Thomas J. Rachko, Jr., MPA Staff Writer, Brief Policy Perspectives

In 2017, more than 72,000 people in the United States died from drug overdoses. This alarming statistic represents a record high in annual overdose deaths and a roughly 20 percent increase from 2016, with nearly 200 people dying from drug overdoses each day. Over half of drug overdose deaths last year were caused by opioids, according to data released by the Center for Disease Control and Prevention. Nearly one in three Americans know someone addicted to opioids; this health crisis ravages families and communities across the country as fatal overdoses take the lives of veterans, retired athletes, celebrities, and senior citizens. This crisis also affects incarcerated and formerly incarcerated people.

Rates of drug overdose, including opioid overdose, are high among the incarcerated and formerly incarcerated. A study published in the New England Journal of Medicine found that incarcerated persons released from the Washington State Department of Corrections between July 1999 and December 2003 were 129 times more likely to die from a drug overdose within the first two weeks of their release than the general state population. Another analysis conducted by the Justice Department Bureau of Justice Statistics determined over half of state prisoners and sentenced jail inmates met the criteria for drug dependence or abuse for three consecutive years from 2007 to 2009. In September 2018, research published in the American Journal of Public Health found that among formerly incarcerated people opioid overdose death risk was 40 times higher than general North Carolina residents.

As the nation wrestles with policy solutions to alleviate the opioid overdose epidemic, policymakers cannot afford to forget the health and safety of incarcerated and formerly incarcerated persons. State and local governments could play a crucial role in addressing this epidemic by providing access to, funding, and maintaining medication-assisted treatment programs in jails and prisons as a part of more comprehensive reentry services.

What is Medication-Assisted Treatment?

Medication-assisted treatment, or MAT, is defined by the U.S. Department of Health and Services as, “the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders.” There are three medications commonly used to treat opioid addiction: methadone, naltrexone, and buprenorphine. These drugs are FDA-approved medicines that treat opioid dependence and addiction. The Substance Abuse and Mental Health Services Administration acknowledges MAT’s effectiveness and The World Health Organization has designated methadone and buprenorphine as “essential medicines.”

Doctors widely consider MAT the standard of care for opioid use disorder. Earlier this year, the American Society of Addiction Medicine and the American Correctional Association issued a joint statement expressing support for the use of medications in jails and prisons. Unfortunately, due in part to misinformation about MAT, these medications are not widely used and most states have insufficient capacity to provide MAT to every patient with an opioid use disorder.

Rhode Island Demonstrates a Model of Better Care

Currently, only one state in the U.S. provides the full-suite of MAT in jails and prisons: Rhode Island. The Rhode Island Department of Corrections (RIDOC) launched the nation’s first comprehensive MAT program in 2016, providing individuals coming into or leaving the correctional system access to all three MAT medications. In April 2018, the Journal of the American Medical Association published a study evaluating the effectiveness Rhode Island’s MAT program. It found that the state saw a “large and clinically meaningful reduction in post-incarceration deaths” following implementation of the MAT model. The percentage of recently incarcerated Rhode Islanders (within 12 months of release from RIDOC) who died from an overdose decreased to 5.7 percent during a 6-month period in 2017 down from 14.5 percent in the same period of 2016. Although the study admittedly has a small sample size, Rhode Island’s MAT model shows promise as an example of the vital role correctional institutions can play when it comes to community health and opioid use disorder.

Improving Public Health by Providing Medication-Assisted Treatment to Incarcerated People

Incarcerated persons have rights to medical and mental health care while in custody. In September, the ACLU filed a lawsuit that “challenges the policy and practice of denying MAT to incarcerated people who are diagnosed with opioid use disorder.” The non-profit organization argues that denying incarcerated individuals adequate medical care and MAT during incarceration violates the Eighth Amendment of the U.S. Constitution and constitutes cruel and unusual punishment. Abstinence and forced withdrawal only contribute to further punishment for incarcerated individuals. Instead of denying MAT to incarcerated peoples, jails and prisons can help to save lives. The U.S. can take a public health and safety approach towards opioid use disorder that includes equitable access for all justice-involved individuals. States across the nation should follow Rhode Island and make MAT a part of the rehabilitation process.