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January 31, 2020

"How America’s prisons and jails perpetuate the opioid epidemic"

The title of this post is the headline of this new Vox piece by German Lopez.  Here are excerpts:

Just Rhode Island and Vermont officially offer all three federally approved opioid addiction medications (buprenorphine, methadone, and naltrexone) to jail and prison inmates.  The 48 other states and the federal government offer them only in limited circumstances or not at all.

The lack of adequate treatment in jails and prisons puts a vulnerable population of around 2.3 million people at risk. About 58 percent of people in state prisons and about 63 percent of those sentenced in jails meet the definition for drug dependence or misuse, compared to 5 percent of the general population, according to a 2017 report from the Bureau of Justice Statistics.

Yet a 2017 study by Johns Hopkins researchers found that less than 5 percent of people who were referred to opioid use disorder treatment through the justice system received methadone or buprenorphine, compared to nearly 41 percent of people referred through other sources.

The result is likely more overdoses and deaths.  A 2007 study in The New England Journal of Medicine found ex-inmates’ risk of a fatal overdose is 129 times as high as it is for the general population during the two weeks after release.  Other studies have backed up the finding that recently released inmates are at particular risk of overdose. In Rhode Island, a preliminary research letter in 2018 found that the state’s program offering medications for opioid addiction was followed by a more than 60 percent drop in overdose deaths among recently released inmates.

But many local and state lawmakers and jail and prison officials remain skeptical. Some of that skepticism is driven by stigma: the view that addiction is a moral failing, not a medical condition, so public resources shouldn’t go to treating it. Stigma toward medications for addiction — like the myth that medications are simply “replacing one drug with another” — is especially prominent. And there are funding and logistical concerns with better addiction treatment programs in jails and prisons, although Rhode Island and Vermont show those issues can be overcome.

“We have a population that’s incredibly vulnerable,” Sarah Wakeman, medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, previously told me. “It’s really inexcusable that we don’t make this available for people who are at such risk of death.”

January 31, 2020 at 08:39 PM | Permalink


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