The Burden On America’s Prison’s: America’s Opioid Crisis:
May 15, 2019
The United States jail system has become a revolving door for those struggling with mental health and substance use disorders. Every year, roughly 10 million individuals pass through its doors, with estimates ranging from 50-90% of those individuals having some type of substance dependency problem.
With little recourse for adequate treatment, the majority of these individuals wind up continuing to use substances after their release, resulting in cyclic arrest, incarceration, and addiction rates that are slowly disintegrating communities across the nation.
Jails are in a unique position to operate on the front lines of the addiction crisis by providing effective treatment in a controlled and safe environment. With thousands of Americans dying every week from drug overdoses and those recently released from jail among the most high-risk population, a new paradigm must arise to help people get the treatment they need.
Treatment in Prison vs. Jail
After changes enacted under the Obama administration, drug laws in the United States have slowly shifted away from punitive and more towards restorative. One thing that has been getting more federal focus is federal prison drug treatment programs. According to the Federal Bureau of Prisons, drug treatment programs in prison have been effective in:
- Reducing relapse
- Reducing recidivism
- Reduce inmate misconduct
- Increase levels of education and employment upon return to the community
- Improve health and mental health symptoms and conditions
Despite the intentions of making treatment a stronger option, data still suggests that many who need treatment aren’t getting it. According to the National Survey on Drug Use and Health, as many as 1 in 13 Americans currently qualify for substance abuse treatment, or roughly 7.7%. Unfortunately, only about 1 in 8 will ever receive the kind of clinical treatment they need to get well, or 12%. Using In other words, of the roughly 20.7 million people in need of treatment for substance abuse in the United States, only 2.5 million will receive treatment, while 18.2 million will not.
“Two-thirds of people in jail meet the criteria for drug dependence or abuse.” – Bureau of Justice Statistics
That disparity in treatment only grows greater when you consider the amount of individuals in jail and prisons suffering from substance use disorders. While federal prisons have largely begun utilizing more treatment programs for incarcerated individuals, In the last several years, MAT programs in jails have only been expanded into 30 states. In some states, only a few counties utilize these programs.
The Current State of Treatment in Jails
“We are in a critical situation,” says Middlesex County Mass. Sheriff Peter Koutoujian. “We have to physically, medically detox about 40% of our population as they come off the street,” he says, “and probably about 80 to 90% of our population inside has some type of drug or alcohol dependence.”
Across the country, a growing number of jails are seeking some kind of band-aid solution for the thousands of inmates who come into jail with a severe substance use disorder. Most of these correctional institutions are unprepared to help correct something as complicated as drug addiction, but there’s little choice they have in the matter if they want to reduce recidivism rates.
As such, many jails across the nation are looking for ways to expand the use of MAT options for those behind bars, including drugs such as buprenorphine and methadone. This way, incarcerated individuals can safely detox behind bars and hopefully stay sober afterwards. However, as with MAT policies anywhere, there is controversy surrounding the correct way to implement these into a viable infrastructure.
The Complications of Treatment in Jail
For example, in some prisons that do provide medication-assisted treatment options, drugs such as buprenorphine and methadone wind up becoming hoarded, sold, and abused. In this kind of environment, it’s easy to see how recidivism becomes cyclic, putting even more strain on the correctional system as a whole.
If jails are going to perform as more effective correctional institutions, it will become more necessary to provide an adequate level of treatment for substance use disorders. Currently, only 10% to 12% of the nation’s 4,000 jails are trying some form of addiction medication as part of treatment. This number feels hopelessly inadequate given the rate of inmates struggling with substance use disorder.
Of course, more research is needed to confirm the long-term benefits of treating addiction in jail. Currently, studies have shown that medication-assisted treatment works well in reducing fatal overdoses, relapse and in reducing the spread of infectious diseases, such as HIV. After all, the period immediately after release from jail is one of the highest-risk time frames for overdose. With more prisons able to provide injectable naltrexone upon release, the risk of death could be reduced.
Liability concerns are part of what is driving more and more jails to incorporate better treatment for addiction. One study claims that 80% of all detoxification for drugs and alcohol occur in jails and prisons and that well over $70 million has been paid out for withdrawal-related deaths of inmates.
In Massachusetts, legislature has given the green light for seven-county pilot programs utilizing evidence-based opioid treatment in jails. Starting in August, the jails will provide MAT and track data on efficacy. Hopefully, the program can help produce more reliable data on the correct way to implement treatment for inmates.
The Benefits of Treatment in Jail
Careful integration of MAT into jail systems can yield numerous benefits not only for individuals struggling with addiction but also communities and the jail system as a whole. When used appropriately as a tool in the range of jail-based treatment options, the benefits include:
- Stemming the cycle of arrest, incarceration, and release associated with substance use disorders
- Contributing to the maintenance of a safe and secure facility for inmates and staff .
- Comprehensive drug treatment programs in jails are associated with reduced system costs.
- By facilitating continued access to MAT for individuals who are on prescribed FDA-approved MAT, correctional agencies can minimize the risk of post-release overdose and death.
