Assignment Prompt & Instructions
Please see attached.
**files (3)**
– ## SWK5002PolicySelectionandBackground.docx
– ## SWK5002ExplorationofSocialJustice.docx
– Week6Assignment_PolicyAnalysis.pdf
**## SWK5002PolicySelectionandBackground.docx**
2
**Policy Selection and Background**
Tierainie C. Johnson, MS, MCAP
Capella University
SWK 5002- Social Welfare History Policy Practice
Professor Anna Richmond, LAPSW, LISW
May 10, 2026
**Policy Selection and Background**
Social policy is largely concerned with social justice. However, policies aimed at tackling issues in society can also lead to inequality and oppression. The policy dynamic of social work is critical in recognizing the advantages and the unforeseen outcomes of policies in the social work field. The Controlled Substances Act is one of the key federal policies that exemplify this tension. The policy was introduced in 1970 in response to the need by the United States to regulate the use and distribution of drugs (Lampe, 2025). Despite aiming to safeguard the health of the population and minimize drug abuse, the policy has been widely criticized as having disproportionately impacted the Black and Hispanic communities and contributed to systemic inequality. Substance use and incarceration for drug-related problems are long-standing social justice issues that are both intersectional in nature and combine with race, socioeconomic status, and access to medical care and legal services. The issue is not new, but an extension of historical trends of discrimination embedded within legal and political systems. This paper explores the mission and objectives, programs and services, and the history of the Controlled Substances Act.
**Purpose of the Policy**
The main aim of the Controlled Substances Act is to regulate the production, distribution, and use of some drugs using a hierarchical classification system. This system classifies substances into five schedules rooted in their accepted medical use, potential abuse, and potential to cause dependency (Ortiz and Preuss, 2024). Schedule I drugs are the most dangerous and do not have an endorsement under medical use, and the likelihood of abuse is high. Conversely, Schedule V substances are considered to be less risky and have accepted medical use. The policy was developed to create a unified federal effort to regulate drugs, replacing inconsistent state regulations and giving them clear guidelines on rules of enforcement and control.
As Otiz and Preuss (2024) describe, the policy is a health intervention aimed at decreasing substance abuse and safeguarding communities. Nevertheless, practically, it has acted more as a criminal justice policy. Instead of focusing on treatment and prevention of controlled substances, the law focuses on the punishment of possessing, distributing, and manufacturing controlled substances. Studies have shown that such a punitive process has not helped decrease the rate of drug use but instead has also caused a rise in mass incarceration (DEA, 2025).
**Programs and Services Provided Through the Policy**
The Controlled Substances Act supports numerous programs and services aimed at drug enforcement, prevention, and treatment. The most conspicuous one is enforcement programs, which involve federal and state agencies that control the drug-related activities, carry out investigations, and prosecute individuals violating drug laws (Lampe, 2025). Such attempts include surveillance, arrests, and imprisonment, which form the backbone of the policy implementation.
Prevention programs are also part of the policy framework and entail a public education campaign that discourages drug use. In many cases, these programs address the youth and strive to address the issue of raising awareness of the dangers of using the substance. Though prevention programs are important, it is often dominated by the enforcement programs that limit their overall effectiveness.
Moreover, the policy offers assistance with treatment services. These services include substance-abuse rehabilitation programs, counseling, and medication-assisted therapeutic programs for individuals with substance abuse. However, these services are not equally accessible, particularly among marginalized populations (Lampe, 2025). High cost, absence of insurance, the fact that there are not enough treatment centers, and stigma are some of the barriers that many individuals have to face. Consequently, services offered by the policy fail to sufficiently respond to the needs of all the impacted populations.
**Target Population for Programs and Services**
The target population groups covered in programs and services in the Controlled Substances Act would include individual users of controlled substances, persons at risk of use of controlled substances, and victims of crime related to drug use. Ideally, this policy is applicable to all people irrespective of race or socioeconomic status. However, in actuality, its impacts have disproportionately affected the Black and Hispanic communities.
As Rouhani et al. (2023) report, there is a comparatively equal distribution of drug use across racial lines. Minority groups have a significantly higher likelihood of being arrested, convicted, and imprisoned for committing drug crimes. Such a disproportion refers to structural, deep-rooted ills of the criminal justice system. The criminal justice system has long-term implications on many people in these communities, including job loss, housing insecurity, and social stigma. The findings are also part of the poverty and inequality cycle that leaves the affected individuals in a difficult situation where they can hardly reconnect with society.
