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March 12, 2015

"Prisons Are Making America's Drug Problem Worse"

The title of this post is the headline of this notable new Politico piece.  Here are excerpts that reinforce my fear that one of the biggest problems with the modern drug war is that we are fighting it so very poorly:

After two decades of rapidly rising incarceration rates — rates that continued to rise even as crime sat at record historic lows — America today has nearly 2.2 million adult inmates in local, state and federal jails and prisons, including about 300,000 who have a history of heroin addiction.  The BOP spends $110 million annually on drug treatment programs for approximately 80,000 inmates identified as dependent on narcotics.  But for the 10,000 or so federal inmates dependent on heroin or other opioids, millions of those dollars are currently spent on outdated, ineffective approaches that wrongly prohibit medication-assisted therapies — approaches that, in other words, fail to help prisoners addicted to opioids during their sentence and ultimately return them afterwards to society as addicted as they were when they went into jail.

It doesn’t have to be that way.  A recent study of opioid-dependent inmates leaving Rikers Island jail in New York City showed that nearly nine out of ten inmates who were not medicated relapsed within a month, as opposed to just 2 out of 5 inmates who were on medication-assisted treatment.  The difference to society between those two numbers — in terms of health outcomes, reduced crime, and improved employment stability — is huge.

Science notwithstanding, the U.S. criminal justice system has resisted medication-assisted therapy, with only a few large urban jails (e.g. New York City, San Francisco, Albuquerque) and a handful of state prisons such as those in Rhode Island and Vermont opting to use it.  Yet most major correctional experts, including the U.S. Bureau of Justice Assistance (BJA), the National Re-Entry Resource Center and the National Commission on Correctional Health Care, all recommend increasing the availability of medication-assisted therapy for opioid dependence in the country’s jails and prisons.  The U.S. Bureau of Justice Assistance (BJA) recently concluded that the effects of MAT are “many times greater” than behavioral therapies without medications.

Beyond the correctional world, the World Health Organization, UNAIDS, the United Nations Office on Drug Policy, and the National Institute on Drug Abuse (NIDA) all agree that people dependent on heroin and other opioids should have access to medication-assisted therapy.  In a recent publication, NIDA stated, “Taking these medications as prescribed allows patients to hold jobs, avoid street crime and violence, and reduce exposure to HIV.” The White House Office of Drug Control Policy calls MAT combined with behavioral therapy the “standard of care” for opioid dependence and recently announced that drug courts, which offer treatment as an alternative to prison for some criminal offenders, will be required to offer MAT in order to continue to receive federal dollars.

Nevertheless, despite the evidence to the contrary, the Federal Bureau of Prisons prohibits such treatments entirely for “routine” (non-detox) purposes.  Corrections officials frequently cite security concerns to justify denying buprenorphine and methadone therapy to inmates, fearing the medicine will be diverted to other prisoners — despite the fact that these issues can be resolved with tighter security measures and closer staff supervision (the prison systems of Western Europe, Scotland, Canada and even Iran can attest to that).

March 12, 2015 at 08:47 AM | Permalink

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Comments

One problem with successful technology, such as suboxone, an opioid analog that is less likely to get people high, just to control cravings, is the DEA. Their statutory mandate is to reduce addiction in the nation. So if everyone got on suboxone, there would be little opiate addiction, and the DEA would lose funding. So they intimidate and terrorize prescribers, demanding huge, but unnecessary paper work documentation. This raises the cost of care for this medication. and makes it less accessible to the poor. It is far more preferable to methadone. The latter requires parking the Mercedes in front of a building with a sign, "Methadone Clinic," but every day. People on methadone are dopey looking. Suboxone, is prescribed monthly, obtained from a drug store, and one stays sharp looking.

Thank the lawyers at the DEA making policy to terrorize doctors willing to treat these addicts.

Posted by: Supremacy Claus | Mar 12, 2015 9:18:08 AM

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