Treat­ment in prison would curb over­doses

Med­i­ca­tion-as­sisted pro­gram could help in­mates beat their ad­dic­tions and be more suc­cess­ful upon re­lease

Houston Chronicle - - OUTLOOK - By Katharine Neill Har­ris Neill Har­ris is the Al­fred C. Glas­sell III fel­low in drug pol­icy at Rice Univer­sity’s Baker In­sti­tute for Public Pol­icy.

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.

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