SWK 5002| Week 9: Policy Analysis and Recomendations

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Exploration of Social Justice

Tierainie C. Johnson, MS, MCAP

Capella University

SWK 5002-Social Welfare History Policy Practice

Professor Anna Richmond, LAPSW, LISW

April 23, 2026

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Exploration of Social Justice

Social Problem: Criminalization of Substance Use Disorder

Substance use disorder (SUD) is a long-term medical condition that burdens millions

of Americans, yet the prevailing societal reaction is criminalization, as opposed to treatment.

The practice drives recidivism, stigmatization, and morbidity, especially in already

marginalized groups. This paper examines oppression and discrimination faced by

individuals with SUD, ethical issues, contemporary policies, and analyzes advocacy

techniques to resolve this existing social justice crisis.

Forms and Mechanisms of Oppression and Discrimination

Racial Discrimination: One of the most institutionalized oppressive processes

related to individuals with SUD is racial bias. Although racial groups have similar drug

consumption rates, the criminal justice ramifications of drug consumption are considerably

more humiliating to the Black and Native American communities. The Office of the Assistant

Secretary for Planning and Evaluation (ASPE, 2023) concluded that criminalization of

substance use resulted in disproportional criminal justice engagement, especially with Black

and African American individuals who are disproportionately targeted, arrested, convicted,

and incarcerated on drug charges. This difference is indicative of policies that perceive

addiction as a criminal offense when it happens in a community of color and offer medical

compassion to White communities.

Socioeconomic Oppression: Low-income people with SUD have an added

disadvantage that further marginalizes them. Individuals who are unable to post bail are in

jail awaiting trial, which cuts them off of jobs, housing, and treatment. Schumacher et al.

(2025) observe that the War on Drugs spurred the growth of mass incarceration and

overpopulated correctional facilities with those convicted of nonviolent, drug-related crimes

and that jails are the crucial yet often insufficient contacts of healthcare among justice-

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involved people. Poverty is the ultimate determinant of an individual into the treatment

system or criminal justice pipeline.

Stigma as a Structural Barrier: Stigma is a type of oppression because it deters

seeking help and allows discriminatory policies. When SUD is presented as a moral failure,

instead of a medical condition, people are not willing to disclose, professionals provide

substandard care, and policymakers reduce their focus on treatment funding. Xu et al. (2023)

highlight that Blacks are more likely to receive methadone maintenance treatment, compared

to the more accessible office-based buprenorphine, which also highlights how stigma is a

contributing factor to unequal treatment pathways even within the healthcare system.

Impact on the Population

The extent of the harm associated with the criminalization of SUD is massive.

National Institute on Drug Abuse (NIDA, 2020) estimates that about 65 percent of the prison

population in the U.S. has an active SUD, with 20 percent having been under the influence at

the moment of their offense, but only a small percentage receive evidence-based treatment in

prison. Moreover, when released, most individuals resume earlier levels of use unaware that

their tolerance has decreased, a significant risk of overdose.

The racial influence is particularly strong. According to ASPE (2023), the Black and

Hispanic people who need treatment have lower rates of treatment utilization than their White

counterparts, despite their equal rates of substance use. This difference is not motivated by a

clinical need, but instead a systematic injustice of the implementing system, referral

procedures, and access to care.

Ethical Problems

Ethical Considerations

The NASW Code of Ethics (NASW, 2021) gives rise to several fundamental ethical

considerations. First, the human dignity value necessitates social workers to oppose any

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policies that consider people with SUD as criminals not patients since this will essentially

infringe on the right of humane care by non-judgmental professionals. Second, social justice

requires practitioners to determine and address policies that yield racially and economically

unfair results in drug enforcement. Third, confidentiality is an ethical issue when court-

mandated care requires disclosure in other areas where legal ramifications may follow,

sabotaging the therapeutic relationship and deterring potential participants into truthful

participation.

Implications for Social Work Practice and Positive Client Outcomes

These ethical requirements have a number of important practice implications. Social

workers should be prepared to use non-stigmatizing and trauma-informed approaches because

clients who have undergone criminalization have a layer of trauma and mistrust that requires

resolution prior to effective treatment contact with the client. Practitioners are also required to

refer clients to evidence-based treatment, especially medication-assisted treatment (MAT),

which can greatly decrease overdose deaths. Tarfa et al. (2026) affirm that the strongest

empirically supported interventions in reentry involve peer navigation and opioid agonist

medications, and case management. Lastly, social workers need to participate in macro-level

advocacy, which involves the diversion of resources away out of incarceration into

community-based services that can lead to sustainable recovery impacts.

Current Enacted Policies

The SUPPORT for Patients and Communities Act (2018)

The SUPPORT Act, signed into law on October 24, 2018, was the biggest federal

investment in overdose prevention to date (Bryant, 2024). It increased Medicaid and

Medicare coverage of SUD treatment, permitted nurse practitioners and physician assistants

to prescribe MAT, and mandated states to maintain the eligibility of incarcerated youth to

Medicaid to facilitate a smooth reentry process. The law also instructed the Centers of

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Medicare and Medicaid Services to collaborate with the states to increase capacity of

treatment by providing demonstration grants.

Mainstreaming Addiction Treatment (MAT) Act (2023)

The MAT Act was signed into law as an extension of the Consolidated

Appropriations Act on January 3, 2023, and repealed the federal X-waiver requirement that

previously limited prescribing buprenorphine to opioid use disorder by licensed providers

(Center for Excellence on Addiction, 2023). Before this change, more than 40 percent of the

U.S. counties had no authorized prescriber. The Act lessened bureaucratic hurdles that had

long prevented a proven, life-saving drug to millions of Americans, especially in rural and

underserved populations.

