The Need for Methadone Maintenance in Jail

Implications of Inadequate Methadone Treatment Policy in Jails

The United States currently has the largest prison population in the world. As a result of “tough on crime” laws enacted in the 1980s, substantial portions of the U.S. population have entered the criminal justice system, and many of these are nonviolent drug offenders. Our society has an important stake in the outcome of incarceration and the rehabilitation of these individuals. Most incarcerated people will re-enter society at some point and it is imperative that we assess the efficacy of our criminal justice policies.

Methadone Maintenance Treatment and Jails

Methadone, an opioid replacement medication, has long been used to stabilize opiate-dependent individuals. Instead of spending time chasing down drugs and possibly engaging in criminal behavior, patients undergoing methadone maintenance treatment receive a safe daily dose of methadone tailored to their level of dependence. When properly utilized, methadone maintenance therapy enables patients to engage in other therapies and live life more normally.

But what happens if such a patient has a run-in with the law? A recent study in Rhode Island revealed some important information regarding methadone maintenance therapy and incarceration. The results of the study have important implications for U.S. policy and for our society at large.

According to Professor Josiah D. Rich, M.D., ninety percent of patients undergoing methadone maintenance therapy are forced into immediate withdrawal upon incarceration. This abrupt treatment cessation has serious consequences, starting with a difficult, and sometimes painful, florid opioid withdrawal.

While on methadone, patients maintain a stable level of opiate tolerance. During incarceration, this tolerance diminishes greatly without access to methadone. Decreased tolerance to opioids leads to a high risk of overdose death upon release. Meaning, when these individuals regain freedom, returning to a customary dose of drugs can prove fatal. Periods after incarceration can represent the highest potential for death in an opioid-dependent person’s disease trajectory.

The Rhode Island study also found that methadone cessation in jail resulted in substantial disruptions in treatment upon release. Almost half of the individuals unable to receive methadone treatment in jail did not return to methadone treatments upon release. Of those receiving methadone in jail, almost all continued their treatment upon release.

What To Do?

The current healthcare paradigm in jails and prisons in the United States needs revision. Unlike the free world, there is no holistic oversight of healthcare behind bars. In the case of methadone, individuals entering the criminal justice system are being removed from legitimate pharmacological therapy.

This is a serious public health issue: inconsistencies and inadequacies in jailhouse healthcare lead to perpetuation of crime, drug use, and transmission of infectious disease. This recent study provides evidence that in-jail methadone treatment greatly improves the likelihood that patients will remain in therapy post-release. Such individuals are less likely to die of overdose, engage in criminal behavior, and contract HIV, Hepatitis C, and other blood-borne illnesses.

Policies supporting the use of methadone maintenance therapy in jails and prisons should be advocated. Additionally, institutions can mitigate harms by educating inmates prior to release. Inmates and their families should be informed about the risks of overdose death, issues of drug tolerance, and how to intervene if an overdose occurs.

Recovery Services of New Mexico solely developed, and has successfully executed for over 5 years, the State's first and only methadone maintenance program inside a correctional facility. For Bernalillo County Metropolitan Detention Center, inmates who enter while enrolled in community methadone treatment will continue to receive treatment while they are incarcerated. We believe strongly in this program, fought hard for its existence, and will work to provide the ongoing efficacious treatment. Please see our webpage HERE to read about our program and the University of New Mexico study proving its effectiveness.

Reference: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62338-2/fulltext

Prescription Drug Abuse Among Elders is a Growing Concern

An Issue on the Rise

When people think about “drug abuse,” their mind usually conjures images of young people partying, working adults juggling addiction and their career, or those involved in criminal behavior. While it is true that illicit street drug use is more prevalent in younger individuals, prescription drug abuse, misuse, and dependency within the elderly population is a growing concern.

As of 2012, individuals aged 65 and older represented approximately 13% of the total US population. However, this same group accounted for 33% of all prescription medications prescribed. This is natural, considering the many illnesses that often accompany advanced age. However, polypharmacy is associated dosing mix-ups, greater risk of dependency, and potential abuse. Furthermore, decreased liver function, memory deficits, and mental illness also potentially contribute to these prescription drug problems. Elderly individuals require close monitoring to ensure their medications are appropriate and that dosing instructions are being followed.

Many different behaviors can constitute prescription drug abuse. An individual might take more medication than required, take their medication at improper times, or mix their medications with alcohol or other drugs. Some classes of drugs which carry an increased abuse potential include anti-anxiety medications, pain medications, and sleep aid medications. Many of these medications may produce feelings of euphoria, a side effect that can initiate or potentiate misuse.

