TB Announced

Critics of U.S. drug policy have long noted that antiparaphernalia laws foster the spread of disease, including AIDS and hepatitis, by encouraging needle sharing among intravenous drug users. A recent article in the Journal of the American Medical Association identifies another way in which the war on drugs makes people sick: by cramming them together in jails and prisons.

The article, in JAMA's December 9 issue, quotes several medical authorities who say the recent resurgence in cases of tuberculosis is partly due to prison overcrowding driven by increasingly strict drug laws. Dr. John Raba, former director of a company that provides health care to prisoners in Cook County, Illinois, notes that a disproportionate number of drug offenders are carriers not only of tuberculosis but of HIV, which makes them vulnerable to TB. Morever, he says, correctional facilities "were not built to provide the ventilation needed for preventing the spread of respiratory diseases."

The number of Americans behind bars doubled in the 1980s, largely due to the war on drugs, and now stands at about 1.2 million. Most federal prisoners are drug offenders, as are one-third of the women and one-fifth of the men in local jails. In 1990, JAMA reports, the average prison was 18 percent to 29 percent over the capacity for which it was designed; federal prisons were 51 percent over designed capacity.

In 1988 the tuberculosis rate was 75 per 100,000 in state and federal prisons, compared to 13.7 per 100,000 in the general population. In 1991 the jail on Rikers Island, where the population quadrupled during the '80s, had a TB rate of 400 to 500 cases per 100,000. Since December 1990, JAMA reports, 11 outbreaks of tuberculosis in correctional facilities across the country have killed 13 inmates and one guard.

Raba tells JAMA that screening methods do not detect infection early enough to prevent transmission. He warns that prison outbreaks of TB, including deadly, drug-resistant strains, threaten the general population, since prisoners are released eventually and prison employees go home at the end of each day.