- When MAT is not feasible (e.g., the individual is facing transfer to a facility that does not offer MAT), FDA-approved medications (e.g., methadone or buprenorphine) should be used to provide medically managed opioid withdrawal.
Considering that the criminal justice system is the largest source of organizational referrals to addiction treatment, justice leaders have a unique and valuable opportunity to facilitate the path to recovery.
In order to provide a guide for some of the best practices when it comes to treatment, the National Sheriff’s Association pieced together an evidence based evidence-based treatment guide for jail executives to use. These include:
Enrolling Inmates in MAT
All individuals who enter jails must be systematically screened for substance use disorders. Afterwards they must consult with medical and treatment providers and willingly decide to start any type of medication treatment program. Individuals must pass specific criteria before they can qualify for MAT.
Correctly Dosing and Administering Medication
Individuals must be routinely tested to ensure that they are appropriately taking the prescribed dosages for the correct duration of treatment. Pregnant women with opioid or alcohol use disorder must be given specialized services to help prevent any risks during pregnancy.
Partnerships and Support Services
For the maximum benefit of treatment for substance use disorders, MAT needs to be coupled with counseling and the appropriate level of follow-up services. Jails implementing MAT programs could benefit from collaborative relationships with community-based treatment, MAT, and other behavioral health providers.
MAT Programs Components
Correctional staff will need to receive proper training and education when it comes to implementing MAT. Residential correctional facilities and community treatment providers will need to have strict safeguards in place to ensure that medications are not diverted. Correctional personnel should refer clients to prescribing providers and other treatment programs with adequate authorization.
Types of Medication-Assisted Treatment Offered in Jail
One the most common types of MATs is methadone. Methadone is a synthetic, long-acting opioid with that is used to prevent withdrawal symptoms in patients who were addicted to opiate drugs and are enrolled in drug treatment programs. Methadone can be used to help wean patients off of their addictions. It is also used to treat chronic pain.
Methadone can cause a number of side effects, including:
- Weight gain
- Dry mouth
- Stomach pain
- Nausea and more
Normally, when methadone is used, patients will be given naloxone for someone around them to use in case they overdose on methadone.
Naloxone is similar to Vivitrol in that is an opioid antagonist that blocks the activity of opioids at the receptor sites and can potentially reverse or prevent life-threatening overdose.
Specifically, Naloxone is used for overdoses to counteract the effects of the overdose and allow the victim to breathe normally. Naloxone only works for people who have opioids in their system and has no effect for people if opioids are absent.
More recently, naloxone, and more specifically Narcan, the brand name for naloxone, is being used by emergency response personnel and even minimally trained individuals for treating people who have overdosed on opioids such as prescription medications and heroin. Naloxone can be administered a number of different ways including injection and as a nasal spray.
Some signs of opioid overdose in which naloxone may need to be administered include:
- Tiny, constricted pupils
- Shallow breathing
- Loss of consciousness and more
Buprenorphine is opioid medication that is used to treat addiction. It is a partial opioid agonist and its euphoric effects increase with increased use of the drug but eventually plateaus. This is called the ceiling effect and helps buprenorphine carry a lower risk of abuse, addiction and side effects compared to full opioid agonists. Like Vivitrol, buprenorphine can also block the effects of full opioid agonists and can lessen the effects of withdrawal symptoms if administered to an opioid-addicted individual with a full agonist in their bloodstream.
Unlike methadone which needs to be taken at a clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed in physician offices.
Buprenorphine, under the appropriate dosage, can help patients suppress the symptoms of opioid withdrawal, decrease cravings for opioids, reduce illicit opioid use and help patients stay in treatment.
Some side effects associated with buprenorphine include:
- Nausea and vomiting
- Muscle aches
- Inability to sleep
Like Vivitrol, Suboxone is a specific brand of naloxone and buprenorphine. It is a prescription medication that is used to reduce the effects of opioids by blocking them from their receptors. It is similar to Vivitrol except suboxone only reduces the effects whereas vivitrol blocks them completely. Suboxone was first approved by the Food and Drug Administration in 2002 and has been used as a treatment for opioid addiction since. Treatment for Suboxone does not require participation in a regulated program like a methadone clinic. The abuse potential for Suboxone is substantially lower than that of methadone.
Some side effects that can occur from using suboxone include:
- Respiratory problems
- Liver problems
- Decrease in blood pressure leading to dizziness
Patients also run a higher risk of death and coma if they are using Suboxone with other medicines such as benzodiazepines.
Again, these medications will need to be used alongside regular treatment in order for major results to be seen. Medication-assisted treatment is only done to help with the physical aspects of treatment, such as dealing with withdrawal symptoms. However, by using medication such as vivitrol along with other major components of treatment like counseling and group therapy, it allows patients to sidestep the physical problems that come with initial sobriety and to focus on the psychological and behavioral issues that all patients have to deal with.
At Landmark Recovery, we offer patients detoxification before inpatient services like group therapy and individual counseling begins. One program that Landmark utilizes is family therapy, when necessary, to promote long term sobriety and clean living. If you would like more information about a personalized treatment path for your loved one, please visit our website and reach out to our admissions staff today.