The First Step Act (2018)

The First Step Act changed the federal sentencing system, decreased mandatory

minimums on some drug crimes, and increased programming within federal prisons (Haber et

al., 2023). Drug treatment post-release lowers the recidivism rates, and the First Step Act

established structural avenues towards that goal by focusing on reentry planning and linking

incarcerated people to rehabilitation programs.

Policy Effectiveness

The SUPPORT Act has led to increased access to treatment through legal

frameworks, but has had inconsistent implementation. NIDA (2023) attests that decades of

research confirm the effectiveness of SUD treatment during and after incarceration in

reducing drug use and criminal recidivism. The MAT Act is more promising as it has directly

eliminated a structural impediment to prescribing. The First Step Act reduced penalties

without addressing the root causes of criminalization. Graves and Fendrich (2024) discovered

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that community-based treatment programs demonstrate beneficial effect on substance use

outcomes, but limited studies have addressed racial and rural disparities in access.

Policy Constraints

Medicaid Inmate Exclusion

Medicaid is prohibited by the federal law to provide healthcare services to

incarcerated individuals. This implies that individuals with SUD in jails and prisons miss

MAT at the time they need it the most, and re-enrollment delays at release pose a fatal gap at

the most dangerous time of overdose.

Racial Gaps in Access

Structural inequities exist, even in the context of increased prescribing authority under

the MAT Act. ASPE (2023) discovered that communities of color are less likely to access

SUD treatment as compared to White populations, and that people of color face barriers that

directly lead to racial differences in health outcomes. Equitable implementation is not

guaranteed by policy change on paper.

Stigma Within Systems

Stigma is a limitation even within institutions that are meant to assist. Numerous

correctional systems and health care providers are opposed to providing MAT because of

deeply ingrained moral framing of addiction. According to NIDA (2023), the lack of pre-

release counseling and post-release follow-up is one of the reasons behind the alarming post-

incarceration mortality rates, highlighting how the impediments to attitudinal changes turn

into life-or-death outcomes.

Advocacy Methods

Strengths and Challenges

The two most notable strategies to this problem are legislative advocacy and

community organizing. The policy of legislative advocacy yielded tangible victories like the

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MAT Act, which has brought systemic change on a large scale. The community organizing

focuses on the voices of people with lived experience, counters stigma, and generates

political will. Nonetheless, legislative advocacy is cumbersome, susceptible to political

changes and may not reach the most vulnerable communities. Community organizing is often

underfunded, lacking the capacity to impact lasting policy change.

Addressing the Challenges

Both approaches would be empowered with long-term investment in peer-recovery

support programs, which would combine lived experience with policy power. Recovery

workers are in an ideal position to access populations that are difficult to reach and decrease

shame-based refusal to seek treatment. Also, advocates need to urgently seek the repeal of the

Medicaid inmate exclusion permanently since allowing uninterrupted coverage both during

incarceration and upon release would close one of the deadliest structural loopholes that this

group is currently experiencing.

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References

ASPE. (2023, November 21). Substance Use and SUDs by Race and Ethnicity. ASPE.

https://aspe.hhs.gov/reports/substance-use-suds-race-ethnicity

Bryant, B. (2024). Six years of the SUPPORT Act: Ongoing behavioral health policy

priorities for counties. National Association of Counties.

https://www.naco.org/news/six-years-support-act-ongoing-behavioral-health-policy-

priorities-counties

Center for Excellence on Addiction. (2023, February 7). Mainstreaming Addiction Treatment

(MAT) Act Signed into Law . Center for Excellence on Addiction.

https://nhcenterforexcellence.org/resource/mainstreaming-addiction-treatment-mat-

act-signed-into-law/

Graves, B. D., & Fendrich, M. (2024). Community-based substance use treatment programs

for reentering justice-involved adults: A scoping review. Drug and Alcohol

Dependence Reports, 10, 100221–100221. https://doi.org/10.1016/j.dadr.2024.100221

Haber, L. A., Boudin, C., & Williams, B. A. (2023). Criminal Justice Reform Is Health Care

Reform. JAMA, 331(1), 21–21. https://doi.org/10.1001/jama.2023.25005

National Association of Social Workers. (2021). Code of ethics. National Association of

Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-

of-Ethics-English

NIDA. (2020). Criminal justice drug facts. National Institute on Drug Abuse.

https://nida.nih.gov/publications/drugfacts/criminal-justice

Schumacher, J. E., Ahsan, A., Simpler, A. H., Natoli, A. P., & Cain, B. J. (2025). An

investigation of drug use among first-time arrestees from 25 county jails across the

United States in 2023. Addiction Science & Clinical Practice, 20(1).

https://doi.org/10.1186/s13722-025-00550-5

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Tarfa, A., Borker, M., Lancaster, M., Santiago, R., Di Paola, A., Frank, C., & Springer, S. A.

(2026). Real-time peer-navigation support during community re-entry for adults with

opioid use disorder. Journal of Substance Use and Addiction Treatment, 183, 209903.

https://doi.org/10.1016/j.josat.2026.209903

Xu, K. Y., Schiff, D. M., Jones, H. E., Martin, C. E., Kelly, J. C., Bierut, L. J., Carter, E. B.,

& Grucza, R. A. (2023). Racial and Ethnic Inequities in Buprenorphine and

Methadone Utilization Among Reproductive-Age Women with Opioid Use Disorder:

an Analysis of Multi-state Medicaid Claims in the USA. Journal of General Internal

Medicine, 38(16), 3499–3508. https://doi.org/10.1007/s11606-023-08306-0