This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.
NEW YORK — For Dr. Ross Macdonald, every person who enters New York City’s main jail with an opioid addiction represents an opportunity for treatment, and the possibility of saving a life.
As the medical director of the city’s correctional health program, he ensures that offenders who come in on methadone continue to receive it. And he and his staff try to persuade as many addicted inmates as possible to get started on methadone before they leave the jail.
Rikers Island Correctional Facility has run a model opioid treatment program since 1987, and it has assisted tens of thousands of inmates in maintaining treatment after they return to their communities. Medical researchers have repeatedly found that the jail’s methadone treatment program has resulted in overall health care cost savings, reduced crime and recidivism, reduced HIV and hepatitis C transmission, and better than average rates of recovery from drug use.
But despite Rikers’ well documented success, few U.S. jails and prisons have emulated the program.
The vast majority of correctional facilities reject the use of methadone, used for addiction treatment since 1964 and approved by the U.S. Food and Drug Administration for addiction treatment in 1972, as well as a newer anti-addiction drug called buprenorphine, approved in 2002. That’s despite a history of researchshowing both medicines are highly effective at keeping people in recovery from opioid addiction with few side effects. Ironically, the subjects of the first major study of methadone’s effectiveness were federal prisoners.
Two-thirds of the nation’s 2.3 million inmates are addicted to drugs or alcohol, compared to 9 percent in the general population, according to a study by the National Center on Addiction and Substance Abuse at Columbia University.
From Macdonald’s perspective, prisons and jails are the perfect place to start addiction treatment. In the general population, only 11 percent of people with a substance use disorder seek treatment at a specialty facility. Opioid addicts who commit crimes to pay for their habit are no different. But once they show up at Rikers, they are cut off from their usual supply and it can be easier to persuade them to get treatment.
Few corrections officials see things the same way. The problem, many say, is that both medications are themselves narcotics, something the criminal justice system works hard to keep out of its facilities. As with any controlled substance, corrections officials are wary of methadone and buprenorphine being diverted to other inmates who are not in drug treatment or leaking out of the prison to illicit drug markets.
There’s another reason for their resistance: a common belief — among the public, as well as treatment providers and criminal justice officials — that methadone merely substitutes one addiction for another and is not a true tool of recovery.
But now that the opioid overdose epidemic, which killed more than 28,000 people in 2014, has become a top political priority, a few correctional authorities are rethinking long-held biases against the oldest and most widely researched anti-addiction medication.
Connecticut tested methadone treatment programs at jails in New Haven and Bridgeport, and is looking to expand them to jails statewide. Rhode Island already offers the other two federally approved addiction medications, methadone and buprenorphine, at its prisons. And it is poised to add Vivitrol, which was federallyapproved in 2010, this year. Vermont plans to expand a limited correctional methadone program it started 10 years ago.
The Standard of Care
Here in New York, where methadone was first researched at The Rockefeller Institute for Medical Research in the 1960s and methadone clinics are more plentiful than Broadway theaters, use of the drug in the city’s jails has never been controversial.
“It’s the standard of care in the community, so why would it not be in a jail setting where the problem of addiction affects a huge percentage of our patients?” Macdonald said.
At Rikers, 75 percent of people who enter the jail are addicted to drugs, with 20 percent addicted to heroin or painkillers. For those who aren’t already on anti-addiction medications when they arrive, the jail’s addiction treatment team offers all three available medications and counseling. Most choose methadone.
But for the vast majority of the nation’s more than 5,000 prisons and jails, use of the relatively cheap medication is a nonstarter. Methadone is offered in correctional institutions in only a few other urban centers, such as Baltimore, Chicago, Philadelphia, San Francisco and Washington, D.C., that have battled heroin addiction for decades, as well as in a handful of smaller jurisdictions.
In all, fewer than 40 correctional facilities are offering methadone to inmates for addiction treatment, according to data from the U.S. Substance Abuse and Mental Health Services Administration and Stateline interviews with addiction and corrections experts. Even fewer facilities are administering buprenorphine, which like methadone blocks the brain’s cravings for drugs and eliminates withdrawal symptoms.
Jails and prisons routinely force inmates who come in on addiction medications to withdraw from them abruptly and remain abstinent while behind bars. Abrupt withdrawal, without tapering off methadone over a period of weeks, is considered inhumane and has resulted in numerous deaths inside prisons and jails. Symptoms include vomiting, diarrhea and insomnia.
Abstinence from all opioids during confinement has also resulted in thousands of overdose deaths when inmates are released. They return to either heroin or prescription drug use after losing their tolerance to the powerful drugs. All three addiction medications protect inmates from overdosing as long as they continue to take them.
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