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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.