Following the deaths of 15 inmates last month, the failures of the Mississippi state justice system have become the most recent motivator for prison reform. According to Joseph Neff and Alysia Santo from the Marshall Project, the problems with Mississippi prisons include corrupt, underpaid staff, a poor guard to inmate ratio, powerful gangs, and frequent lockdowns. Of course, such cases of inhumane prison conditions are not exclusive to Mississippi. Recall — in 2019, video footage of a Brooklyn prison surfaced, revealing inmates beating on the windows to attract attention; they were out of lights, heat, and warm showers for an entire week in the middle of winter. Later in the same year, several prisons in Alabama were declared unconstitutional for violating the 8th amendment condemning “cruel and unusual punishment,” after investigators uncovered the routine occurrence of sexual assault and excessive violence toward inmates. These cases are not outliers; if anything, they speak to how negligence and lack of transparency are not only widespread problems that pervade the country, but also a structural issue that plagues the incarceration system at large. As medical professionals, it is imperative to promote the reform and reconstruction of the correctional system.

It is no secret that our prison system is in total ruin. Experts use adjectives like overcrowded, understaffed, violent, unsanitary, and even unconstitutional when reporting about our correctional facilities. In addition, prisons are expensive and do not deliver the promised results of rehabilitating inmates to eventually reintegrate into safer communities. According to an article from the Vara Institute of Justice, incarceration does little to alter crime rates, and instead diverts attention from the more effective and less costly ways to reduce and prevent crime. The fact that we spend nearly $24,000 more on inmate retention than education in the public-school system speaks volumes to our country’s priorities. Moreover, most of the money spent on these inmates go toward advancing punishment methods, even though many studies conducted by other countries like Norway have consistently shown that rehabilitation is the most efficient method for crime reduction. With such a defective system, Americans should reflect seriously on why so many of us are unconcerned about our prison system, and how acceptable it is that we have not yet demanded its complete overhaul.

The Maya Angelou quote, “when you know better, you do better,” comes to mind. We possess too much evidence to claim that we are unaware of the gravity of the problems in our justice system. And yet, despite this knowledge, we are still not doing better. Therefore, we must consider another variable unmentioned in the quote. That is emotion. Imagine this — a person comes to your home, tells you he or she was recently released from prison and asks for work. What are you feeling? Although the person has done nothing wrong, the feeling that you are experiencing is probably in the realm of fear — fear that this person is a criminal, doubt that he or she has learned to be “good” from their punishment, concern that his or her behavior has not truly changed, and anxiety that you might be the next victim. These are all valid reasons to be afraid.

However, criminal behavior is explained by far more than the mere notion that past actions predict future ones (i.e., once a criminal, always a criminal). A more realistic and humane understanding should recognize the fact that people who enter prison are not allowed to learn more adaptive ways of living, since punishment is the primary approach to corrections. Studies show that punishment is the least effective method for learning and changing behavior. It takes rehabilitation.

Twenty years ago, Norway’s “revolving door to prison” was much like that of the U.S., with a recidivism rate of about 60-70 percent. This rate decreased after focusing more on the humane treatment of inmates. They built prison facilities that look like dorms or apartments, and trained guards to be more helpful, like counselors. They treat inmates like students, providing education and counseling in a healthy environment to address the circumstances that landed them in prison. Now, their recidivism rate is down to about 20 percent. The Norwegian system is the model for restructuring our correctional system.

Unfortunately, we as a society have bought into the fear-based logic that confinement and punishment improve our collective safety and criminals cycle through prison because they cannot amount to anything else. We allow our fears to overshadow credible data and examples of more effective, less expensive correctional systems. We must gain the courage to trust the facts. As Albert Einstein said, “The definition of insanity is doing the same thing over and over again, but expecting different results.” Let’s do better. Let’s try something different.

How do Joe Biden and Cory Booker differ on their policy stances on marijuana decriminalization and legalization? Which is the better policy?

