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Rhode Island Takes Uncommon Steps to Address a Common Problem: Drug Addiction in Prison

Though it’s the smallest state in the country, Rhode Island has the ninth highest rate for drug overdose deaths. This prompted Governor Gina Raimondo to invest $2 million in 2020 into a program that provides prisoners the option of medication-assisted-treatment (MAT) for their drug addiction. The program was implemented in 2016. Within one year, drug overdose deaths of prison releasees dropped by 61 percent.

The program is so effective that the American Medical Association’s journal Psychiatry published a report on it in February 2018, suggesting that Rhode Island’s MAT program prevented one overdose for every 11 prisoners it treated.

But Rhode Island is an outlier. While this country imprisons more than 2 million of its residents, at least 60 percent of whom struggle with drug addiction, most prison systems don’t offer MAT — or any drug addiction treatment. Two reasons they cite are lack of money and staffing, and the false belief that simply keeping drugs away from addicted prisoners is enough.

Some have questioned why it’s necessary to give someone who’s been off opioids for years this drug-assisted treatment. After all, they’ve stayed off drugs this long, so they must be over it by now, they assume.

But that assumption is wrong, as Rhode Island prison officials found. “They’re still addicted,” Linda Hurley, president and CEO of Behavioral Healthcare, a state-funded nonprofit that administers the MAT in Rhode Island’s prisons, said. “When they get out they don’t have the same tolerance anymore, but the brain wants the same amount.” So, they end up overdosing.

Prison administrators who object to MAT also fear that bringing opioid-based drugs into prison, like suboxone and methadone, would create a black market in the prison for the drugs. But what Rhode Island prison officials discovered is that the drug market in prison actually dried up — because the people who were seeking the drugs were getting treatment.

“Inmates with untreated addiction struggle to get drugs inside, resulting in violence, extortion, stress, conflict and a strengthening of illegal drug networks and gangs,” said Patricia Coyne-Fague, Rhode Island’s Department of Corrections director. But “once you put the addict on medications, most inmates become fine, perfectly reasonable people and stop causing trouble.”

It begs the question of why we lock them up for the disease of addiction in the first place,” she said.

A 2018 study in North Carolina found that, in the first two weeks of being released from prison, addicted ex-convicts were 40 times more likely to die of an opioid overdose than someone in the general public. “When I saw the number of people not dying after release,” Coyne-Fague said, “that’s all I had to see.” 



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