Incorporating a Public Health Approach in Drug Law: Lessons from Local Expansion of Treatment Capacity and Access under California's Proposition 36

Abstract

A major state drug abuse initiative, California's Proposition 36 of 2000, mandated that adults convicted of drug possession be offered treatment in lieu of incarceration. While the law expanded public treatment for arrestees, the counties were given discretion in structuring their systems of care and procedures to manage clients. Using data from a study of key informants in eight counties, this article examines local planning to increase drug treatment capacity and manage clients' access to treatment. In both these planning domains, it describes the counties' strategies and concerns, reasons for their differences in approaches, and whether and how this state initiative, which explicitly incorporated treatment objectives into penal drug law, will shift the debate over drug abuse policy toward greater consideration of public health goals.

Outcomes in a Sample of Opioid-Dependent Clients Treated under California's Proposition 36

“…Early concerns expressed about Proposition 36 related to the effectiveness of treatment and the quality of treatment provided (Riley et al, 2000;Young & Belenko, 2002). Another concern was that Proposition 36 clients would be less engaged in treatment because they were there by external mandate rather than by internal motivation, and so they would have shorter stays in treatment and poorer outcomes (Klein et al, 2004;Speiglman et al, 2003). This study found no evidence that treatment outcomes were different between the two groups.…”

“…One of the earlier concerns with Proposition 36 was the client's lack of engagement in treatment participation (Klein et al, 2004;Speiglman et al, 2003). Using data collected in the course of a larger treatment outcome study (Andrews, Sorensen, Guydish, Delucchi, & Greenberg, 2005), this paper reports substance abuse, criminal justice and employment outcomes, and retention in treatment for a sample of residential therapeutic community (TC) participants referred through California's Proposition 36.…”

Jurisdictional Variation in the Economic Impact of California’s Proposition 36 Drug Offender Diversion Program

“…Jurisdictional, or county-level, variation has been reported in SACPA program operations [8,[18][19][20][21][22][23][24][25], characteristics of participating offenders [18], and outcomes [26].…”

“…Probationers or parolees who violate drug-related conditions of community supervision are also eligible. In operation since 2001, SACPA implementation successfully applied a public health approach to drug-related offending, reducing drug use among offenders [7,8]. Many drug-abusing offenders entered treatment within a very short time period [9], and the program resulted in favorable outcomes, especially among treatment completers [10], while yielding noteworthy cost savings [11][12][13].…”

“…Jurisdictional, or county-level, variation has been reported in SACPA program operations [8,[18][19][20][21][22][23][24][25], characteristics of participating offenders [18], and outcomes [26].The attitudes, training, and practices of key implementers impact the degree of success, or failure, of social policy initiatives [27], as does the nature of the linkages between cooperating agencies (i.e., exchanges of communication, trust, and resources) and the boundaries Methods: Administrative data were used to conduct multilevel, difference-in-differences analysis examining the effect of individual-and county-level variables on total service-utilization costs across eight domains over 30 months pre-and post-conviction.Results: County-level variability in the severity of offender populations served under SACPA and in the level of collaboration between SACPA stakeholders contributed to cost variability. More severe populations and less effective stakeholder communication produced increases in costs.…”