**Connection Between the Policy and the Social Justice Problem**
The Controlled Substances Act is directly related to the social justice issue of racial inequality in the enforcement of the act and the mass incarceration. The problem has been lingering for decades and appears to be a general tendency of systemic discrimination in the United States (Sonderlund et al., 2022). Although the policy was meant to deal with drug abuse, the implementation of the policy has helped cause unequal results among various racial and ethnic groups.
This social justice issue is a continuation of historical inequalities that have never been resolved completely. Criminalization of drug use has resulted in an unequal distribution of incarceration and other adverse consequences related to social and economic disadvantage towards the marginalized communities. Such inequalities do harm the processes of social justice, as they restrict access to opportunities and perpetuate inequality. As Cohen et al. (2022) indicate, the policies towards punishment for drugs do not work better compared with public health policies that emphasize treatment and harm reduction. The Controlled Substances Act did not prove effective in addressing the actual causes of substance abuse, such as poverty, trauma, and lack of access to healthcare (Cohen et al., 2022). Consequently, the policy still creates a social justice issue of its own that the policy was meant to address.
**Historical Issues and Context of the Policy**
The Controlled Substances Act was adopted during a period of many social and political changes in the late 1960s and early 1970s. Through this period, related issues such as the perceived threats to the population and the growing visibility around substance use informed policymakers to seek stringent regulatory actions. Congress passed the legislation with very strong bipartisan support and was signed into law by Richard Nixon, who framed drug abuse as a national crisis. As much as the policy was presented as a required public health response, it was also influenced by political interests and societal biases. Other academics show that the systemic enforcement measures were disproportionately directed elsewhere at Black communities and political activists (Manneh, 2025).
The policy voting outcomes showed that there was a vast majority among political parties, which is possibly an indication of a single attitude towards drug control. Leadership in the legislature at that time pointed out that they needed to have a comprehensive framework that would regulate the use of the substances and reduce crime. The policy was also expanded over the years as tougher sentencing legislation reforms were introduced, and inflexible measures of enforcement were also put in place. These tendencies enhanced a punitive approach and resulted in significant increases in incarceration rates among the minority population. Such inequalities are beginning to be accepted and reforms encouraged by policymakers today, although it is a slow and uneven process.
The historical aspects of the policy continue to shape the implementation process. The emphasis on enforcement has directed resources to policing and incarceration at the expense of prevention and treatment services (Washington, 2021). This lack of balance has constrained the efficiency of the policy in addressing substance use as a health issue in society. In addition, the historical context of racial disparities has created a mistrust factor among the affected communities, which contributes to the resistance to responses and support.
**Conclusion**
The Controlled Substances Act illustrates that a policy formulated to address a burning social problem can contribute to inequality and injustice. Even though the policy was developed to regulate drug usage and have a positive impact on the overall health of the population, its implementation has disproportionately impacted marginalized populations and has increased systemic inequalities. The policy has placed a lot of emphasis on enforcing the programs and services instead of placing much emphasis on preventing and treating, which the policy has not addressed.
**References**
Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system.
_Annals of Medicine_,
_54_(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926
DEA. (2025).
_The controlled substances act_. Www.dea.gov. https://www.dea.gov/drug-information/csa
Lampe, J. R. (2025, January 22).
_The Controlled Substances Act (CSA): A Legal Overview for the 119th Congress_. Congress.gov. https://www.congress.gov/crs-product/R45948
Manneh, T. (2025, June 2).
_Controlled Substances, controlled people: How drug laws reinforce colonial power structures_. Drug Science. https://www.drugscience.org.uk/controlled-substances-controlled-people
Ortiz, N. R., & Preuss, C. V. (2024). Controlled Substance Act. In
_www.ncbi.nlm.nih.gov_. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574544/
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). https://doi.org/10.1016/j.amepre.2023.04.004
Sonderlund, A. L., Charifson, M., Ortiz, R., Khan, M., Schoenthaler, A., & Williams, N. J. (2022). A comprehensive framework for operationalizing structural racism in health research: The association between mass incarceration of Black people in the U.S. and adverse birth outcomes.
_SSM – Population Health_,
_19_, 101225. https://doi.org/10.1016/j.ssmph.2022.101225
Washington, M. (2021, November).
_Beyond Jails: Community-Based Strategies for Public Safety_. Vera Institute of Justice. https://www.vera.org/beyond-jails-community-based-strategies-for-public-safety
**## SWK5002ExplorationofSocialJustice.docx**
2
**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
**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-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 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 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 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 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.
