Time to Stop Forcing Addicted Prisoners Off Their Medication

Thursday, June 11th, 2015

person in prison

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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  • John Gilbert LMFT

    Personally, I find many reasons (moral, ethical, religious) to provide meaningful and compasionate care to those who are incarcerated. Chief among them is my belief that the ultimate indicator of the quality of any society is how they treat their least enfranchised members. The financial benefits of providing treatment to those who are incarcerated are well documented. However, recently, I came across a statistic (I believe it was from the US Department of Justice) that iluminates the issue in a most pragmatic way. The statistic stated that 95% of those currently incarcerated will, eventually, be released back to society. I find this a particularly compelling reason to ensure that those who are incarcerated have access to meaningful treatment.

  • Paula Rice-Sherman, MS, CAS

    As someone who personally experience being forced off MMT in jail more than once I can acknowledge it left me broken both physically and mentally with no help from the withdrawal and nothing to take it’s place in my daily life. MMT is in my view a bad way to try to stop using Heroin but that was my story for some it has been successful for me it tore me apart as I had to kick it in jail with no HELP, no Treatment, no 12 step groups, no counselor, no nothing. If done right in the jail system it can be used appropriately and we can help those who need the help by offering them a different way. I have seen jail and prison treatment that is followed up with treatment in the community be successful for the past 25 years. IT WORKS and we as Treatment Professionals should do all we can to make it work for those who still suffer in the incarcerated.

  • Renee Riebling

    Well said, John! Those are such compelling reasons to do everything we can to offer addiction treatment to people who are incarcerated. Thank you for sharing your thoughts. –Renee Riebling, Phoenix House

  • Renee Riebling

    Paula, thank you for sharing your personal story with us. We are so inspired by how you’ve chosen to use your personal experience to help others. All the best to you. –Renee Riebling, Phoenix House

  • Akilah Templeton MPA, MSW

    Thank you for this contribution to the conversation on how to best provide services to inmates who are also afflicted with health and mental health issues. One might argue that substance use could easliy fit into either category. The argument you present is compelling and timely. We should also consider the correlation between substance use and recidivism. It is in our best interest as a society to actually treat the problem rather than dismiss it. Great work here on your part and great food for thought!!

  • Renee Riebling

    Absolutely, Akilah. You bring up important points that need to be addressed. Thank you for adding to the conversation. –Renee Riebling, Phoenix House