01 Jun The Need for Methadone Maintenance in Jail
Implications of Inadequate Methadone Treatment Policy in Jails
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.