SWK 5002| Week 9: Policy Analysis and Recomendations

1

Policy Analysis: Controlled Substances Act and Criminalization of Substance Use Disorder

Tierainie C. Johnson, MS, MCAP

Capella University

SWK 5002: Social Welfare History, Policy, and Practice

Professor Anna Richmond, LAPSW, LISW

May 24, 2026

2

Policy Analysis: Controlled Substances Act and Criminalization of Substance Use Disorder

Development of the Controlled Substances Act

The Controlled Substances Act is the key to understanding the criminalization of

substance use disorder due to its linkage of public health and criminal enforcement. The policy

was enacted by Congress as Title II of the Comprehensive Drug Abuse Prevention and Control

Act in 1970, and established a comprehensive national framework to control the distribution of

controlled substances by scheduling them according to their medical use, abuse potential, and

safety risks (Lampe, 2025). This arose in response to legitimate concerns for diversion and the

safety of the public, but it also came at a time when federal leaders had characterized drug use as

a national crisis where police authority is needed. Thus, medical regulation, criminal prohibition,

and social control were combined into a single policy.

The historical context of the policy demonstrates the importance of a social justice

approach instead of a legal approach. The earlier papers contextualized the Act as a policy that is

formally applicable to everyone, but which affects Black and Hispanic communities

disproportionately, due to differential enforcement results. Drug war logic was inculcated into

housing, employment, education, public benefits, family regulation, and health care systems,

further extending punishment beyond arrest or conviction (Cohen et al., 2024). This history is

relevant because the Act was a contributor to the social problem by making drug use a more

consistent condition to be punished than a treatable health disorder.

Goals, Programs, and Services

The purpose of the Controlled Substances Act is to regulate the manufacture, distribution,

prescribing, and possession of controlled substances to safeguard the public health and safety.

According to the Drug Enforcement Administration (n.d.), the Act categorizes regulated

3

substances into five schedules according to their medical use, abuse potential, and dependence

liability. These objectives are to be achieved through registration requirements, enforcement,

penalties for illegal possession and trafficking, and controls on prescribers and manufacturers.

These programs, in practice, come with a massive enforcement system but not a robust treatment

system. The policy is about control rather than care.

The policy also indirectly relates to the prevention and treatment services, but they are

not as legally binding as the enforcement services. Enforcement has been identified as a strategy

that is most effective in relation to implementation, as noted in the previous policy background

paper, with the mechanisms being surveillance, arrests, and incarceration. That worry is

supported by current scholarship, which shows that reforms that reduce arrests have the potential

to reduce criminal legal exposure, but racial disparities can still exist even after de facto

decriminalization (Rouhani et al., 2023). This evidence indicates that, in the absence of equal

institutional practices, legal structure cannot guarantee equitable access to assistance. Therefore,

the policy is partially effective in achieving public safety objectives, and the target population

lacks adequate treatment pathways.

Effectiveness for the Target Population

The Controlled Substances Act is effective in regulating substances of abuse but not

human needs; this is a limitation that impacts others with substance use disorder. People with

substance use disorders require easy access to treatment, stable housing, employment assistance,

culturally sensitive treatment, and protection from stigma. Criminalization negatively impacts

social determinants of health, including access to housing, employment, education, and health

systems (Cohen et al., 2024). These consequences affect social functioning, as convictions can

4

create barriers that persist beyond court involvement. Thus, the policy has not sufficiently

addressed the social justice issue raised by the previous assignments.

The policy has also not worked for people of color with SUD, as it has been applied

unequally, leading to low levels of trust and access for Black and Hispanic people. De facto

decriminalization worked to decrease overall drug arrests in Baltimore; however, the policy

change did not yield racial parity in drug arrests for Black residents (Rouhani et al., 2023). The

trend indicates that there is a possibility of reducing enforcement and still obtaining better results

in certain areas without solving structural inequity. The social justice paper highlighted the

interrelated nature of racial discrimination, poverty, and stigma when communities of color

experience punishment for addiction. The Act, therefore, hinders social functioning where local

enforcement systems perpetuate racial harm.

The policy is poorly aligned with good ethics, which can sometimes clash with social

work values of dignity, social justice, and service. According to the NASW Code of Ethics

(2021), social workers seek social change on behalf of vulnerable and oppressed individuals and

uphold the dignity and worth of the individual. However, criminalization may deem an

individual with a substance use disorder as a criminal and not a client, patient, worker, or

community member. Substance use stigma and anti-Black racial stigma research indicate that

racism and stigma overlap, harming care seeking and impacting institutional responses

(Ghonasgi et al., 2024). This moral shortcoming is significant because, ideally, policies should

lower the barriers to care and not reinforce shame and exclusion.

The policy is more effective in reducing punitive impacts and increasing evidence-based

treatment. Graves and Fendrich (2024) identified evidence of positive outcomes for community-

based program interventions for reentering justice adults that incorporate medications for opioid

5

use disorder and peer support, but noted limited evidence on cost, racial equity, and

implementation. It suggests that health-focused programs can also have a positive impact even in

a policy context oriented towards control. Those gains, however, come not from the punitive

intent of the Act itself but from the reforms made around it.

Feasibility of the Policy

The Controlled Substances Act is now so entrenched in federal drug policy, law

enforcement practice, and public perceptions about drug control that it is politically viable.

According to the Congressional Research Service, the Act provides a single set of regulations for

the control of substances designated for control (Lampe, 2025). The wide scope of the policy

allows for scheduling, rescheduling, and regulation of substances, contributing to its longevity

over administrations. However, even political feasibility is not social justice effectiveness. The

Act gives the public a sense of security that the government is responsible for controlling

dangerous substances, but it can also shield punitive practices from broader reform.

