Providing addiction treatment in prisons is the right thing to do

TThe overdose crisis is claiming lives in the United States, but reaching new depths of despair in the criminal justice system. Overdose is the main cause of death among people returning to their communities after serving time in jail or prison. Providing addiction care in these settings could change that.

About 60% of people in prison have a substance use disorder, in many cases an opioid use disorder. When people with addiction leave prison and return to their communities, they are at very high risk of returning to drug use and overdose. Their tolerance for drugs has decreased during their captivity, and fentanyl is ubiquitous in the street drug supply. Even one relapse can be fatal.

It remains a common belief that simply keeping someone from using drugs while in prison is an effective treatment approach. But that belief is inaccurate and dangerous. As scientists, we look to research to guide us. And if research shows that there are strategies with clear benefits, they should be deployed.

The Food and Drug Administration has approved three medications for opioid use: methadone, buprenorphine and naltrexone. All three are effective, safe and life-saving. But they are woefully underused, especially in criminal justice.

a 2020 study in Rhode Island, it was estimated that overdose deaths in the state could be reduced by 30% if jails and prisons made all three drugs available to those who needed them. Research also shows that people who receive these medications while in prison do so less likely to return to substance use and more likely too continue treatment in the community afterwards.

Less than half of the prisons rural, and less than 10% of state prisons, offer all three medications. While 96% of prisons provided the anti-overdose drug naloxone to staff, only 1 in 3 provided naloxone and training on how to use it with incarcerated citizens during the critical period of return to their communities.

Failure to provide access to these life-saving treatments and harm reduction measures creates deadly gaps for people when they leave prison. Its consequences reverberate across communities and generations. They increase racial inequality and the overrepresentation of communities of color within the criminal justice system. They cause havoc for children And families.

Providing medications for opioid use disorder in prisons benefits public health and public safety. Are cost–effective. It can help break the cycle of recidivism. It can reduce pressure on the wider healthcare system, including emergency care.

Programs are underway across the country to provide naloxone and medications for opioid use disorder in jails and prisons, combined with instruction, training and social support. Federal agencies have launched programs to help people managing prison withdrawals and provide financial healthcare support to people about to re-enter the community. A recently published one revised methadone rule now allows any jail or prison registered as a hospital or clinic to provide opioid use disorder medications under certain circumstances.

Law enforcement leaders are beginning to recognize how addiction treatment increases safety for everyone. Chris Donelan, the sheriff of Franklin County, Massachusetts, is cooperating with investigators study what happens when prisons offer all three FDA-approved opioid use disorder medications. His prison became one of only a few in the country to be licensed as an opioid treatment program.

“When someone is booked with us, we are often the first practitioner the person has seen in years,” Donelan told his research partners at the University of Massachusetts. “These treatments save lives and help people recover. Treatment makes the work of our institution much easier. We have less fighting, less contraband and a much safer facility.”

As of 2019, the National Institutes of Health has done so funded partnerships across the country to find out how to connect people with addiction to care during and after their stay in the corrections system. These researchers stand ready to share new evidence as it emerges that will help other communities do so data-driven changes so that they can implement what is most efficient in judicial contexts.

There is still a long way to go. A dangerous supply of street drugs, fragmented treatment systems, lack of funding, lack of training, pervasive stigma and complex logistics all work against people with substance use disorders as they work to rebuild their lives after incarceration. Support for recovery and continuity of care are essential during this vulnerable time.

Fundamentally, the best or only opportunity for an individual to receive addiction treatment should not be while incarcerated. In an ideal world, treatment and prevention systems in the U.S. would proactively address social determinants of health care and mental health needs to break the cycle between addiction and incarceration. Away from criminalization of substance use disorders toward a public health approach would eliminate a key structural practice that perpetuates inequality. It would improve the lives of people and their families.

Nora D. Volkow, MD, is a psychiatrist, scientist, and director of the National Institute on Drug Abuse, part of the National Institutes of Health. Tisha Wiley, Ph.D., is a social psychologist, associate director for justice systems at NIDA, and leads the NIH Justice Community Opioid Innovation Network initiative, which studies approaches to improve quality care for people in correctional settings with opioid abuse or disorder in the use of opioids.