT), and Arlen Specter (R-PA), provides critical resources designed to reduce recidivism and increase public safety. The legislation passed the Senate by unanimous consent and now proceeds to the
President's desk for signature.

"The passage of the Second Chance Act reflects the strong consensus that improving prisoner reentry is not a partisan issue, but a matter of public safety, improving lives, and making effective use of taxpayer dollars," said Assemblyman Jeffrion Aubry, Justice Center board member and chair of the New York State Assembly Correction Committee.

The Second Chance Act includes key elements of President Bush's Prisoner Reentry Initiative, announced in the 2004 State of the Union address, which provides for community and faith-based organizations to deliver mentoring and transitional services. The bill will also help connect people released from prison and jail to mental health and substance abuse treatment, expand job training and placement services, and facilitate transitional housing and case management services.

"It is vitally important that we do everything we can to ensure that, when people get out of prison, they enter our communities as productive members of society, so we can start to reverse the dangerous cycles of recidivism and violence, " said Senator Leahy. "I hope that the Second Chance Act will help us begin to break that cycle."

According to the U.S. Department of Justice, Bureau of Justice Statistics, an estimated 95 percent of all state prisoners will be released-with half of these individuals expected to return to prison within three years for the commission of a new crime or violation of their conditions of release. This cycle of recidivism not only compromises public safety, but also increases taxpayer spending. A February 2007 report from The Pew Charitable Trusts stated that if federal, state, and local policies and practices do not change, taxpayers are expected to pay as much as $27.5 billion on prisons alone from 2007 to 2011 on top of current corrections spending.

"The Second Chance Act will provide an opportunity for realistic rehabilitation for the more than 650,000 inmates who return to their communities each year," said Senator Specter. "The bill's focus on education, job training, and substance abuse treatment is essential to decreasing the nationwide recidivism rate of 66 percent." The U.S. Senate passed the Second Chance Act of 2007. This landmark bill, introduced by Senators Joseph Biden (D-DE), Sam Brownback (R-KS), Patrick Leahy (D-VT), and Arlen Specter (R-PA), provides critical resources designed to reduce recidivism and increase public safety. The legislation passed the Senate by unanimous consent and now proceeds to the President's desk for signature.

"The passage of the Second Chance Act reflects the strong consensus that improving prisoner reentry is not a partisan issue, but a matter of public safety, improving lives, and making effective use of taxpayer dollars," said Assemblyman Jeffrion Aubry, Justice Center board member and chair of the New York State Assembly Correction Committee.

The Second Chance Act includes key elements of President Bush's Prisoner Reentry Initiative, announced in the 2004 State of the Union address, which provides for community and faith-based organizations to deliver mentoring and transitional services. The bill will also help connect people released from prison and jail to mental health and substance abuse treatment, expand job training and placement services, and facilitate transitional housing and case management services.

"It is vitally important that we do everything we can to ensure that, when people get out of prison, they enter our communities as productive members of society, so we can start to reverse the dangerous cycles of recidivism and violence, " said Senator Leahy. "I hope that the Second Chance Act will help us begin to break that cycle."

According to the U.S. Department of Justice, Bureau of Justice Statistics, an estimated 95 percent of all state prisoners will be released-with half of these individuals expected to return to prison within three years for the commission of a new crime or violation of their conditions of release. This cycle of recidivism not only compromises public safety, but also increases taxpayer spending. A February 2007 report from The Pew Charitable Trusts stated that if federal, state, and local policies and practices do not change, taxpayers are expected to pay as much as $27.5 billion on prisons alone from 2007 to 2011 on top of current corrections spending.

"The Second Chance Act will provide an opportunity for realistic rehabilitation for the more than 650,000 inmates who return to their communities each year," said Senator Specter. "The bill's focus on education, job training, and substance abuse treatment is essential to decreasing the nationwide recidivism rate of 66 percent."

Query Patients About Past Drug Problems to Prevent Prescription Misuse, Docs Told

March 14, 2008

Diversion and misuse of prescription drugs is a growing problem, but one that physicians can help prevent by asking patients about their addiction history before prescribing drugs with high abuse potential, experts say.

AMANews reported March 17 that doctors who want to prescribe adequate medication to treat pain can take a number of precautions to avoid running afoul of law enforcement or unwittingly contributing to an addiction problem. "Because so many patient problems have fallen at the feet of primary care, we need to look at ways primary care can be part of the solution and not part of the problem," said Michael M. Miller, M.D., president of the American Society of Addiction Medicine.

Miller advises doctors to start by asking about the patient's past history with alcohol and other drug addiction as well as past problems controlling prescription medication use. Prescribing only as much medication as the patient will reasonably need also can prevent diversion or misuse, such as kids or others taking unused pills from a parent's medicine cabinet.

"We hate to see somebody in pain run out of medicine, so sometimes we may be a little too generous," said Kyle Kampman, M.D., medical director of the Charles O'Brien Center for Addiction Treatment at the University of Pennsylvania.

"Patients tell me they worked as a maid at the height of their addiction and they would go through people's medicine cabinets. I had a patient who was a roofer tell me, 'If you ever let a roofer in your house and in the bathroom, chances are they are looking through your medicine cabinet.'"

Patients returning early to seek a refill of their prescription also should raise a red flag with physicians. "It's a joke among addiction providers that sinks and toilets seem to be magnets for people's medications," said Kampman. "That's an excuse you often hear: 'I dumped my medicine down the sink or down the toilet.' So that should ring alarm bells."

If a problem is suspected, doctors should question patients directly, said Kampman. Some will admit an addiction problem and can be referred to treatment, while others may need stronger medications for their pain and should be referred to a pain specialist.

Doctors also should be careful to adhere to rules requiring them to conduct a physician exam before prescribing medication, and inform patients that sharing prescription drugs with others is illegal and that leftover medicine should be destroyed.

Finally, doctors can now check prescription-drug databases to find out if patients are "doctor shopping" -- visiting multiple physicians for prescriptions to feed their addiction or illicit sales. "It takes about 30 seconds to check to see if patients are filling other prescriptions," said family physician Terry Haffner, M.D., of Kokomo, Ind., where such a tracking system is now in place.  

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