A look at the state of addiction treatment in our prison system.
This blog post was inspired by a recent provocative article on this subject by National Institute on Drug Abuse (NIDA) director Nora Volkow.
It is striking how inadequate addiction treatment is in our jails and prisons. This is especially dire when you consider that most of the people in prison in this country are living with chronic drug issues that contributed to their incarceration in the first place.
Statistics that really illustrate how serious this problem is include:
- 60% of people who are incarcerated have a substance use disorder (SUD), according to the DOJ.
- Another 20% of inmates don’t have SUD, but were under the influence of drugs or alcohol when they committed their crime.
- Just 5% of people in jail with opioid use disorder (OUD) receive medical treatment for it.
That final stat says it all. Even though the majority of people in our prison system are struggling every day with an SUD, and SUD likely put them there to begin with, only a small fraction are being treated for it.
What’s behind these low treatment numbers?
There seems to be two key, interrelated reasons why incarcerated persons are left to struggle on their own with their SUDs: (1) because the treatment is believed to be too expensive to deliver, and (2) because prison systems often do not focus on reintegration or rehabilitation.
- Addiction treatment is too expensive
In fact, it isn’t. Especially when you consider the huge amount it saves society in terms of drug-related crime, drug-related ER visits, and so on. Countless studies have proven the cost-effectiveness of treatment.
Here’s just one: A 2020 New Mexico study found that inmates in a large urban jail were significantly less likely to return to jail (recidivism) when they were given methadone medication during incarceration versus inmates who received no methadone. Alongside the obvious benefit to those inmates and their families, less jail time translates to huge cost savings for society.
In the end, drug-use prevention is what’s behind the cost savings. Without exception across mental and physical health, it costs less to prevent diseases and conditions than it does to treat them. And by the way, SUD and other addictions are health conditions, not criminal behaviors. Our justice system and society at large don’t always see it that way.
- A lack of focus on the future
Some believe that prison time is meant to be purely punitive, rather than punitive and rehabilitative.
If the goal is simply to punish someone by putting them behind bars, providing addiction treatment to improve their life doesn’t really fit into that scenario. But if your priority is also to help rehabilitate them back into society, offering SUD treatment makes sense.
A small jail in rural Maine lands on a promising strategy
As recently reported in the New York Times, Somerset County jail began offering extended-release buprenorphine injections to its inmates who were addicted to opioids.
Because these injections help keep cravings at bay for a month, inmates are functioning far better while in jail. Just as importantly, newly released prisoners have more (sober) time and breathing space to set up continuing addiction treatment that helps them avoid relapse and move forward toward long-term recovery. One of the gold-standard medications for OUD, buprenorphine helps these newly released inmates bridge a very high-risk time when withdrawal, relapse, and overdose rates all skyrocket.
The main glitch in this once-a-month dosing strategy? Injectable buprenorphine (commercially known as Sublocade) is expensive. That means Somerset County and the other locales that are using it are struggling to pay for it. Same goes for the inmates once they leave prison, as many are uninsured, or their insurance doesn’t cover the drug, so they can’t continue with the drug.
Despite the drawbacks, this Maine experiment shows a way forward for our fellow citizens with SUD who are behind bars. The high cost makes it a flawed answer at this point, but it’s an answer nonetheless, and it’s a lot more cost effective for society than offering no medication.
