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July 31, 2024
Quarterly Opinion
Harold A. Pollack
Eshan Dosani
Mar 25, 2024
Jan 9, 2024
Nov 28, 2022
Back to The Milbank Quarterly Opinion
Working in the fields of substance use and harm reduction, we encounter the suffering and trauma experienced by study participants, community residents, and colleagues affected by the overdose epidemic, many of whom face the dual challenges of substance use disorder (SUD) and criminal-legal involvement. In confronting and researching these challenges, we also witness disparities between the impressive resources deployed to study medical and public health interventions and the far more limited resources available to criminal justice research agencies, such as the National Institute of Justice, responsible for exploring important issues related to public safety, gun violence prevention, and the well-being of crime victims and their communities, incarcerated and formerly incarcerated persons.
In nationally-representative surveys, 8.3% of American adults living with an SUD other than marijuana use disorder report having been arrested in the past year, and more than 35% report having experienced some form of prior criminal-legal involvement. The Bureau of Justice Statistics (BJS) estimates that 63% of people in jail and 58% of people incarcerated in prison live with some form of SUD. Effective measures to address the overdose epidemic are impossible without effective policies, interventions, and post-carceral services connected to the criminal-legal system. The same is true for other public health challenges, including mental illness and gun violence that disproportionately impact Americans touched by correctional, legal, and public safety systems.
In the face of these realities, incarceration-related research is particularly under-resourced. Boch and colleagues assessed federal funding of incarceration-related research from 1985 to 2022. They found that 0.12% of funded NIH projects were related to incarceration, compared to 9.38% for education and 0.58% for the military. For fiscal year 2025, the President’s Budget request for the National Institute on Drugs and Addiction (NIDA) is about $1.7 billion. In the face of a raging overdose epidemic that kills more than 100,000 Americans every year, NIDA is hardly over-funded. Nor are other pertinent NIH agencies, such as the National Institute on Mental Health (NIMH), whose 2025 budget request totals $2.5 billion.
Still, the contrast is glaring. Including research set-asides, the combined fiscal year 2025 budget requests for the National Institute of Justice (NIJ) and BJS total roughly $145 million—less than 4% of the combined total of NIDA and NIMH. By other reasonable measures, criminal justice research agencies’ true research budgets are far smaller. To place this in context, a single private philanthropy—Arnold Ventures—has $146 million invested in active criminal justice research, and expects to invest $50 million in criminal justice research projects in 2024.
Some in the research community cite such figures to promote greater NIH funding to fill the gap in gun violence and related research. Increased NIH funding is certainly welcome. Yet agencies such as NIJ and BJS have distinct missions, relationships. and expertise. They pursue important research and policy questions that do not (and should not) always overlap with those of NIH institutes. These agencies require commensurate independent resources to support their important work.
Interventions such as the recent expansions of services to provide medication for opioid use disorder (MOUD) in jails and prisons exemplify the role criminal-justice systems can play in addressing public health challenges. Policymakers’ ability to effectively field such interventions remains hampered by a lack of available data and accompanying research concerning many basic matters, including:
Other topics carry less immediate relationships to health outcomes but have clear importance for corrections and criminal justice outcomes. For example:
It has been eight years since the last nationally-representative survey of persons incarcerated in state and federal prisons—the 2016 Survey of Prison Inmates (SPI). Implemented by Research Triangle Institute (RTI), SPI successfully surveyed more than 24,000 incarcerated individuals in 306 state prisons and 58 federal prisons across the United States. These surveys were accomplished for about $9 million—less than is spent on many individual NIH grants—far less than NIH funds for a typical center grant across its many institutes.
Released for public use in 2021, SPI is an outstanding accomplishment and resource. Yet from the start, many public health and health services research journals would categorically reject analyses performed with these data, since 2016 falls outside the five-year window deemed timely by many journals for services research. These data also cannot address crucial policy initiatives and developments that have emerged since 2016, including state decarceration efforts, policy innovations, such as Section 1115(b) Medicaid waivers designed to improve services for persons leaving jails and prisons, and the recent acceleration of the overdose epidemic. This long list underscores the need for a more recent survey—indeed for regular survey waves.
RTI and the BJS are now working on a successor survey, policymakers and researchers will wait many years before these data become available. BJS and its partners require proper funding for the regular administration and timely dissemination of such resources. For roughly $9 million annually, a survey of State Prison Inmates could be an annual resource to policymakers, the American public, and the research community. For not much more, such a survey could include innovations such as linkages to Medicaid claims and other health data, employment or tax records, death certificates, and other pertinent sources to examine post-release outcomes.
Comparable nationally-representative jail data are even older, with the latest available data from 2002. We hope that the 2024 Survey of Inmates in Local Jails will help to address these issues. Such jail surveys, too, should be administered in waves, with generous predictable funding and similarly proper linkages to Medicaid and employment records, death certificates, and other resources.
Individuals and communities affected by incarceration, crime, and violence deserve better and more timely criminal justice-related data, evaluations, and services research. So, too, do the law enforcement and corrections communities, who rely on NIJ, BJS, and others in the design and operation of evidence-informed services and interventions.
We who benefit from generous NIH funding have a special responsibility to ensure such efforts receive proper support. We must use our influence to ensure that our colleagues in the criminal justice research community have the resources they need to rigorously and effectively pursue their important work.
Harold A. Pollack, PhD, is the Helen Ross Distinguished Service Professor at the University of Chicago. He is faculty codirector of the University of Chicago Health Lab. He researches services for severely disadvantaged populations for individuals at the interface between Medicaid and the criminal justice system.
Eshan Dosani is a senior at the University of Chicago. He started the UChicago Harm Reduction Project, a student organization focused on naloxone distribution and overdose prevention interventions in Chicago. He organizes the Appalseed Fund, which distributes housing grants to vulnerable persons in Madison County, Kentucky.
