The Washington PostDemocracy Dies in Darkness

Ron Paul thinks drug use is rampant inside prisons. He’s wrong.

Lucy Nicholson — Reuters
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In his final speech on the floor of the House of Representatives, Ron Paul opined that reducing access to drugs in society was hopeless because "the authorities can’t even keep drugs out of prison." Other politicians and activists of varying stripes have charged that drugs are as available in jail as in the community, to nods of agreement from much of the citizenry (some resigned, some outraged). Media around the world reinforce this common knowledge, describing how drug markets “thrive” in prisons, which are “awash” with a “flood” of drugs.

But is the common knowledge actually true?

There are many reasons to care. Drugs could not be readily available behind bars without widespread corruption of correctional officials, which would be a serious concern in itself. Further, if drug use is truly normative among prisoners, the millions of tax dollars spent each year on in-prison addiction treatment may largely be a fool’s errand. In terms of political implications, libertarians like Paul might argue that if drug use is pervasive in a situation as ostensibly restricted as prison, it proves that drug-related control policies in the rest of society can make no difference. Other political actors might draw a different conclusion: Prisoners clearly have it too easy and it’s time to make the conditions of incarceration tougher.

Because prisoners are sometimes caught with drugs in almost every correctional facility, no rational person would deny that some drug use occurs behind bars. The question is whether it rises to a level similar or even close to what occurs outside the walls.

To establish a baseline for comparison, consider the high prevalence of drug use among prisoners prior to their incarceration. The most recent federal Arrestee Drug Monitoring Program found that over 60 percent of adult men test positive for drug use at the time of arrest. More generally, the history of about half of all prisoners indicates that they meet the medical criteria for a diagnosed drug use disorder. If a subset of this population were without warning given drug tests in the community, most of them would test positive.

But when such random audits are conducted in correctional facilities, the percentage of inmates testing positive is consistently much lower. The Louisiana state prison system received negative publicity for 1,402 drug tests of prisoners being positive over a three-year period. But because over 120,000 tests were administered, this implies a drug use rate of about 1 percent. Outside prison, the rate is at least 50 times higher.

In Pennsylvania, during what was considered a crisis of in-prison drug use, tests of inmates’ hair showed that 7.8% had used drugs at least once in the past 90 days. After drug testing, addiction treatment and interdiction were expanded, that number dropped to 1.4%. But even before the “crisis,” drug use was not a sixth of what it would have been outside the walls.

The frightening post-release overdose death rate is another hard indicator of the limited availability of drugs in prison. A Scottish study found that the risk of drug-related death is seven times higher in the first two weeks after prison release than it is when drug users are living in the community. Because they cannot usually get drugs in prison (most notably, opiates like heroin), users’ physiologic tolerance drops, making their return to drug use upon release fatal.

Given these realities, why are many people convinced that being sent upriver does not reduce a convict’s access to drugs? It may be due to the power of the fascinating anecdotes we hear (or see dramatized in movies and on TV shows) about the ingenious methods by which drugs are smuggled into prison: LSD concealed on the back of the stamp on a letter from a friend, a bag of heroin passed orally during a passionate kiss with a girlfriend in the visitors’ room, oxycontin pills buried in rolls of fat on the obese body of a newly admitted prisoner, cocaine hidden by a fellow gang member in a specially marked Coke can left on the side of rural road maintained by the prison work crew on which his buddy serves.

Cognitive psychology research reveals the human tendency to overestimate the representative nature of such vivid and engaging examples. But the reality remains that while some prisoners of course manage to obtain and use drugs, their likelihood of doing so is a bare fraction of what it is outside of the big house.

Keith Humphreys is a Professor and the Director of Mental Health Policy at the Department of Psychiatry at Stanford University.  Follow him on Twitter @KeithNHumphreys