Ten years ago, President George W. Bush signed the Second Chance Act, and President Trump recently memorialized the event by declaring Second Chance Month. This important change in public policy resulted from the efforts of courageous members of Congress and other likeminded justice reformers who believed that incarcerating certain offenders, again and again, was incredibly inefficient — both as a matter of economics and as a means of administering justice.
Around this same time a decade ago, our company was busy developing new medicines for addiction and serious mental illness: conducting new research and clinical trials, building manufacturing capability, and seeking approval from the Food and Drug Administration for our medicines. At that time, if we had paid any attention at all to the new law, we certainly had no idea that our work in neuroscience would end up converging so meaningfully with the work of government.
Why did this happen? Why do we, as a biopharmaceutical company, feel compelled to understand and interact with jails, prisons and the criminal justice system? The answer is simple and tragic: because this is where many of our patients are. People living with addiction and serious, chronic mental illnesses make up a large proportion of our nation’s jail and prison population, and, as a result, correctional health care providers and officials are on the front lines of ensuring patient access to needed treatment.
Many Americans do not realize the outsized importance of the criminal justice system on our culture and economy. Millions of people occupy our nation’s correctional facilities at an estimated cost of more than $80 billion a year. Many states spend more on incarcerating their residents than they do on educating them. In New York City, the cost of incarcerating a single inmate can exceed $100,000 per year — an astonishing number.
At the risk of being labeled “soft on crime,” the backers of the Second Chance Act fought for their beliefs and enacted reforms designed to be smart on crime. Jails and prisons could be places for more than just doing time. Incarceration could be avoided, and needed treatment provided, through the use of rigorous alternative programs like drug courts and community-based alternatives. And those for whom incarceration was not avoidable could receive treatment for their addiction and serious mental illness while incarcerated.
At the same time, in the halls of academia, scientists were working with a new drug molecule called naltrexone, a compound that blocked opioid receptors in the brain — exploring its potential for preventing relapse to opioid dependence following detoxification.
Our company was working on a long-acting formulation of this compound, using proprietary technology to create an injectable version that could be administered once a month.
As the Second Chance Act was written, a section was added calling for a study of “depot naltrexone” for heroin-addicted probationers and parolees. The idea was to test the concept of offering addiction treatment as part of a comprehensive release and re-entry initiative.
From our perspective, this was a forward-looking and surprising addition to the law. We became aware of it only after the act’s implementation. As it turned out, the “depot naltrexone” was our company’s product, which we had not tested in opioid-dependent patients and was still years away from FDA approval for that use.
Ten years later, much has changed, but much remains to be done. Thanks to the work of the Prison Fellowship and more than 100 other nonpartisan organizations such as Right on Crime, the Drug Policy Alliance, the American Civil Liberties Union, Treatment Alternatives for Safe Communities, and federal agencies, real justice reform has momentum. Jail and prison populations are decreasing while the number of formerly incarcerated individuals with addiction and serious mental illness, now in treatment and returning to their communities, is growing.
That study of “depot naltrexone” for prevention of relapse to opioid dependence in individuals with prior criminal justice involvement was published in 2016. Along with other studies of jail and prison re-entry programs, evidence is building that recovery can happen and relapse to opioid dependence is not inevitable.
While there is no silver bullet, the destructive cycle of release, recidivism and re-arrest can be broken. Across the nation, hundreds of courts, jails and prisons are initiating programs that offer treatment for addiction and other serious mental illnesses, and independent research is demonstrating that these programs can offer a chance for recovery — not just time served.
Because we have come to understand the real-world issues complicating treatment for addiction and serious mental illness, our company has organized to become a consistent and reliable resource for state and federal government entities interested in treating addiction and serious mental illness. We have learned that the hard work of successfully developing new medicines is not enough. We also have to play a role in assuring that deserving patients can get access to them — both within and outside criminal justice settings.
On this 10th anniversary of the signing of the Second Chance Act, we join the many individuals and families who know from experience successful re-entry to the community is possible, applaud the visionaries who challenge us to organize and act to create a better future, and encourage others to join in these efforts to ensure that justice reform continues unabated and that patients have access to needed treatment, regardless of the setting of care.