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RSAT Forum > Monthly Discussion > February 2017: Keeping Suboxone Contraband Out of RSAT Pods View modes: 
JCosta - 2/1/2017 1:38:08 PM
   
February 2017: Keeping Suboxone Contraband Out of RSAT Pods
A RSAT counselor writes: We are having a problem with Suboxone smuggled into our institution, even reaching the RSAT pod. While we have no control over the entire prison, what can the RSAT program do to respond to this problem?

Answer: You are certainly not alone. Unlike buprenorphine in the pill form, Suboxone strips can be easily divided into smaller strips and sold or shared among multiple individuals. There was so much Suboxone in the Maryland prisons that state correctional officials convinced the state Medicaid program to take Suboxone off the preferred medication list for those covered by Medicaid. It is reported that Suboxone contraband in the state’s prisons was dramatically reduced as a result. However, it was also reported that some patients outside the prison reported distress because it became more difficult for them to continue to access this important FDA approved medication that was working for them in their recovery from opioid use disorder. Obviously, RSAT programs require periodic drug testing so that making sure the tests detect buprenorphine is an essential element in deterring illicit use of buprenorphine or buprenorphine with naloxone (Suboxone™). Prisons and jails that allow inmates to receive agonist medications (methadone or buprenorphine) or antagonist medication (naloxone) should remove the incentive for these same individuals to access smuggled drugs.

We reviewed 15 state prisons system policies but did not find any that included specific protocols in place to respond to buprenorphine contraband/diversion although some states have specialized committees that are responding to the issue.

Examples of Policies Reviewed
New Mexico Contraband Policy: http://cd.nm.gov/policies/docs/CD-090300.pdf
New Hampshire Contraband Policy: https://www.nh.gov/nhdoc/policies/documents/5-22.pdf
Kentucky Contraband Policy (2016): http://corrections.ky.gov/communityinfo/Policies%20and%20Procedures/Documents/CH9/CPP%209-6-Contraband%20-%20Eff%208-5-16.pdf
Massachusetts DOC 2012 Drug Detection Fact Sheet (Canine): http://www.mass.gov/eopss/docs/doc/drug-detection-fact-sheet-11-13-13.pdf

A review of Federal Bureau of Prisons’ Contraband and Drug Interdiction Efforts found at https://oig.justice.gov/reports/2016/e1605.pdf indicates the BOP is still struggling with the challenge. In June of 2016, a redacted report on a review of BOP contraband reduction efforts was release. Findings include:
“The BOP Does Not Have a Comprehensive Contraband Tracking Capability”
“The BOP Did Not Effectively Implement Its 2013 Staff Search Policy to Deter Staff Introduction of Contraband
“The BOP Has Deployed New Technologies to Detect Contraband, but More Operational Guidance and Training Are Needed to Maximize Security”

We do know why Suboxone is so popular as contraband. In addition to the ease in which it can be smuggled, Suboxone is stronger than morphine at low doses. If people who are not currently opioid dependent inject a low dose, the Narcan does not kick in and the high that it can produce is found to be desirable. This type of demand - combined with the demand created by individuals in custody that are dealing with opioid withdrawal- may conspire to create the demand in custody settings. In a qualitative study in Massachusetts and Vermont, treatment seekers in the community also frequently reported using illicit buprenorphine. Most patients indicated non-medically supervised buprenorphine was used to prevent withdrawal and to self-treat withdrawal symptoms. This phenomenon has also been attributed to insufficient treatment dosages. The conclusion of researchers is that overall illicit buprenorphine users are primarily comprised of people who use it with motives related to withdrawal from other opioids. But, that may or may not be entirely true for the prison population.

But we also know that well run prison and jail MAT programs that provide Suboxone can control its diversion. On the rsat-tta website, you can find the RI prison protocol for its Suboxone MAT program. As RSAT visitors to this program found last July, the RI prison program has not resulted in great diversion of Suboxone or put individuals in the program at risk from others seeking access to their medication. It should be noted that the World Health Organization Expert Committee on Drug Dependence Report concluded the following: Buprenorphine diversion does pose a public health concern, but risk-to-benefit ratio for the continued use of buprenorphine is favorable. The World Health Organization also added buprenorphine as a complementary medication to the 14th edition of The Model of List of Essential Medicines.

(Bourin M, Zhiji C, DeLima L. WHO Expert Committee on Drug Dependence: Thirty-third Report. WHO; 2003. pp. 1–31. )

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