The policy is economically viable as it provides public funding for enforcement, but it

will also incur unnecessary costs if there are treatment gaps. A large number of resources are

needed to incarcerate, process through court, keep people under supervision, and cycle them

repeatedly through jail. Resources increase when people leave jail without stable treatment.

According to national prison data, few people incarcerated have a substance use disorder, and

medications like methadone are very uncommon in prisons (Chen et al., 2025). The discovery is

that public systems spend money on incarceration, but do not invest enough in intervention to

decrease recidivism and relapse. Thus, the policy is economically viable as an enforcement

policy but not as a health policy.

6

Administrative feasibility is also not uniform, in that the services required for recovery

can be coordinated by the Act but not by the agencies charged with implementing it.

Enforcement is clear and efficient as federal and state agencies can classify substances, inspect

registrants, investigate violations, and prosecute offenses. However, access to treatment is

subject to Medicaid policies, correctional health capacity, provider availability, community

programs, and stigma reduction efforts. Racial disparities in the use of buprenorphine and

methadone were observed in studies that examined medication treatment for women enrolled in

Medicaid, despite the availability of treatment (Xu et al., 2023). As a result, the machinery of

control works more smoothly than the machinery of recovery.

Policy Constraints

There are multiple factors that limit the Act from addressing the criminalization of

substance use disorder among black and Hispanic communities. One, scheduling and criminal

sanctions can take precedence over treatment priorities. Even states with limited protections that

seem health-focused continue to see criminalization and structural racism in drug policy,

according to scholarship on overdose Good Samaritan laws (Pamplin et al., 2023). This

restriction is important because individuals may not seek assistance due to fear of arrest,

separation from family, surveillance, or punishment. Thus, the problem cannot be fully solved

with the Act in place, and the fear of implementation remains.

The second limitation is that of fragmented coverage and correctional care. The Medicaid

inmate exclusion was a significant barrier identified in the earlier social justice paper, as it

interferes with treatment during incarceration and upon release. Substance use treatment in

prison is still not widely available, and Black and Hispanic people are less likely to receive

treatment than White people (Chen et al., 2025). This inequity exacerbates the conditions the Act

7

seeks to address, as untreated substance use disorder can be compounded with housing

instability, unemployment, trauma, and overdose risk upon release. This means that the coverage

exclusion and lack of continuity of care reduce the policy's real-world impact on health

protection.

Stigma within legal, health, and community systems is a third limitation. Substances are

classified under the Controlled Substances Act, and social institutions will render a moral

judgment against people who use drugs. Ghonasgi et al. (2024) identified the relationship

between substance use stigma and anti-Black racial stigma, which can influence the diagnosis,

access to treatment, and harm reduction response. These social constraints exacerbate the

situation because even when treatment is expanded, respectful and culturally responsive services

do not necessarily result. Therefore, policy reform will require focus on attitudes, institutional

racism, and community trust as well as statutory reform.

Conclusion

In conclusion, the CSA has established a long-term nationwide framework, but has failed

to solve the social justice issue of criminalizing substance use disorder. Its design was a marriage

of public health objectives and criminal legal tools, and the design has contributed to inequitable

outcomes for the Black and Hispanic communities. The evidence indicates that the policy is

politically and administratively viable as a control system, but has limited ethical and economic

impact due to under-delivering treatment, perpetuating stigma, and enabling racialized

enforcement to continue. The social work analysis, therefore, justifies efforts to reduce the

criminal penalty, increase community-based treatment, maintain continuity in Medicaid

coverage, and ensure that the reforms are implemented in a race-neutral manner. These changes

would bring the policy closer to caring practices of dignity, social justice, and effective care.

8

References

Chen, S. J., Pollack, H. A., Salisbury-Afshar, E. M., & Pho, M. T. (2025). Access to and

predictors of substance use treatment and support among people experiencing

incarceration in the United States: Analysis of a national cross-sectional study. Drug and

Alcohol Dependence Reports, 15, 100343. https://doi.org/10.1016/j.dadr.2025.100343

Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2024). How the war on drugs

impacts social determinants of health beyond the criminal legal system. Focus, 22(4),

515–526. https://doi.org/10.1176/appi.focus.24022021

Drug Enforcement Administration. (n.d.). The Controlled Substances Act. U.S. Department of

Justice. https://www.dea.gov/drug-information/csa

Ghonasgi, R., Paschke, M. E., Winograd, R. P., Wright, C., Selph, E., & Banks, D. E. (2024).

The intersection of substance use stigma and anti-Black racial stigma: A scoping

review. International Journal of Drug Policy, 133, 104612.

https://doi.org/10.1016/j.drugpo.2024.104612

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. https://doi.org/10.1016/j.dadr.2024.100221

Lampe, J. R. (2025). The Controlled Substances Act (CSA): A legal overview for the 119th

Congress. Congressional Research Service.

https://www.everycrsreport.com/reports/R45948.html

National Association of Social Workers. (2021). Code of Ethics of the National Association of

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

Ethics-English

9

Pamplin, J. R., Rouhani, S., Davis, C. S., King, C., & Townsend, T. N. (2023). Persistent

criminalization and structural racism in US drug policy: the case of overdose good

Samaritan Laws. American journal of public health, 113(S1), S43-S48.

https://doi.org/10.2105/AJPH.2022.307037

Rouhani, S., Tomko, C., Silberzahn, B. E., Weicker, N. P., & Sherman, S. G. (2023). Racial

disparities in drug arrest before and after de facto decriminalization in

Baltimore. American journal of preventive medicine, 65(4), 560–567.

https://doi.org/10.1016/j.amepre.2023.04.004

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