Why all Correctional Facilities should provide the option for medication-assisted treatment
By CHHS Extern Nicole Kulaga
Medication-assisted treatment (MAT) is defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as programs that provide behavioral therapy and medications to patients with substance abuse disorders. MAT programs treat opioid use disorder with either methadone, naltrexone, or buprenorphine. Implementing these programs into correctional facilities will reduce relapses, prevent overdoses, and consequently, could help reduce drug-related crimes.
A study conducted in Massachusetts found that the “opioid-related overdose death rate is 120 times higher for people who are released from Massachusetts prisons and jails.” This is because while incarcerated, inmates who do not receive MAT and instead abstain from drug use, will become less tolerant to the drug. Once released, former inmates may return to the drug, use the same dosage, and due to their lower tolerance, and overdose on that drug. What MAT does for inmates is replace the dangerous drug “’with a drug that allows you to go back to work and have money in your pocket and allow you to live normally again,’ said Dr. Stuart Gitlow.’” While incarcerated, those who receive MAT may be prescribed:
“opiates that activate the same receptors but are absorbed into the blood over a longer period of time — staving off withdrawal symptoms and breaking a psychological link between taking a drug and immediately feeling high. Doctors can also give someone an opioid antagonist — a non-opioid drug that sits on those same receptors and blocks them — so that if someone relapses, he or she won’t feel anything.”
These treatments have proven to be successful in places such as Baltimore, Maryland. A study found that “increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths.” The implementation of MAT in correctional facilities specifically has been successful in reducing the number of fatal overdoses post-release. Rhode Island created a state-led initiative which demonstrated that “offering medication to inmates with opioid use disorders reduced fatal overdoses once the inmates were released.” In the first six months of 2017, “only nine of 157 fatal overdoses(5.7 percent) in the state occurred among recently released inmates, compared to 14.5 percent of overdose deaths in the first six months of 2016, representing a 60.5 percent reduction in mortality.”
Those who receive treatment and continue their treatment post-incarceration, are less likely to return to their former drug usage because the medication they receive reduces cravings. Further, an estimated 39% of state prisoners said they are serving time as a result of property offenses that were committed “to get drugs or obtain money to get drugs.” An argument can be made that if the 39% receive proper treatment though MAT and continue their treatment, then they are less likely to reoffend. Therefore, the implementation of MAT may lead to a reduction in drug-related crimes.
Even while an estimated 58% of individuals in state prisons are drug dependent, there are 28 stateswho do not “fully offer any medication to prisoners with opioid use disorders.” Certain barriers are responsible for correctional facilities not providing MAT including: lack of resources, fear of the medication being illegally sold among prisoners, costs, stigma against prisoners, stigma against those addicted to drugs, and stigma against the medication itself: buprenorphine, naltrexone, and methadone. This failure to provide MAT to those who require treatment for their opioid use disorder has raised concerns on a national level.
The American Civil Liberties Union (ACLU) has recently filed a lawsuit against the County Sherriff’s Office in Washington State alleging that “refusal to provide the medicine violates the Americans with Disability Act, because opioid addiction qualifies as a disability under the law. Prisoners suffering from opioid addiction are as entitled to medication as those with any other condition requiring medical treatment.” Further, the US Department of Justice (DOJ) is “investigating whether Massachusetts prison officials are violating the Americans with Disabilities Act by forcing incoming inmates who had been taking medications for addiction to stop the drugs once behind bars.”
The push for MAT in correctional facilities is justified in the amount of lives that will be saved, crime that may be reduced, and overall harm that may be reduced. However, if the lawsuit in Washington or the investigation by the DOJ prove that denial of MAT in correctional facilities is a violation of the ADA, the need to implement these programs will become not just a moral issue, but a legal issue.