Prison: the forgotten front in the battle against the opioid epidemic

Multiple leaders across the nation, including Maryland Gov. Larry Hogan and even President Donald Trump, have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails.

Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely to die from overdose than members of the general population.

This is despite the fact that we have robust evidence showing that we can decrease the incidence of relapse, overdose, drug-related health complications like HIV transmission, criminal activity after release and recidivism by offering treatment. And unequivocal data highlights that medication-assisted therapy — that is, treatment with methadone or suboxone — in prisons saves lives.

A study published recently in the journal Addiction showed that offering medication-assisted treatment in prisons reduced drug-related overdose deaths by 85 percent in the four-week period following prisoner release and reduced mortality from all causes by 75 percent over the same period. Few other medical interventions have demonstrated such success.

Unfortunately, however, the majority of correctional facilities in the United States do not offer programs for people addicted to opioids. Out of the 3,200 U.S. jails, only 23 provide maintenance therapy to inmates. And out of the 50 state prison systems, only four offer such treatment. This means that people who are fortunate enough to be part of a treatment program before their incarceration are, upon their entrance to a jail or prison, often taken off their medications and forced to endure cruel, painful and dangerous periods of withdrawal.

This is not a problem of resources. Many incarcerated patients currently receive appropriate care for other chronic conditions, including diabetes, HIV, cancer and even more newly recognized conditions, like gender dysphoria. Our federal and state corrections systems have the capacity to offer this treatment — a treatment defined as “essential medicine” by the World Health Organization. Anne Arundel's Road to Recovery program and other correctional facility programs (Riker's jail in New York, the prison system of Rhode Island and Vermont) demonstrate that success with medication-assisted therapy is possible.

The inability to access medical treatment with such established benefits is an unacceptable violation of prisoners’ constitutional right to basic health care. But this is not just an issue of rights, and this is not just about prisoners. This is a critical public health issue, and the benefits of the therapies we can offer to people with opioid addiction who are currently incarcerated reach far beyond those individuals. Our communities benefit too when we help those suffering from addiction get the care they need to survive and live healthy lives.

Skeptics will argue against such treatment by asserting that it is too expensive, or that it will be “diverted” and used inappropriately, or that the people with addictions who end up incarcerated should have taken more personal responsibility. But these interventions have been shown to be cost-effective. Diversion can be minimized, while treatment could actually improve security. And moralizing arguments against a well-recognized psychiatric disorder are antiquated, demonstrating poor knowledge of evidencebased treatment, if not also little compassion for a vulnerable population.

As a primary care physician who has worked with formerly incarcerated patients, I have seen first-hand that suboxone allows many people to concentrate on their lives instead of their addictions upon their release from jail or prison. And if we want to save lives on the streets, we cannot send people out of prisons untreated and abandon them when they are the most vulnerable to overdose. If we’re serious about addressing the opioid epidemic, we have to pay attention to the evidence demonstrating that opioid treatment in jails and prisons is highly effective, and we must act by quickly expanding such treatment to many more facilities around the country.

Current programs offering in-facility treatment should guide the nation, serving as examples of how we can provide vulnerable, disenfranchised people with the care they deserve as fellow humans and members of our society. If we claim, whether as a community, a state or a nation, to be fighting the opioid crisis on all fronts, let us not forget one that offers undeniable evidence of a way to save lives.