Treatment in prison would curb overdoses
Medication-assisted program could help inmates beat their addictions and be more successful upon release
If there is one point on which U.S. policy experts, public health officials, law enforcement groups and politicians can all agree, it is this: Increased funding for drug treatment is needed to address the opioid epidemic. This consensus stems from the realization that incarceration, the weapon of choice in past drug wars, will not abate the current crisis.
And yet we continue to lock up a lot of people — more than 400,000 in 2015 — for drug offenses alone. Another sizable portion of the incarcerated population is serving time for offenses directly related to their drug use. An estimated 65 percent of inmates have a substance use disorder, yet only 11 percent receive treatment.
Access to treatment is woefully lacking across the United States, but incarcerated individuals have even fewer options. Medication-assisted treatment is the gold standard of care for opioid use disorder, but 28 states do not offer access to any of the three treatments to their incarcerated populations, and 16 states provide access to only one — naltrexone.
By not providing inmates access to effective drug treatment, the criminal justice system perpetuates a high-risk cycle of relapse and recidivism. After serving months or years behind bars, former inmates are typically sent back to environments where drugs are readily available. They may feel a strong urge to use opioids, and with a reduced tolerance following their incarceration, are at serious risk of overdosing, particularly in the first two weeks post-release. Those who do not overdose may still fall back into old habits; lacking critical social support services they are unlikely to seek out the treatment they need on their own. Relapse increases the likelihood that these individuals will be rearrested for drug possession or a drug-related offense and sent back to jail or prison.
Denying or limiting MAT to people in jails and prisons results in a missed opportunity to connect these individuals with much-needed services. Multiple studies have shown that providing MAT to inmates can significantly reduce their risk of overdose upon release, increase the likelihood that they will continue treatment post-incarceration, reduce the risk of recidivism and lower their health care costs.
Corrections officials are beginning to recognize the importance of providing MAT. The Harris County Sheriff ’s Office has launched a pilot program offering Vivitrol, an injectable, extended-release form of naltrexone, to eligible inmates before they leave jail. Vivitrol blocks the euphoric effects a person would ordinarily get from consuming opioids and can effectively help people abstain from opioid use. But it will not necessarily work for all inmates, and at $1,000 per month it is also quite expensive. (Alkermes Pharmaceutical, the makers of Vivitrol, is providing funding for the Harris County pilot.)
Best practices recommend that people addicted to opioids have the option of treatment with any of the three federally approved MATs. Methadone and buprenorphine satisfy a person’s physical cravings for opioids without providing the same euphoric effects. Though less popular among law enforcement because they are not abstinence-based treatments, methadone and buprenorphine have a longer record of efficacy than Vivitrol and cost much less. Rhode Island recently became the first state to make all three MATs available to inmates and has already seen a reduction in post-incarceration overdose deaths.
Expanding MAT access to people in prisons and jails can make a dent in the opioid epidemic by connecting one of the most vulnerable populations to muchneeded treatment services and lowering their risk of overdose death.
U.S. Rep. John Culberson, a Republican representing Harris County and Texas’ 7th Congressional District, plays a critical role in ensuring that Harris County and communities across Texas can employ this important tool for addressing the opioid epidemic. As chair of the House Appropriations subcommittee that deals with criminal justice funding, Culberson can decide whether federal dollars are approved to increase MAT funding in the federal prison system and to fund grants for states to expand MAT access in jails and re-entry programs.
Some people may object to their tax dollars being spent on treatment for people who have committed crimes. But taxpayers already foot the bill for the arrest, prosecution and incarceration of this population. When released, with their addictions left untreated, these individuals are likely to cost taxpayers more money through utilization of high-cost services such as emergency medical care. Investing in MAT can lower the costs associated with this population by reducing the likelihood that they will engage in high-risk behavior once released.
In the past, Culberson has demonstrated that he understands the value of pragmatic criminal justice reforms. Now, by providing funding for MAT for incarcerated inmates, he again has the opportunity to support a criminal justice initiative that is both compassionate and fiscally responsible.