The Senate reached a bipartisan deal to vote next week on a package of bills in response to the opioid crisis. The House of Representatives passed bipartisan package of legislation of their own in June.
In both chambers, the proposed legislation does a lot to make Americans safer and save lives. One thing that the Senate package (or the version likely to be voted on) does not do, however, is provide treatment for incarcerated people with opioid substance use disorder. (In the House, a limited measure to provide some treatment via Medicaid coverage prior to release did pass.)
Here’s how providing broad, medicated assisted treatment to incarcerated populations would help save lives, save money and reduce recidivism.
Numerous studies have established that treating opioid substance use disorder with opioid antagonists, such as buprenorphine and methadone, is highly effective. Many of the people who could benefit from that treatment end up in the criminal justice system and are incarcerated. Unfortunately, medication-assisted treatment for addiction is not widespread in the United States criminal justice system. That means that an effective option to help people break the cycle of abuse, that usually played a role in putting them behind bars in the first place, is lost.
So, what’s standing in the way? As with so many things, ineffective (and in this case dangerous) federal regulations prevent access to this sort of treatment. Currently, the federal government requires that only licensed opioid treatment programs can treat opioid addiction with methadone. That means that correctional facilities would need to partner with an existing treatment program in the community – programs which themselves are often unable to meet the needs of the nonincarcerated population.
The other option, buprenorphine, doesn’t have such stringent requirements, but it still can only be administered by a doctor who has obtained an additional license. That means that unlike other medications and treatments, medical providers must jump through additional licensing hoops in order to provide this life-saving treatment.
Given those barriers, it’s not surprising that most correctional facilities haven’t taken the steps to provide methadone or buprenorphine to inmates.
These barriers to treatment have serious consequences.
For one thing, limiting the access of those incarcerated to medication-assisted treatment means that those already on medication-assisted treatment prior to entering the criminal justice system often lose access to it. That forces people who are already trying to curb their addiction to go through withdrawal, where the human body reacts to the loss of drugs on which it has become dependent. Withdrawal is not only painful, but it doesn’t treat addiction, and it increases the likelihood of overdose upon release – indeed, a recent study found that for those who received treatment, post-release deaths decreased by more than 60 percent.
Beyond simply continuing to provide people with medication they are already using, however, correctional facilities could also play a role in helping some of the most vulnerable people suffering from addiction to begin the process of long term recovery by enrolling in effective treatment.
That would mean that instead of releasing people only to have them likely re-enter the criminal justice system or die from an overdose, treatment would pave the way for stable and successful post-incarceration lives, including employment and an ability to take care of themselves and support their families. This would not only be good for the individuals getting treatment, but it would also save money in the long run. People would be more likely to work and far less likely to need emergency treatment, spend additional time incarcerated or die from overdoses.
Finally, for lawmakers who are always talking about wanting to do “what works,” treatment for those incarcerated with substance use disorder has lots of evidence on its side. Already, treatment in prisons has been shown to be successful in New York City, San Francisco and in several statewide prison systems.
