To put a dent in opioid addiction, start with the corrections system

Incarcerated individuals have the hardest time receiving medication for treatment even though they are often the most vulnerable to opioid use disorders. 

People entering the corrections system, for instance, can have untreated opioid addictions that trigger a fatal opioid withdrawal. In fact, “a quarter of the people that die a drug-related or alcohol-related death in jails die in the first 24 hours,” said Shelly Weizman, associate director of the Addiction and Public Policy Initiative at the O'Neill Institute for National and Global Health Law, a health policy think tank at the Georgetown University Law Center. 

Plus, a study found that individuals leaving a prison were up to 40 times more likely to die of an opioid overdose within the first two weeks after leaving detention compared with the general population. That’s primarily because they lose their tolerance to opioid substances during their incarceration, leaving them more likely to overdose if they take drugs upon their release. 

If state and local governments want to have an impact on the opioid epidemic, which killed more than 100,000 people in 2022, correctional facilities are a good place to start.

“The criminal justice system offers a lot of individuals who benefit from treatment medication for opioid use disorder,” said Justin Berk, director of the Center for Health and Justice Transformation, a research and advocacy organization formed by Brown University and Lifespan. 

Increasing access to medications for opioid use disorders, or MOUD, must be part of the solution, Berk said.

The three medications federally approved to treat opioid use disorders—buprenorphine, methadone and naltrexone—can reduce disease transmission among users and can encourage them to remain in treatment, further minimizing additional risks associated with substance use disorders like dying of an overdose. The medications are prescribed both separately or in combination, depending on a patient’s needs.

And while the federal Department of Justice deemed it a violation of the Americans with Disabilities Act to deny incarcerated individuals medical treatment for their opioid addiction, many correctional systems restrict who is eligible to receive MOUD, limiting access to pregnant women or individuals with distant release dates. 

In Washington state, for example, the Department of Corrections can only administer MOUD to individuals who will be released within 90 days, who have violated parole or who were already on addiction medication when brought to prison with a sentence shorter than six months. The rule is designed to stabilize users as they transition in and out of corrections facilities, but it provides only a temporary solution to a long-term addiction. It stems from the guidelines of a past pilot program, and is a policy observed in many other states with MOUD programs, Weizman said. 

Another barrier to effective treatment is the fact most correctional systems providing MOUD don’t offer all three federally approved medications for addiction treatment. 

This could be due to stigma against drug abuse carrying over to the addiction medications, Berk said. Plus, buprenorphine can induce a “mild buzz” for users, and many jail and prison officials view that response as recreational drug use, he said. However, the actual purpose of the medication is to lessen the user’s cravings and withdrawal symptoms. 

With more education, correctional officials could better understand the need for increasing access to addiction medications, he said.

But scaling up MOUD programs is not possible without more funding, said Catherine Smith, director of addiction medicine at Washington’s Department of Corrections in an email to Route Fifty. “Until we have more legislative funding to expand our current staffing model, we are not able to expand our treatment services in the way we would like.”

Additional funding to support more comprehensive MOUD programs could help “reduce in-prison overdose, contraband, behavioral issues and alleviate the suffering of many,” she said. 

State governments are in the early stages of reversing those restrictions, Weizman said, as there’s momentum building across the country to increase MOUD access across the corrections system. 

In 2022, for instance, New York passed a bill to require state prisons and local jails to offer all three forms of MOUD to individuals being treated for substance use disorders, regardless of prior treatment status. The same year in Colorado, Gov. Jared Polis signed a bill that required public and private jail facilities by July 2023 to allow incarcerated individuals and their health care professionals to choose which of the three federally approved medications they would like to take.  

These changes are "being fueled, I think, by the threat of litigation and enforcement action by the [federal] Department of Justice but also by the recognition that [MOUD] saves lives and it saves money,” Weizman said. 

Take Rhode Island, the first state to offer all three forms of MOUD for all incarcerated individuals following a 2016 pilot program. Data shows that after program implementation, there was a 61% decrease in post-release overdose deaths and a 12% dip in statewide overdose deaths overall. 

“Patients often have a preference for one medication over another. One is not better than the other, but the one that a patient is willing to take will obviously have the best compliance rates and positive results,” said J.R. Ventura, chief of information and public relations officer at the Rhode Island Department of Corrections in an email to Route Fifty. “To save lives, we need to use what works for the patient.”

“The research is clear that, out of all the different types of treatment for people with opioid use disorder, only treatment with methadone or buprenorphine prevents overdose,” Weizman said. “Counseling and therapy can be helpful for many people on their recovery journey, but the research shows that this isn’t what prevents overdose.” 

That’s why jail and prison officials should “prioritize the intake process using evidence-based screening, assessment and treatment right away.” 

In Kentucky, for example, the Big Sandy Regional Detention Center decided to alter its intake process late last year. Now individuals entering incarceration for the first time who need treatment can be identified by screeners who can initiate treatment—rather than only issuing medication to new inmates who have already been on MOUD or another treatment course. 

Policy decisions about substance abuse treatment for individuals in state or local government custody sit at a nexus of the law, health care, corrections and social services. But when developing and implementing MOUD programs, government officials should always consult with individuals who have experienced substance use disorders to learn what they think will help with treatment and recovery, Weizman said. 

“Make sure their perspective is incorporated into policymaking decisions and implementation at every stage … and to keep that feedback loop open around what’s working and what’s not working,” she said. 

However, solutions will not be one and done. MOUD programs should be nimble enough to adapt as the drug crisis continues, she said. “This is a dynamic problem. It needs dynamic solutions.”