Lack of access to methadone and burprenorphine, lifesaving opioid use disorder medications, for vulnerable incarcerated populations has long been a stain on the US criminal justice system.
On April 3, a groundbreaking open letter—signed by 58 current or former elected sheriffs, district attorneys and other law enforcement and criminal justice officials and leaders from across the US—called for this situation to end in jails and prisons, and for naloxone distribution on release.
Incarcerated populations are hugely important in the context of addressing the opioid-involved overdose crisis. A 2018 CDC report indicated that in around 10 percent of overdose deaths, there was evidence of the person being released from an institutional setting in the month prior.
Law enforcement voices have the potential to be powerful influences on mainstream and government opinion. The letter was organized by Fair and Just Prosecution and the Law Enforcement Action Partnership (LEAP)*, two pro-reform advocacy groups.
“For too long we have tried to punish people into abstaining from drugs rather than expanding access to strategies that work,” said Miriam Krinsky, executive director of Fair and Just Prosecution. “Requiring people to be cut off from medically assisted treatment while in custody flies in the face of proven best practices and increases fatal overdoses when people reenter the community. It’s time for a different way forward.”
“Society demands that [jails] also serve as a hospital, mental health institution, school and rehabilitation center,” said Richard Van Wickler, Superintendent of the Cheshire County Department of Corrections in New Hampshire and a speaker for LEAP. “Providing adequate and responsible healthcare to treat addiction through medication-assisted treatment is a requirement, not an option.”
“A prosecutor’s role does not end at the prison door,” said signatory Sarah George, Chittenden County State’s Attorney. “We are obligated to use our voices to ensure in those instances when people absolutely must be incarcerated, they leave custody in a position to safely reenter their communities.”
As Filter has reported, a few encouraging signs of increased MAT availability for incarcerated people have emerged in recent months—with a federal judge in Massachusetts ruling in favor of a defendant receiving methadone, and a pilot program for injectable burprenorphine announced by Pennsylvania’s Department of Corrections. It is to be hoped that the new letter will increase this momentum.
Here is the full text of the letter, which attorney and Filter contributor Rory Fleming played a role in drafting, with the full list of signatories below:
As current and former elected local sheriffs and current elected prosecutors, as well as other law enforcement professionals, we are committed to protecting public safety and the safety of individuals in our custody. We believe that providing medication-assisted treatment (MAT) like methadone and buprenorphine in jails and prisons, as well as ensuring that individuals released from custody have naloxone and a continuing care plan, is part of that duty.
Medical research shows that many people who are unable to stop illegally using opioids through abstinence-based treatment are able to stop when using methadone or buprenorphine as a part of medication-assisted treatment (MAT). While abstinence-based heroin treatment has a 5 to 15 percent long-term success rate, MAT program success rates exceed 50 percent. In addition, most people relapse at least once before they successfully enter recovery. People on MAT are much less likely to die of an overdose if they relapse.
Decades of studies show that MAT use decreases illicit drug use, crime, and health costs to communities. Continuing MAT care in county jails and prisons is essential to ensuring that formerly incarcerated people do not relapse and reoffend upon release.
Forcing people in jail to detox is difficult and dangerous. Withdrawal brings vomiting, diarrhea, and low blood pressure. People can die from dehydration while detoxing in jail—and a number have.
Those forced to detox in jail or prison are also more likely to die from overdose upon release. According to a report last August by CDC researchers on overdose deaths, “Approximately one in 10 decedents had evidence of having been released from an institutional setting in the month preceding the fatal overdose . . . [T]he most common settings being jail, prison, or detention facilities when only illicit opioids were involved (4.9%). . . These data suggest a need . . . to expand treatment in detention facilities and upon release.” Fortunately, research shows that providing MAT in correctional facilities reduces the risk of overdose death post-release by 85 percent.
In order to reduce overdose and improve recovery success, we also believe in ensuring that individuals struggling with addiction should be provided with naloxone and a continuing care plan upon release.
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