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Why in the world should prisons or jails provide medications, i.e. drugs, to addicted inmates who are now off drugs , some for the first time in years and years?

Answer: Just because someone is off drugs while incarcerated 24/7 for months, even years, doesn’t mean they will remain drug free upon release.  In fact, incarcerated opioid addicts are at extremely high risk to die of an opioid overdose within two weeks of release, notwithstanding abstinence obtained and maintained while in prison or jail.  On the other hand, it may be totally inappropriate for incarcerated inmates who are drug free to be introduced to agonist or partial agonist medications such as methadone and suboxone, respectively.  However, once released, these medications may be appropriate if the former inmates find they cannot maintain abstinence in the community. This is why many correctional institutions are creating re-entry medication assisted treatment programs centered around naltrexone, an antagonist medication that blocks the euphoric effect of opioids and alcohol and reduces the cravings for these drugs. Naltrexone can be taken daily as a pill or injected every 28 days.  In the latter form, marketed as Vivitrol, injections immediately before release from prison or jail gives inmates several weeks to re-integrate in the community and get into treatment and relapse prevention support groups without re-experiencing the immediate cravings for these drugs they might otherwise experience once back in the community surrounded with the old temptations to get high.  If released inmates feel they can remain abstinent without continued medication, they can stop taking or being injected with naltrexone without suffering withdrawal.  Some correctional institutions are providing inmates with an additional injection of naltrexone a month before their release.  They find that when some inmates realize they are getting out, the inmates’ old drug dreams, cravings, even withdrawal symptoms come back and makes it more difficult for them to work with correctional officials to develop transitional plans and post release treatment arrangements. 

Research also finds that continuing inmates on methadone or suboxone who are not drug free when they enter prison or jail significantly improves their chance of success in the community upon release. Providing methadone to pregnant drug addicted inmates has long been recognized as the standard of care for corrections.  Some prisons and jails now provide pregnant inmates with buprenorphine, another agonist medication.  (Suboxone contains both buprenorphine and naloxone, making it a partial agonist.)  The challenge for correctional agonist maintenance programs is preventing diversion of these medications sought after by inmates.  To date, no one reports any attempts to divert naltrexone!

For excellent  examples of prisons and jails with medication assisted treatment re-entry programs, see the training video on the home page of this website and read the accompanying manual that offers more detailed information.

Given that medication assisted treatment has been found to significantly improve treatment outcomes for persons with opioid and alcohol use disorders, it amounts to substandard care not to offer it to appropriate clients in appropriate situations.

The Pew Charitable Trusts Stateline publication has a series on MAT.  The second covers prison and jail MAT programming. It points out a simple fact: “Most inmates start using drugs again as soon as they’re released. If they don’t die of an overdose, they often end up getting arrested again for drug-related crimes.”  How can we ignore the use of any medication that promises to help?

If an offender who has been receiving treatment for an opioid problem in the community that employs an approved opioid agonist medication (methadone or buprenorphine) it is important that they continue to their medication for two reasons:

•    First - There have been successful legal challenges by inmates whose prescribed medications were not provided. If the medications are part of a physician-prescribed treatment for a diagnosed medical condition (an opioid use disorder or OUD is such a condition).  Most of the court decisions in these cases have affirmed that if there is no evidence that the inmate was abusing these medications or illicitly using other drugs, then correctional facilities must provide these drug or comparable drugs. This would be true for an inmate that was receiving insulin for a diabetic condition prior to incarceration; the courts and other authorities are increasingly viewing addiction as a similar health care issue.  You can find more information about related legal challenges in the resource section of the MAT Training http://www.rsat-tta.com/Files/Trainings/FinalMAT

•    Second – People who are in recovery from addiction to opioid drug and who are recovering long-term maintenance therapy that employs an approved opioid agonist medication (often referred to as opioid replacement therapy or ORT) go through significant withdrawal symptoms when these medications are abruptly discontinued.  In community-based treatment, these meds are usually reduced gradually over a period of months when a patient has successfully completed a significant period on maintenance and is ready to discontinue meds. Studies have shown that inmates who are forced to withdraw from these medications abruptly report that the withdrawal was longer and more difficult than any they experienced when using heroin and other opioids. The majority who have this experience say they will not seek treatment again once they are released and that they would rather withdraw from heroin in prison or jail. This could be very counterproductive to treatment and rehabilitation efforts upon re-entry.

Also, offenders who are not receiving medications in the community, prior to incarceration, and who initiate medication-assisted treatment in a jail or prison based program, tend to show up for continuing care after they are released at a much higher rate. 

MAT is now the standard of care for OUD’s.  What we now know is that prolonged opioid use can permanently change a person’s ability to generate feelings of well-being and can have long term effects on their response to pain.  We also know that chronic pain and opioid dependency often co-occur and may be related in many complex ways.  An offender who is opioid –free for many months while in custody, may still remain unable to produce normal levels of brain chemicals.  This could put that individual at risk for relapse into addiction upon release, despite a sincere level of motivation to remain clean.

~Niki

A prosecutor in my state has raised the alarm that inmates are leaving prison drug free and then obtaining prescriptions for Suboxone so that they can continue to receive this medication while on subsequent community supervision.   Not sure if this is a good or bad thing. Perhaps the Suboxone will stop them from returning to heroin.  Perhaps if Vivitrol were available to them leaving jail, they would not seek Suboxone.  Unfortunately, our prisons and jails are not providing inmates with Vivitrol.

~Concerned New Hampshire Official

New Hampshire is way behind its neighbors, Vermont and Massachusetts that offer MAT for inmates leaving jails and state prisons as well as defendants in many of their drug courts. NH has only one drug court the offers MAT and no correctional facilities. Rhode Island and Connecticut prisons also offer MAT. Maine appears to be the only other state in the region way behind the curve. Given the high death rate across New England for opioid overdoses, the reluctance or inability of correctional officials in Maine and New Hampshire to join their colleagues across the region in offering addicts MAT is telling. There is no excuse. - Concerned Correctional Drug Counselor