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
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