**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
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
**Week6Assignment_PolicyAnalysis.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/week6assignment-policyanalysis-pdf)
**Week6Assignment_PolicyAnalysis.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/week6assignment-policyanalysis-pdf)
**## SWK5002PolicySelectionandBackground.docx**
2
**Policy Selection and Background**
Tierainie C. Johnson, MS, MCAP
Capella University
SWK 5002- Social Welfare History Policy Practice
Professor Anna Richmond, LAPSW, LISW
May 10, 2026
**Policy Selection and Background**
Social policy is largely concerned with social justice. However, policies aimed at tackling issues in society can also lead to inequality and oppression. The policy dynamic of social work is critical in recognizing the advantages and the unforeseen outcomes of policies in the social work field. The Controlled Substances Act is one of the key federal policies that exemplify this tension. The policy was introduced in 1970 in response to the need by the United States to regulate the use and distribution of drugs (Lampe, 2025). Despite aiming to safeguard the health of the population and minimize drug abuse, the policy has been widely criticized as having disproportionately impacted the Black and Hispanic communities and contributed to systemic inequality. Substance use and incarceration for drug-related problems are long-standing social justice issues that are both intersectional in nature and combine with race, socioeconomic status, and access to medical care and legal services. The issue is not new, but an extension of historical trends of discrimination embedded within legal and political systems. This paper explores the mission and objectives, programs and services, and the history of the Controlled Substances Act.
**Purpose of the Policy**
The main aim of the Controlled Substances Act is to regulate the production, distribution, and use of some drugs using a hierarchical classification system. This system classifies substances into five schedules rooted in their accepted medical use, potential abuse, and potential to cause dependency (Ortiz and Preuss, 2024). Schedule I drugs are the most dangerous and do not have an endorsement under medical use, and the likelihood of abuse is high. Conversely, Schedule V substances are considered to be less risky and have accepted medical use. The policy was developed to create a unified federal effort to regulate drugs, replacing inconsistent state regulations and giving them clear guidelines on rules of enforcement and control.
As Otiz and Preuss (2024) describe, the policy is a health intervention aimed at decreasing substance abuse and safeguarding communities. Nevertheless, practically, it has acted more as a criminal justice policy. Instead of focusing on treatment and prevention of controlled substances, the law focuses on the punishment of possessing, distributing, and manufacturing controlled substances. Studies have shown that such a punitive process has not helped decrease the rate of drug use but instead has also caused a rise in mass incarceration (DEA, 2025).
**Programs and Services Provided Through the Policy**
The Controlled Substances Act supports numerous programs and services aimed at drug enforcement, prevention, and treatment. The most conspicuous one is enforcement programs, which involve federal and state agencies that control the drug-related activities, carry out investigations, and prosecute individuals violating drug laws (Lampe, 2025). Such attempts include surveillance, arrests, and imprisonment, which form the backbone of the policy implementation.
Prevention programs are also part of the policy framework and entail a public education campaign that discourages drug use. In many cases, these programs address the youth and strive to address the issue of raising awareness of the dangers of using the substance. Though prevention programs are important, it is often dominated by the enforcement programs that limit their overall effectiveness.
Moreover, the policy offers assistance with treatment services. These services include substance-abuse rehabilitation programs, counseling, and medication-assisted therapeutic programs for individuals with substance abuse. However, these services are not equally accessible, particularly among marginalized populations (Lampe, 2025). High cost, absence of insurance, the fact that there are not enough treatment centers, and stigma are some of the barriers that many individuals have to face. Consequently, services offered by the policy fail to sufficiently respond to the needs of all the impacted populations.
**Target Population for Programs and Services**
The target population groups covered in programs and services in the Controlled Substances Act would include individual users of controlled substances, persons at risk of use of controlled substances, and victims of crime related to drug use. Ideally, this policy is applicable to all people irrespective of race or socioeconomic status. However, in actuality, its impacts have disproportionately affected the Black and Hispanic communities.
As Rouhani et al. (2023) report, there is a comparatively equal distribution of drug use across racial lines. Minority groups have a significantly higher likelihood of being arrested, convicted, and imprisoned for committing drug crimes. Such a disproportion refers to structural, deep-rooted ills of the criminal justice system. The criminal justice system has long-term implications on many people in these communities, including job loss, housing insecurity, and social stigma. The findings are also part of the poverty and inequality cycle that leaves the affected individuals in a difficult situation where they can hardly reconnect with society.
