In summary

Jail should not punish people just for using drugs; lengthy incarceration won’t help. Rather, we must use the criminal justice system strategically to promote behavioral change in people whose drug use threatens public safety.

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By Sam Liccardo

Sam Liccardo is the mayor of San Jose, America’s 10th-largest city, and a former federal prosecutor.

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Keith Humphreys, Special to CalMatters

Keith Humphreys is the Esther Ting Memorial Professor at Stanford University and former senior drug policy adviser in the Obama White House.  

Drug addiction has become an ideological Rorschach test: a disease meriting treatment for some, and a crime deserving punishment for others. California’s methamphetamine epidemic challenges these polarized perspectives, because the drug inflicts both devastating harm on users and (too often violent) victimization on others.  Reducing meth’s many harms requires that we beat our ideological swords into pragmatic plowshares. 

While opiates such as fentanyl draw the brightest media spotlight, methamphetamine inflicts a greater toll. From California’s rural communities to our largest cities, including Bakersfield, Fresno, Los Angeles, San Jose and San Diego, methamphetamine (individually, and when taken in combination with fentanyl) kills more users than any other illicit drug. Since 2006, meth-related admissions to California’s emergency rooms increased sevenfold, and deaths tenfold. Meth’s psychological effects exacerbate homelessness and often induce violent behavior, while sustained use also contributes to an alarming rate of psychosis.

Our criminal justice and health responses to meth-related crime are failing.

In large counties such as San Diego, a majority of arrestees test positive for meth.  Revolving doors at county jails return untreated individuals to the street within hours of their arrest, often still agitated and intoxicated. Diversion from jail benefits some individuals, but when combined with the lack of detoxification or inpatient facilities, our communities increasingly endure the release of addicted defendants destined to reoffend. More than 40% of pretrial arrestees released from jail in Santa Clara County (which has many methamphetamine users but a paucity of detoxification or treatment beds) commit a new crime or fail to appear in court. Too often, we see horrific consequences in the form of meth-induced assaults—and worse. 

We lack any FDA-approved medication for methamphetamine addiction, but a promising behavioral therapy has emerged. “Contingency management” enables patients to earn rewards for repeatedly testing negative for drugs while they participate in therapy. The Veterans Health Administration’s use of contingency management with 5,600 addicted patients resulted in a 92% rate of drug-free tests. State-funded contingency management programs show promise, and we commend efforts by state Sen. Scott Weiner, a San Francisco Democrat, to expand successful pilots to other cities. 

Contingency management succeeds where other treatments fail by providing certain and immediate consequences that reinforce abstinence. For methamphetamine users who refuse treatment and threaten public safety, swift, definite consequences most effectively reduce the harms of use.  

This requires prudent, lawful intervention by police and judges. Open-air drug markets pose unique risks of violence in vulnerable neighborhoods, requiring proactive police enforcement, implemented in partnership with community stakeholders. We also need dramatic expansion of detoxification facilities for meth-intoxicated arrestees to ensure they do not return to communities while still high, agitated and prone to aggression. We must again empower judges to impose consequences in cases where a defendant refuses to participate in treatment as a condition of release.  

And yes, we still need jails. Jail should not punish people just for using drugs; lengthy incarceration won’t help. Rather, we must use the criminal justice system strategically to promote behavior change in people whose drug use threatens public safety. The nation’s most effective judicially imposed therapeutic program for methamphetamine, Honolulu’s HOPE probation, employs frequent drug testing and contingency management with modest-length—typically one to several day—jail terms.   After a year, felony offenders enrolled in HOPE reduced new arrests by 55% and positive drug tests by 72%. Its success compelled other states to follow suit, deploying frequent testing with modest jail terms to reduce alcohol use and related domestic violence.    

Local resistance and state laws, driven more by ideology than evidence, prevents pragmatic solutions. We need citizens to speak up, both about the lack of quality treatment and the lack of consequences. Faith-based and other nonprofit organizations must continue to provide recovery support, but need public funding. We need stronger alliances between health and law enforcement professionals, community organizations and families for evidence-based solutions. 

We can reduce methamphetamine’s toll on our communities only by casting aside our political predilections and deploying all of the tools at our disposal.   


Sam Liccardo previously has written about PG&E operations, solar metering rules and electricity rate hikes.

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