Over the past 40 years, the number of people in US prisons has increased by more than 600%. On 1 January 2008, one of every 100 adults were behind bars. For black Americans, especially men with no college education, incarceration has become an alarmingly common life experience. Much of the increase in the prisoner census is a result of the “War on Drugs” and our country’s failure to treat drug dependence and mental illness as medical conditions.

A new evidence-based approach is desperately needed. The medical profession has the chance both to advocate for changes in the criminal justice system to reduce the number of people behind bars who would be better served in community-based treatment and to capitalise on the tremendous public health opportunities for diagnosing and treating disease and for linking patients to care after release.

In addition to capitalising on the public health opportunities that incarceration presents, the medical community and polic ymakers must advocate for alternatives to imprisonment, drug-policy reform, and increased public awareness of this crisis in order to reduce mass incarceration and its collateral consequences.

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