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More Success for Medication-Assisted Treatment Programs in Prisons and Jails

by Keith Sanders

The opioid crisis has reached every segment of American society, from fentanyl-laced candy found in elementary schools to party-goers dying from innocent-looking pills that are really fatal fentanyl cocktails.

Opioid abuse killed over 80,000 people in 2021, pushing U.S. life expectancy to its lowest level in 25 years. Prisons and jails have not been spared; approximately two thirds of those incarcerated suffer substance abuse disorders.

The crisis has prompted some prison systems to think outside the box. Rhode Island’s Department of Corrections (DOC) became the first state prison system in 2016 to provide FDA-approved Medication-Assisted Treatment (MAT). Maine’s DOC followed suit the next year. California’s Department of Corrections and Rehabilitation (CDCR) instituted its Integrated Substance Use Disorder Treatment Program in 2019, offering MAT for both alcohol and opioid abuse. Over the next three years, CDCR’s overdose rate plummeted 62% – while opioid overdose deaths nationwide increased almost 30% in 2021. [See: PLN, Dec. 2022, p.42.]

Such programs not only save prisoner lives but also taxpayer money through reduced recidivism. Yet according to the Jail and Prison Opioid Project, a nonprofit research organization, only 12% of U.S. jails and prisons provide MAT.

There is a widespread misperception that MAT swaps one addiction for another. One skeptical administrator with the federal Bureau of Prisons (BOP) changed his mind after seeing prisoner disciplinary incidents drop once MAT treatment was offered.

“There were less fights. There were less debts. The drug dealers on the compound went out of business,” the administrator noted.

Congress ordered BOP to roll out an MAT pilot in the First Step Act of 2018. [See: PLN, Jan. 2019, p.34.] A year later BOP settled a lawsuit by providing MAT to prisoner Leaman Crews. [See: PLN, Mar. 2020, p.44.] Yet when the government’s fiscal year ended in October 2022, BOP estimated that MAT was being provided to only 10% of the 15,000 federal prisoners who need it. Meanwhile, during the same year, BOP disciplined 500 prisoners for abusing Suboxone, the combination of buprenorphine and naloxone most often used in MAT.

“Believe me,” said another BOP administrator, “100% I recognize the irony there.”

BOP’s parent agency, the federal Department of Justice, has had more success making MAT available through its Bureau of Justice Assistance, providing about $2 million to 14 county jail programs in 13 states.

A Maine state prisoner, Chuck Schooley, 29, credited MAT for helping him kick a decade-long opioid addiction. “It allowed me the freedom of not being the victim of my own vices,” said Schooley, now a program peer recovery coach.

Additional source: The Marshall Project