Changing Demographics

The elderly population is expected to increase dramatically as the “baby boomer” generation ages, and corresponding increases in prescription drug abuse are anticipated. While many have commented that the "World War II generation" generally avoids taking medications, this trend does not necessarily hold true for their offspring. The baby boomer generation is somewhat characterized by a different set of values and cultural norms than their parents. Illicit drug use was ubiquitous during part of this generation's formative years in the 1960s & 1970's, and baby boomers are generally more willing to take substances.

Practical Issues

Well-meaning friends and family members represent one common means of inappropriately obtaining prescription drugs. Many of our medicine cabinets contain unused pain medication and other prescriptions. It may seem harmless, even altruistic, to share medicine with a suffering friend or family member. However, this practice is very dangerous; prescriptions are tailored to suit individual need, and one's prescribed medication could be life threatening to another person. Moreover, sharing prescription medications is prohibited under federal and state law.

Managing pain and illness in the elderly population can be a tough balancing act. Many prescription drugs have a high potential for abuse and medication misuse is a growing trend. Although we should avoid baseless paranoia and suspicion of our loved ones, a few behaviors represent red flags for prescription abuse:

• Using multiple doctors and/or pharmacies for the same medication
• Taking more medication than required or more often than required
• Abrupt mood changes
• Frequently talking about a medicine
• Reacting in a defensive manner when asked about medicines
• Hording or stockpiling medicines
• Hiding medicines

If you or someone you love is misusing medications, please reach out to find a treatment center or addiction professional in your area. Recovery Services of New Mexico is committed to addressing this troubling trend and is available for treatment or referral. 

New Mexico Study Highlights Rising Opioid Use, Need for Changes

 

Opioid drugs represent the second most prevalent type abused nationally. These substances possess significant pain relieving properties and often cause euphoria. Physical and psychological dependence on these substances is a well-established risk and the misery of opioid withdrawal has become part of our collective consciousness.

In response to suspected rises in opioid use, the City of Albuquerque recently commissioned researchers to assess local trends in drug use and treatment. The results are in: opioid use is increasing – both in adults and youth. This rise in opioid use also means an unfortunate rise in corresponding overdose deaths, joblessness, family problems, and crime. In this article we’ll explore the current state of affairs and recommendations for the future.

A Deadly Habit

Opioid drug abuse poses great risk to the user due to the possibility of fatal respiratory depression (reduced breathing) at high doses. At double the national rate, New Mexico holds the inauspicious top rank for drug overdose deaths by an enormous margin. Heroin and prescription opioids account for almost three quarters of these deaths.

 

Younger individuals in our community have increasingly high rates of opioid use and youth represent the fastest-growing sector of the opioid-using population. In 2001, New Mexican high school students were more likely to have used heroin compared to students in other states. Bernalillo County statistics reveal that from 2002 – 2004, people between ages 18 and 25 had much higher rates of prescription painkiller abuse than older age segments. As a proportion of statewide heroin-related overdoses, deaths in the youth increased more than fivefold since 2004.

One interview respondent stated that “We are sitting on a new epidemic of young people. They start out with pills and then switch to heroin, and it is a struggle to get them into therapy.” It is common for users to begin with prescription painkillers and then transition to using heroin because heroin is cheaper and widely available.

Good Help is Hard to Find

The study also indicates that the New Mexico substance abuse treatment infrastructure has some serious problems. There is a severe shortage of counseling services, medical care, treatment facilities, and medication support for opioid-dependent patients. A study respondent reported that “It is a struggle to find consistent counseling, and there are no efforts to increase availability.”

Considering the alarming increases of opioid use in the youngest populations, one would hope that treatment options for young people were plentiful. However, Albuquerque currently has precious few facilities willing to accept minors and none which are equipped to handle minors undergoing opioid withdrawal.

Local treatment providers also cite a lack of education as a problem. Both treatment professionals and the community at large would benefit from increased awareness. Proliferation of information about prevention, intervention, overdose treatment, and medications available to assist drug-dependent individuals is necessary.

Taking Action

Considering the prevalence of opioid use and the lack of necessary support systems, researchers recommend some changes. Important changes fall into one of these categories:

• Curb prescription drug abuse before users move on to heroin
• Bolster prevention efforts in the youth
• Establish more treatment programs, especially those which accommodate youth
• Incentivize buprenorphine treatments and publicize information about buprenorphine treatment availability

Our Pledge
Recovery Services of New Mexico is committed to the prevention and treatment of opioid addiction in our State, as well as education and community outreach. Please check out our website to get involved! 


References

Greenfield, B. L., Owens, M. D., & Ley, D. (2014). Opioid use in Albuquerque, New Mexico: a needs assessment of recent changes and treatment availability. Addiction science & clinical practice, 9(1), 1-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070335/.

 

 

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