**Connection Between the Policy and the Social Justice Problem**
The Controlled Substances Act is directly related to the social justice issue of racial inequality in the enforcement of the act and the mass incarceration. The problem has been lingering for decades and appears to be a general tendency of systemic discrimination in the United States (Sonderlund et al., 2022). Although the policy was meant to deal with drug abuse, the implementation of the policy has helped cause unequal results among various racial and ethnic groups.
This social justice issue is a continuation of historical inequalities that have never been resolved completely. Criminalization of drug use has resulted in an unequal distribution of incarceration and other adverse consequences related to social and economic disadvantage towards the marginalized communities. Such inequalities do harm the processes of social justice, as they restrict access to opportunities and perpetuate inequality. As Cohen et al. (2022) indicate, the policies towards punishment for drugs do not work better compared with public health policies that emphasize treatment and harm reduction. The Controlled Substances Act did not prove effective in addressing the actual causes of substance abuse, such as poverty, trauma, and lack of access to healthcare (Cohen et al., 2022). Consequently, the policy still creates a social justice issue of its own that the policy was meant to address.
**Historical Issues and Context of the Policy**
The Controlled Substances Act was adopted during a period of many social and political changes in the late 1960s and early 1970s. Through this period, related issues such as the perceived threats to the population and the growing visibility around substance use informed policymakers to seek stringent regulatory actions. Congress passed the legislation with very strong bipartisan support and was signed into law by Richard Nixon, who framed drug abuse as a national crisis. As much as the policy was presented as a required public health response, it was also influenced by political interests and societal biases. Other academics show that the systemic enforcement measures were disproportionately directed elsewhere at Black communities and political activists (Manneh, 2025).
The policy voting outcomes showed that there was a vast majority among political parties, which is possibly an indication of a single attitude towards drug control. Leadership in the legislature at that time pointed out that they needed to have a comprehensive framework that would regulate the use of the substances and reduce crime. The policy was also expanded over the years as tougher sentencing legislation reforms were introduced, and inflexible measures of enforcement were also put in place. These tendencies enhanced a punitive approach and resulted in significant increases in incarceration rates among the minority population. Such inequalities are beginning to be accepted and reforms encouraged by policymakers today, although it is a slow and uneven process.
The historical aspects of the policy continue to shape the implementation process. The emphasis on enforcement has directed resources to policing and incarceration at the expense of prevention and treatment services (Washington, 2021). This lack of balance has constrained the efficiency of the policy in addressing substance use as a health issue in society. In addition, the historical context of racial disparities has created a mistrust factor among the affected communities, which contributes to the resistance to responses and support.
**Conclusion**
The Controlled Substances Act illustrates that a policy formulated to address a burning social problem can contribute to inequality and injustice. Even though the policy was developed to regulate drug usage and have a positive impact on the overall health of the population, its implementation has disproportionately impacted marginalized populations and has increased systemic inequalities. The policy has placed a lot of emphasis on enforcing the programs and services instead of placing much emphasis on preventing and treating, which the policy has not addressed.
**References**
Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system.
_Annals of Medicine_,
_54_(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926
DEA. (2025).
_The controlled substances act_. Www.dea.gov. https://www.dea.gov/drug-information/csa
Lampe, J. R. (2025, January 22).
_The Controlled Substances Act (CSA): A Legal Overview for the 119th Congress_. Congress.gov. https://www.congress.gov/crs-product/R45948
Manneh, T. (2025, June 2).
_Controlled Substances, controlled people: How drug laws reinforce colonial power structures_. Drug Science. https://www.drugscience.org.uk/controlled-substances-controlled-people
Ortiz, N. R., & Preuss, C. V. (2024). Controlled Substance Act. In
_www.ncbi.nlm.nih.gov_. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574544/
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). https://doi.org/10.1016/j.amepre.2023.04.004
Sonderlund, A. L., Charifson, M., Ortiz, R., Khan, M., Schoenthaler, A., & Williams, N. J. (2022). A comprehensive framework for operationalizing structural racism in health research: The association between mass incarceration of Black people in the U.S. and adverse birth outcomes.
_SSM – Population Health_,
_19_, 101225. https://doi.org/10.1016/j.ssmph.2022.101225
Washington, M. (2021, November).
_Beyond Jails: Community-Based Strategies for Public Safety_. Vera Institute of Justice. https://www.vera.org/beyond-jails-community-based-strategies-for-public-safety
**## SWK5002ExplorationofSocialJustice.docx**
2
**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
**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-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 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 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 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 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.
