Using drugs to treat addicts inside prison might just be the best way to stem the crisis of overdose deaths
With a disproportionate number of Black, Indigenous and people of color in the criminal justice system, that puts those groups in particular peril. Individuals leaving prison are as much as 40 times more likely to die from an opioid overdose in the first two weeks after their release than the general population.
But the growing number of programs still only cover a fraction of America’s incarcerated population. The, a non-profit research group, estimated in 2021 that just 12 percent of jails and prisons in the country offered medication for opioid use disorder. Two of the main drugs used to treat opioid use disorder — buprenorphine and methadone — are controlled substances, tightly regulated by the DEA.
Rahul Gupta, President Joe Biden's drug czar, center, during a visit to a prison, where he reviewed a medication treatment program for opioid addiction, in Warren, Maine, July 12, 2022. | Sophie Park/The New York Times, Rahul Gupta, Biden’s director of National Drug Control Policy, visited the Maine State Prison in Warren to learn more about its opioid treatment program.
In early 2019, Janet Mills was coming to office as Maine’s new Democratic governor after campaigning on a pledge to tackle the state’s spiraling opioid crisis. Mills’ newfor opioid use disorder in the state’s criminal justice system. It would build on the Department of Corrections’ progressive philosophy of trying to humanize and destigmatize the experience of being in prison. In Maine prisons, inmates are all called “residents.
But the program hit a snag when it introduced a concept called “early induction,” which allowed some high-risk inmates who weren’t going to be released any time soon to apply for treatment as well. That idea, according to prison officials and prisoners alike, did not go well.
“I’m probably one of the biggest turnarounds in the history of the state prison,” Bieler told me during an interview in a group meeting room, where various classes were being held down the hall. “I’ve assaulted people for drugs. I’ve trafficked drugs. I’ve shot drugs. I’ve been the worst kind of monster on drugs. When we finally got this program here running… this place has changed so much. And it’s changed for the better.
Fewer are convinced of the value of treating people who have already gone through withdrawal while incarcerated, whether it’s before their release or if they won’t be released for decades. Hurley said she still has people ask her, “‘Why do you want to hook them again, when they’re better? What are you doing?’ And that’s because there’s not an understanding of the brain disease, versus just physical dependency.
The most common objection, however, is more fundamental. For years, prisons and jails have been fighting a rising tide of opioids smuggled inside their walls. Giving residents the greenlight to take them is antithetical to the job that security staff have been asked to do for years. Concern that the prescription drugs will be “diverted,” or passed on and sold to other people in the facility’s black market for profit, is widespread.
It allows states and counties “to make good, evidence-based decisions, and go back to their state legislatures — and for us to go to Congress — and say, ‘Look, this works. This is the way we’re gonna save these lives, and every taxpayer dollar that gets invested is worth investing,’” said Gupta. Correctional facilities need the help, said Regina LaBelle, a former acting director of National Drug Control Policy and now director of the Addiction and Public Policy Program at the O’Neill Institute. “Jails and prisons really need more information… They’re trying to figure out how to do the right thing.”
When Knockwood was getting ready to be released, he said a medical staff member pressured him to go onto buprenorphine and he had to fight to stay off it. “Why would I want to revert back to an addictive substance? Makes no sense,” Knockwood said. He said he has no objection to medication as one path of recovery, but he didn’t feel that the voluntary program was really giving people all the information they needed.
The Maine Department of Corrections responded that it “encourages and offers all pathways to recovery, including peer-based, faith-based, recovery units, clinical, non-clinical, and medication.” The department also said it begins the planning for people in the treatment program when inmates are nine months out from their release, but that in reality, given the prison’s emphasis on education and vocational training, it starts much sooner.
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