Saint Louis University Journal of Health Law & Policy

Document Type



Our society often operates under the delusion that more incarceration in urban areas will make us safer. Crowded cities and the problems for its inhabitants are not new. Those problems often fall more heavily on minority groups. Failed education, healthcare unavailability, and a lack of decent housing have made it difficult for cities to cope with addiction and crime. The COVID-19 pandemic has made the issues in the criminal system harder to ignore. Decline of major manufacturing jobs in cities like the steel and auto industries removed key opportunities for those seeking to overcome poverty and raise families. Debilitating riots during the late 1960s caused a retreat from the inner city and flight to the suburbs. Drug addiction growing from the 1950s further agitated the challenges of urban life. We should use this crisis as an opportunity to reset and launch new initiatives that have some chance of success.

The so-called “War on Drugs” that began in the 1970s has also had a lasting effect on current approaches to people being unable to get off of the “hamster wheel” of the criminal system. This “Urban Drama Trauma,” as I define it, is the failure of our criminal justice and health care infrastructure to address the root problems of urban living among marginal populations. The opioid crisis of the early 21st-century has also magnified the challenges of major cities in ways that have never been contemplated. Despite these dire circumstances, this crisis may create an opportunity to reset our focus and not repeat the mistakes of the past. Re-directing drug abuse through the healthcare system rather than the criminal system makes sense from an economic and public policy perspective. By addressing the trauma issue directly and focusing on job creation and workforce development for those hampered by the criminal system, we can experience better long-term outcomes.