**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
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
**Week6Assignment_PolicyAnalysis.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/week6assignment-policyanalysis-pdf)
**## SWK5002PolicySelectionandBackground.docx**
2
**Policy Selection and Background**
Tierainie C. Johnson, MS, MCAP
Capella University
SWK 5002- Social Welfare History Policy Practice
Professor Anna Richmond, LAPSW, LISW
May 10, 2026
**Policy Selection and Background**
Social policy is largely concerned with social justice. However, policies aimed at tackling issues in society can also lead to inequality and oppression. The policy dynamic of social work is critical in recognizing the advantages and the unforeseen outcomes of policies in the social work field. The Controlled Substances Act is one of the key federal policies that exemplify this tension. The policy was introduced in 1970 in response to the need by the United States to regulate the use and distribution of drugs (Lampe, 2025). Despite aiming to safeguard the health of the population and minimize drug abuse, the policy has been widely criticized as having disproportionately impacted the Black and Hispanic communities and contributed to systemic inequality. Substance use and incarceration for drug-related problems are long-standing social justice issues that are both intersectional in nature and combine with race, socioeconomic status, and access to medical care and legal services. The issue is not new, but an extension of historical trends of discrimination embedded within legal and political systems. This paper explores the mission and objectives, programs and services, and the history of the Controlled Substances Act.
**Purpose of the Policy**
The main aim of the Controlled Substances Act is to regulate the production, distribution, and use of some drugs using a hierarchical classification system. This system classifies substances into five schedules rooted in their accepted medical use, potential abuse, and potential to cause dependency (Ortiz and Preuss, 2024). Schedule I drugs are the most dangerous and do not have an endorsement under medical use, and the likelihood of abuse is high. Conversely, Schedule V substances are considered to be less risky and have accepted medical use. The policy was developed to create a unified federal effort to regulate drugs, replacing inconsistent state regulations and giving them clear guidelines on rules of enforcement and control.
As Otiz and Preuss (2024) describe, the policy is a health intervention aimed at decreasing substance abuse and safeguarding communities. Nevertheless, practically, it has acted more as a criminal justice policy. Instead of focusing on treatment and prevention of controlled substances, the law focuses on the punishment of possessing, distributing, and manufacturing controlled substances. Studies have shown that such a punitive process has not helped decrease the rate of drug use but instead has also caused a rise in mass incarceration (DEA, 2025).
**Programs and Services Provided Through the Policy**
The Controlled Substances Act supports numerous programs and services aimed at drug enforcement, prevention, and treatment. The most conspicuous one is enforcement programs, which involve federal and state agencies that control the drug-related activities, carry out investigations, and prosecute individuals violating drug laws (Lampe, 2025). Such attempts include surveillance, arrests, and imprisonment, which form the backbone of the policy implementation.
Prevention programs are also part of the policy framework and entail a public education campaign that discourages drug use. In many cases, these programs address the youth and strive to address the issue of raising awareness of the dangers of using the substance. Though prevention programs are important, it is often dominated by the enforcement programs that limit their overall effectiveness.
Moreover, the policy offers assistance with treatment services. These services include substance-abuse rehabilitation programs, counseling, and medication-assisted therapeutic programs for individuals with substance abuse. However, these services are not equally accessible, particularly among marginalized populations (Lampe, 2025). High cost, absence of insurance, the fact that there are not enough treatment centers, and stigma are some of the barriers that many individuals have to face. Consequently, services offered by the policy fail to sufficiently respond to the needs of all the impacted populations.
**Target Population for Programs and Services**
The target population groups covered in programs and services in the Controlled Substances Act would include individual users of controlled substances, persons at risk of use of controlled substances, and victims of crime related to drug use. Ideally, this policy is applicable to all people irrespective of race or socioeconomic status. However, in actuality, its impacts have disproportionately affected the Black and Hispanic communities.
As Rouhani et al. (2023) report, there is a comparatively equal distribution of drug use across racial lines. Minority groups have a significantly higher likelihood of being arrested, convicted, and imprisoned for committing drug crimes. Such a disproportion refers to structural, deep-rooted ills of the criminal justice system. The criminal justice system has long-term implications on many people in these communities, including job loss, housing insecurity, and social stigma. The findings are also part of the poverty and inequality cycle that leaves the affected individuals in a difficult situation where they can hardly reconnect with society.
**Connection Between the Policy and the Social Justice Problem**
The Controlled Substances Act is directly related to the social justice issue of racial inequality in the enforcement of the act and the mass incarceration. The problem has been lingering for decades and appears to be a general tendency of systemic discrimination in the United States (Sonderlund et al., 2022). Although the policy was meant to deal with drug abuse, the implementation of the policy has helped cause unequal results among various racial and ethnic groups.
