As the rate of illicit drug use in America continues to rise, so does the number of people entering the criminal justice system for it. Today, one in every five incarcerated people is locked up for a drug offense. And despite a clear need to address substance use, less than 1 percent of federal funding is being used to support incarcerated people with substance use disorders. In fact, only 11 percent of incarcerated people in need of substance-abuse treatment are receiving it in prisons and jails. Bloomberg Fellow Hannah Johnson’s interest in supporting vulnerable populations led her to a career in criminal justice reform addressing substance abuse, but she didn’t know it would also introduce her to a new passion: public health.

Hannah is a senior policy analyst for the New York-New Jersey High Intensity Drug Trafficking Areas program, or HIDTA. The Office of National Drug Control Policy traditionally funds HIDTA programs to build partnerships between law enforcement agencies so they can better share information, with the end goal of reducing drug trafficking and drug abuse. Hannah JohnsonHannah works on an innovative partnership between the HIDTA program and the Centers for Disease Control and Prevention called the Overdose Response Strategy. This project spans nearly two dozen states, building partnerships between law enforcement and public health agencies to increase collaboration and prevent drug overdoses. 

We talked to Hannah, who is pursuing a master’s at Johns Hopkins Bloomberg School of Public Health, about working at HIDTA, tying together criminal justice and public health and being a Bloomberg Fellow. 

Tell me about your work at HIDTA. 

My focus is on finding ways to connect people who use drugs to care and treatment. People who use drugs can be very hard to find, let alone get into care because of the stigma associated with drug use and addiction. We also know that people who come into contact with the criminal justice system are at much higher risk of an overdose than the general population. I work with our team to provide assistance and support to agencies interested in getting people into care through their contact with the criminal justice system, such as through drug court programs or when they released from prison. We support pre-arrest diversion programs through which police can offer to take people to a local harm-reduction group or care center, made available to them through partnerships with local agencies, instead of arresting them for illegal drug use. 

We also work with agencies on developing and evaluating programs that reach out to people who survive an overdose because we know they are at a really high risk of having a fatal overdose. Reaching out to them is difficult because public health agencies are bound by the Health Insurance Portability and Accountability Act of 1996 to protect patients’ health information. Law enforcement agencies, on the other hand, are not ruled by HIPAA and I’ve found that they are often eager to find a way to connect these at-risk people to care and treatment. Data-sharing is a big part of our work, and it’s one of the greatest values these partnerships between law enforcement and public health agencies offer.

How do criminal justice and public health overlap?
The criminal justice system has an incredible impact on people’s health. It increases stress levels, takes you out of the labor market and your community, makes it hard to get a job or secure a place to live after you get out — all of which are factors that impact health. However, we can’t generalize and say that putting people who’ve done bad things in jail is good or putting any people in jail is bad. Putting people in jail can be bad for public health, but it can also be good for public health if those people are a real threat to the community. We need to be honest about weighing both sides, admit we can do harm with both options and address it clear-eyed to make the best decision for everyone.

Are your experiences at the Initiative applicable to your work at HIDTA? 

One of our project leaders at the CDC would always joke that I’m reinventing public health because I would come to her with my big ideas that I had put a lot of thought into, and then she would tell me about an existing public health theory that encompasses my idea in even greater depth. So formally learning about this discipline at JHU has been really valuable to me because I’m gaining an understanding about the state of public health, existing research, what we know and what’s still missing. I hope to fill those gaps and focus my efforts on contributing to the field in the future. Policy is a really important mechanism for achieving results in public health, so I have one foot in academia and the other in my work, and I’m excited about finding ways to bridge the two experiences.