German Lopez - January 30, 2020
Medications for Opioid Addiction work. Most Prisons and Jails Don’t Offer Them
Melissa Godsey credits the medication Suboxone, also known as buprenorphine, for her recovery from a years-long struggle with opioid and meth addiction. As she told me, the medication has let her “live a normal life.”
But for a while, the 35-year-old from Seattle feared that she would be cut off from the treatment. This week, Godsey had to turn herself in to serve a two-year sentence in federal prison for identity theft — while she was using, she stole credit cards so she could afford drugs. The feds don’t typically offer medications for opioid addiction in prison, even though studies show the medications are the gold standard for opioid addiction treatment and save lives.
With the help of the American Civil Liberties Union, Godsey got an exemption in a legal settlement with the Federal Bureau of Prisons. It’s one of the handful of cases in recent years in which the ACLU was able to push prison officials to offer medications for opioid addiction. But this exemption is still really rare, even as the country is in the middle of a drug overdose crisis linked to nearly 770,000 deaths since 1999.
Just Rhode Island and Vermont officially offer all three federally approved opioid addiction medications (buprenorphine, methadone, and naltrexone) to jail and prison inmates. The 48 other states and the federal government offer them only in limited circumstances or not at all.
The lack of adequate treatment in jails and prisons puts a vulnerable population of around 2.3 million people at risk. About 58 percent of people in state prisons and about 63 percent of those sentenced in jails meet the definition for drug dependence or misuse, compared to 5 percent of the general population, according to a 2017 report from the Bureau of Justice Statistics.
Yet a 2017 study by Johns Hopkins researchers found that less than 5 percent of people who were referred to opioid use disorder treatment through the justice system received methadone or buprenorphine, compared to nearly 41 percent of people referred through other sources.
The result is likely more overdoses and deaths. A 2007 study in The New England Journal of Medicine found ex-inmates’ risk of a fatal overdose is 129 times as high as it is for the general population during the two weeks after release. Other studies have backed up the finding that recently released inmates are at particular risk of overdose. In Rhode Island, a preliminary research letter in 2018 found that the state’s program offering medications for opioid addiction was followed by a more than 60 percent drop in overdose deaths among recently released inmates.
But many local and state lawmakers and jail and prison officials remain skeptical. Some of that skepticism is driven by stigma: the view that addiction is a moral failing, not a medical condition, so public resources shouldn’t go to treating it. Stigma toward medications for addiction — like the myth that medications are simply “replacing one drug with another” — is especially prominent. And there are funding and logistical concerns with better addiction treatment programs in jails and prisons, although Rhode Island and Vermont show those issues can be overcome.
“We have a population that’s incredibly vulnerable,” Sarah Wakeman, medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, previously told me. “It’s really inexcusable that we don’t make this available for people who are at such risk of death.”
Prisons Don’t Do a Good Job of Treating Addiction
Although the Supreme Court has found that prisoners are entitled to proper health care, medical services in prison are far from ideal — as jails and prisons avoid paying too much for even lifesaving interventions to reduce expenses. But things appear to be particularly bad when it comes to addiction treatment, a space in which jails and prisons don’t even act like they’re providing adequate care.
In 2018, I contacted the 50 state agencies that control prisons, as well as the Federal Bureau of Prisons, to find out whether they offered medications for opioid addiction. Just one state at the time, Rhode Island, offered all three federally approved medications in its jails and prisons. Since my story, Vermont began offering the three medications in jails and prisons. Delaware reportedly plans to do the same soon.
Separately, Michigan plans to offer the three medications in all state prisons by 2023, and Maryland plans to do so in all its local jails by then as well. Those policies still exclude some populations — local jails in Michigan and state prisons in Maryland — but they’re expansions nonetheless.
Other states are pursuing similar efforts, although it’s unclear how expansive or accessible their programs really are or will be, according to the ACLU.
The ACLU hopes its work, through lawsuits and lobbying, will inspire a change. “The end goal is that everybody in America who is in jail and prison [and] who is clinically indicated gets medication-assisted treatment,” Joey Longley, equal justice works fellow at the ACLU’s National Prison Project, told me. “I think we’re moving in that direction now, based on the litigation and legislation strategy that we’ve taken.”
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