Forums

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