Drug trafficking is a business — a multimillion-dollar business — and one to which those not formerly schooled with troubled lives may be tempted to turn to make a quick dollar. Cocaine, methamphetamine, speed, ketamine and heroin arrive freshly delivered by well-organized cartels. These drugs are then snorted, inhaled and injected by loyal customers — Americans self-treating psychiatric, emotional and psychological difficulties, with clearly dire personal and societal consequences.
As a Yale fellow in the infectious diseases section of the Medical School’s Internal Medicine Department who administers health care to inmates in the men’s New Haven and women’s Niantic correctional facilities, I am disheartened to see our promising youth arrested, jailed and then released for drug crimes only to return back to jail. Many relapse into drug trafficking and selling — often interspersed with gun violence and community theft.
There is no mystery here; a troubled childhood, often with fathers and mothers already in the prison system, leads to a life with little support and poor role models. A narrowed world and a feeling of disenfranchisement fuel the cycle of drug use, high-risk sexual behavior, violence and, often, communicable infectious diseases such as HIV and hepatitis C.
Recently, a woman with acquired HIV disease related to me that she remembered to take her antiretroviral medications when she didn’t hear voices in her head. I realized this was undiagnosed schizophrenia with auditory hallucinations; upon further history-taking, I discovered that her son had the same condition. She probably had a long history of undiagnosed schizophrenia she had been self-treating with street drugs for 10 years.
Illicit drug use, far from a romanticized rock singer’s experimentation, becomes a very poor and dangerous substitute for the treatment of a host of disorders and social maladjustments that are not being addressed by our families, schools and society. Even with well-intentioned treatment and group sessions in the correctional facilities, it is clear that doing time behind bars staring at walls alters neither behavior patterns nor the underlying causes of drug abuse and societal dysfunction.
What matters is active rehabilitation and active community involvement with renewed social support systems. The highest percentage of our current health care system’s spending goes towards people who are already gravely ill and in the waning years of life. Unfortunately, it’s often too late to make a difference. Similarly, the judicial system administers expensive correctional care to those who could have been much better served — with less cost — earlier in the process.
Creative interdisciplinary thinking is essential for stopping this cycle. Already, the Yale Law School has partnered with the New Haven Mayor’s Office to create a detailed handbook of community resources for housing, mental health and substance use disorders for those transitioning from prison to the community. Yale’s Department of Internal Medicine and Infectious Diseases hosts numerous programs helping people overcome substance use with legal narcotic substitution therapies. The Yale Community Health Care Van’s bilingual staff travels directly into the poorest neighborhoods to administer needle exchange and health screenings to people at the highest risk for HIV and hepatitis transmission. Nationally, innovative employment opportunities — like Father Greg Boyle’s Homeboy Bakery in Los Angeles — offer jobs only to newly released prisoners. We need to provide incentives to business owners who wish to use federal stimulus money to open similar businesses that connect to parole programs for those leaving the correctional community. Yale College students have done laudable work in the community, but it’s hard for college students to do it all in four years. We need to galvanize community leaders to solidify long-term solutions.
Before the Joint Convention of the General Court of the Commonwealth of Massachusetts in 1961, President John F. Kennedy echoed sentiments from Luke 12:48: “Of those to whom much is given, much is required.” Certainly, with the critical mass of expertise, energy and social conscience currently in the Yale community, we can combine forces to intervene in this tragic cycle that affects us all. In this way may we finally escape the artificial confines of our fortressed residential colleges, nightly police escorts, wailing sirens and nearly daily stories of jarring crime and murder blogs.
As Yale undergraduates and graduates contemplate their future career paths in the setting of our current national financial and social discontent, may the urgency of these voices mired in a cycle of prison and drugs reach them to inspire innovation and reform. Perhaps someday soon at Yale we may no longer walk the streets in constant fear, and our neighbors living the nightmare of addiction in adjacent impoverished communities may also be able finally to breathe a sigh of relief as they welcome the opportunities that open a new life.
Jamie Morano is a second-year fellow in infectious diseases at the Yale School of Medicine.