Doctors know how to treat substance use disorders and save lives based on decades of research. Maine needs to listen to them and apply the science where it’s currently not being applied: at correctional facilities across the state.
There’s no sense blaming jails and prisons for the opiate epidemic; they don’t cause addiction and, as they’ve become de facto detox facilities, they have been forced to deal with a crisis that many others have failed to address. But they do unwittingly help perpetuate the crisis by declining to offer the treatment doctors know works. They need the help of lawmakers, county commissioners and the public to make the necessary changes that can reduce drug use, drug-related criminal behavior and inmates’ risk of death upon release.
The changes are, in theory, simple: Jails should be starting or continuing inmates on physician-prescribed addiction medication within their facilities, rather than forcing them to stop their treatment when behind bars. And they should ensure a seamless transition to treatment in the community when they leave.
Jails don’t offer medications such as methadone, buprenorphine and naltrexone for reasons of cost, logistics and the fear that methadone and buprenorphine — which are narcotics but don’t get people high when taken correctly — will be diverted and abused. But these hurdles can be overcome — and should be if communities want to prevent more deaths and reduce recidivism.
It’s been done elsewhere. Rikers Island, New York City’s main jail complex, has operated a model program since 1987 to provide inmates with medication-assisted treatment, most often methadone, and connect them to community-based treatment upon their release.
The program has resulted in up to 80 percent of people continuing treatment in the community and reduced reoffense rates among 62 percent of program participants. Among released participants who received Medicaid, recidivism was reduced by 100 percent.
Expanding access to treatment at jails is doable. It would likely require funding commitments from state and county governments in the short-term, though it’s possible reducing reoffense rates would lower costs long-term. It would also require providers to step up and work with jails to ensure treatment can be continued in the community.
There’s a role for the public, too: Sheriffs, county commissioners and legislators are elected. Vote for those who are committed to changing long-standing protocols in favor of treatment that saves lives.
They need to know their constituents support ending the inhumane practice of ceasing addiction medication behind bars. Studies have shown that people released from prison, especially in their first two weeks out, are at a high risk of dying in general and are at particular risk of dying from an overdose: up to 129 times more likely than the general population.
When there’s a proven way to get people help, especially in the middle of an opiate epidemic causing record overdose deaths, that statistic is unacceptable.