Without a personal connection to a person in prison, most readers may have skipped right over news of a Brown University study revealing that people are often forced off methadone maintenance therapy (MMT), a form of medication-assisted treatment for addiction, once they’re incarcerated—and that this makes them less likely to return to treatment upon their release. But it’s an important study for anyone who values public safety, smart policy, and access to quality care.
The first thing that struck me about the coverage I’ve seen is that it fails to mention that MMT is actually a controversial treatment even in the non-prison population, and isn’t widely considered to be the best form of medication-assisted treatment. Newer medications, such as Vivitrol, buprenorphine, and Suboxone, which relieve cravings and decrease the potential for abuse, are much better alternatives.
But the question of whether or not people struggling with the disease of addiction should be forced off their medication goes far beyond whether buprenorphine is more effective than methadone; it goes to the very heart of how the people who make decisions about prisoners and their care—and, by extension, the wellbeing of the general population—view people with addictions, especially those who are incarcerated.
Think I’m exaggerating? Imagine that we were talking not about people with addictions being forced off MMT, but about people with diabetes being forced off insulin.
As lead author Dr. Josiah D. Rich of Brown University put it, people are taken off methadone when they are incarcerated because decision-makers believe continuing therapy would cost money and can be very hard to administer in a controlled way. That is absurd. There are many examples of jails, prisons, and other “lockups” administering medication to treat disorders of all sorts: HIV, schizophrenia—you name it. The same protections and processes we have in place to prevent misuse or divergence of other medication will work when the medication is used for substance use disorder treatment. If a facility has the capacity to treat asthma, diabetes, or depression, it has the capacity to medically treat addiction.
The truth is, the real reason we don’t adequately treat addiction in prison—medically or otherwise—has less to do with its difficulty or cost, and much more to do with an objection to caring for people who are perceived as having caused their disorder through their own actions. By that reasoning, why should we, as a society, go out of our way to help people who brought their misery on themselves?
But this kind of thinking gets us nowhere. Regardless of how people begin their drug use, no one chooses to become addicted. Once addiction does take hold, it’s in all our best interests to provide the treatment to people who desperately need it. The difficulty of doing what is right should not be the controlling factor, nor should cost (though studies show that treatment is, in fact, cost effective). We need to do what is best because it produces the greatest chance for the intended outcome we all want to achieve—in this case, having people reenter the community without returning to drug use.
This is both the right and smart thing to do for a number of reasons, the most important of which is that most prison inmates will eventually leave prison to return to our communities. Without treatment, paroled inmates are far less likely to have a successful termination to their parole, to gain employment, go to school, parent their children effectively, have secure housing, or become stable, contributing members of society.
If you still need convincing that providing quality treatment to prisoners is the wise choice, ask yourself this question: Who do you want living in the communities where you live, shop, and work—the person who has overcome his addiction while in custody, or the one who has not?
David M. Richardson, Ph.D.
Vice President, Corrections and Rehabilitation Services
Phoenix House California
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