Legalization of marijuana has become a major issue in the Democratic primary, inspiring the now-viral moment in which Cory Booker quipped at Joe Biden, “I thought you might have been high” when Biden announced he did not support the legalization of marijuana.

The criminalization of mental illness and addictive disorders is the major stressor affecting many stigmatized patients. Incarcerated people with substance use disorders are disproportionately poor and African American. As if suffering from addictive disorders were not difficult enough, the ramifications of resulting arrests are also debilitating. The immediate effects include job loss and homelessness, and the intermediate effects include all of the psychological consequences of incarceration — the trauma of physical violence, the fear for one’s safety, and the pressure to join gangs. Individuals leave prison having missed large portions of their family lives, with resulting damage to meaningful relationships. All of these effects compound with the long-term consequence of a criminal record that significantly limits the ability to acquire jobs or housing, and ultimately increases the risk of future violence and recidivism.

Of all illicit drugs, the one resulting in the most arrests is marijuana. Democratic candidates, Joe Biden and Cory Booker, propose different policies regarding how to address the legal status of marijuana. 

Joe Biden supports the decriminalization of the personal use of small amounts of marijuana, claiming that “The punishment should fit the crime, but I think legalization is a mistake.” Instead, he would prefer to reclassify marijuana from a Schedule I Controlled Substance (where it currently resides with Heroin and LSD) to a Schedule II Controlled Substance (listed alongside Dilaudid®, Percocet®, and Fentanyl). However, the unlawful possession of a Schedule II Controlled Substance is a misdemeanor or a felony depending on local state laws, implying that such a re-classification would likely not affect the rates of marijuana-related arrests. It is unclear how Biden will square this with his stance that marijuana should be decriminalized. 

As a point of comparison, alcohol was not always legal. The prohibition of alcohol between 1920 and 1933 initially reduced alcohol use and alcohol-related harm, but these benefits diminished over time as a black market developed to meet consumer demands. A review of arrest records indicates that prohibition had an immediate effect but no long-term impact on public intoxication. Moreover, Harvard University historian, Lisa McGirr, points out that prohibition had unduly adverse effects on African Americans, immigrants, and those with lower socioeconomic status. Law enforcement disproportionately policed these communities. Much like the war on drugs.  

Conversely, it was the legalization and regulation of alcohol, not its decriminalization, that helped America prosper. After the repeal of prohibition, the U.S. reduced criminal violence costs and accumulated billions from tax dollars, which were often earmarked for education, healthcare, addiction treatment, and prevention programs. What’s more, taxes reduce alcohol consumption, as they would similarly limit marijuana use. 

Cory Booker seeks to legalize marijuana and remove it from the Controlled Substances Act entirely. Booker has said, “It’s not enough to simply decriminalize marijuana. We must also repair the damage caused by reinvesting in those communities that have been most harmed by the War on Drugs. And we must expunge the records of those who have served their time. The end we seek is not just legalization, it’s justice.”

While those opposed to legalization argue that it would lead to increases in cannabis-related medical harms (e.g. pulmonary disease and psychosis), mere decriminalization also carries its own costs. Cannabis smokers will still primarily acquire their marijuana from unregulated and often violent drug cartels. Neighborhoods will still live in fear. Young people will still join gangs. Communities of color will still be over-represented in drug arrests. Only legalization will directly address these factors.

Upon legalization, preemptive policies can be implemented to mitigate the anticipated increase in marijuana use. With proper taxes, age restrictions, and prevention programs, society can reap the benefits of lower crime rates and less undue incarceration. To be sure, there is a cost to every solution, including legalization. However, decriminalizing marijuana will not decriminalize mental illness, and ignoring the societal cost of mass incarceration is more than we can continue to bear.  

Unfortunately, the issues of marijuana legalization and criminal justice reform were excluded from the Democratic Debates in December. As we approach the first primary votes, we can only hope that the American people will notice these omissions and take the initiative to continue this conversation. In Senator Booker’s absence, it will be up to the remaining candidates to pick up the torch and light the way toward reforming our criminal justice system.