This social justice issue is a continuation of historical inequalities that have never been resolved completely. Criminalization of drug use has resulted in an unequal distribution of incarceration and other adverse consequences related to social and economic disadvantage towards the marginalized communities. Such inequalities do harm the processes of social justice, as they restrict access to opportunities and perpetuate inequality. As Cohen et al. (2022) indicate, the policies towards punishment for drugs do not work better compared with public health policies that emphasize treatment and harm reduction. The Controlled Substances Act did not prove effective in addressing the actual causes of substance abuse, such as poverty, trauma, and lack of access to healthcare (Cohen et al., 2022). Consequently, the policy still creates a social justice issue of its own that the policy was meant to address.
**Historical Issues and Context of the Policy**
The Controlled Substances Act was adopted during a period of many social and political changes in the late 1960s and early 1970s. Through this period, related issues such as the perceived threats to the population and the growing visibility around substance use informed policymakers to seek stringent regulatory actions. Congress passed the legislation with very strong bipartisan support and was signed into law by Richard Nixon, who framed drug abuse as a national crisis. As much as the policy was presented as a required public health response, it was also influenced by political interests and societal biases. Other academics show that the systemic enforcement measures were disproportionately directed elsewhere at Black communities and political activists (Manneh, 2025).
The policy voting outcomes showed that there was a vast majority among political parties, which is possibly an indication of a single attitude towards drug control. Leadership in the legislature at that time pointed out that they needed to have a comprehensive framework that would regulate the use of the substances and reduce crime. The policy was also expanded over the years as tougher sentencing legislation reforms were introduced, and inflexible measures of enforcement were also put in place. These tendencies enhanced a punitive approach and resulted in significant increases in incarceration rates among the minority population. Such inequalities are beginning to be accepted and reforms encouraged by policymakers today, although it is a slow and uneven process.
The historical aspects of the policy continue to shape the implementation process. The emphasis on enforcement has directed resources to policing and incarceration at the expense of prevention and treatment services (Washington, 2021). This lack of balance has constrained the efficiency of the policy in addressing substance use as a health issue in society. In addition, the historical context of racial disparities has created a mistrust factor among the affected communities, which contributes to the resistance to responses and support.
**Conclusion**
The Controlled Substances Act illustrates that a policy formulated to address a burning social problem can contribute to inequality and injustice. Even though the policy was developed to regulate drug usage and have a positive impact on the overall health of the population, its implementation has disproportionately impacted marginalized populations and has increased systemic inequalities. The policy has placed a lot of emphasis on enforcing the programs and services instead of placing much emphasis on preventing and treating, which the policy has not addressed.
**References**
Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs impacts social determinants of health beyond the criminal legal system.
_Annals of Medicine_,
_54_(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926
DEA. (2025).
_The controlled substances act_. Www.dea.gov. https://www.dea.gov/drug-information/csa
Lampe, J. R. (2025, January 22).
_The Controlled Substances Act (CSA): A Legal Overview for the 119th Congress_. Congress.gov. https://www.congress.gov/crs-product/R45948
Manneh, T. (2025, June 2).
_Controlled Substances, controlled people: How drug laws reinforce colonial power structures_. Drug Science. https://www.drugscience.org.uk/controlled-substances-controlled-people
Ortiz, N. R., & Preuss, C. V. (2024). Controlled Substance Act. In
_www.ncbi.nlm.nih.gov_. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574544/
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). https://doi.org/10.1016/j.amepre.2023.04.004
Sonderlund, A. L., Charifson, M., Ortiz, R., Khan, M., Schoenthaler, A., & Williams, N. J. (2022). A comprehensive framework for operationalizing structural racism in health research: The association between mass incarceration of Black people in the U.S. and adverse birth outcomes.
_SSM – Population Health_,
_19_, 101225. https://doi.org/10.1016/j.ssmph.2022.101225
Washington, M. (2021, November).
_Beyond Jails: Community-Based Strategies for Public Safety_. Vera Institute of Justice. https://www.vera.org/beyond-jails-community-based-strategies-for-public-safety
**## SWK5002ExplorationofSocialJustice.docx**
2
**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
**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-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 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 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 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 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.
**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
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
**Week6Assignment_PolicyAnalysis.pdf**
This file is too large to display. [View in new window](https://www.sweetstudy.com/files/week6assignment-policyanalysis-pdf)