It is fair to say, as prosecutors and several briefs filed in the case do, that people who suffer from substance use disorders are not wholly unable to choose to abstain from drug use. Most addicts do, after all, manage to refrain from using in any number of public places, in the course of any given day. But their ability to choose rationally and consistently is still impaired, by both brain changes caused by chronic substance use and the sheer force of addiction itself. “It’s not that they don’t have free will,” says Mark Kleiman, a professor of public policy at New York University. “It’s that they are exerting that will against such a colossal force.”

It’s also true that addicts can and do respond to incentives. But the balance of evidence suggests that carrots work far better than sticks, and that in any case, the particular stick of jail time thwarts the treatment process.

“Our patients are far less likely to talk honestly about their relapses and their struggles with recovery if they think it’s going to land them in jail,” says Sarah Coughlin, a social worker and addiction specialist in Charlestown, Mass. “It puts us in a tough spot, because it breeds mistrust.” It also breeds fear: As The Boston Globe reported, one woman committed suicide in the bathroom of a Lowell, Mass., drug court after she watched at least 23 of her 41 fellow probationers get sentenced to jail for relapses and other violations, and after she became convinced that she would soon be sentenced as well.

Of course, criminalizing relapse isn’t the only absurdity that exists at the intersection of drug addiction, criminal justice and public health. As a recent Times article explained, states across the country are enacting laws that allow for homicide charges against just about anyone connected to an overdose death, even if that person is also suffering from addiction.

The irony is both dark and profound: Only in death do drug users become victims. Until then, they are criminals.