The U.S. is in the throes of an opioid crisis: it’s caused over 40,000 deaths annually since at least 2013, and the estimate that opioids caused 67,000 deaths in 2017 shows the toll is still climbing rapidly. That’s greater than the number of deaths nationwide in a year from gunshots, auto crashes, or HIV/AIDS. Official responses have varied, ranging from the mostly rhetorical (calls for border walls and the death penalty for drug dealers) to the more measured (Congress hopes to clear by Memorial Day an omnibus anti-opioid abuse measure containing over $3 billion for government agencies battling the epidemic).
As prescription drug abuse has faded with the onset of increased use of heroin, morphine and cheaper and more powerful synthetics like fentanyl, one side effect has been greater numbers of inmates in jails and prisons entering with opioid problems. When inmates don’t receive needed detoxification care while incarcerated, as is far too often the case, especially in jails, the results can be serious or even fatal. Local jails may not even effectively screen new inmates who have medical problems related to opioid abuse, or to have medications on hand for treating those who do. Unlike federal prisons, local jails may not even have guidelines for treating inmates going through withdrawal.
It’s not a rare condition: in fact, the Bureau of Justice Statistics has found about 63% of inmates serving prison sentences have a drug dependency or are at least occasional substance abusers; the figure for local jails is only slightly lower (58%). But, despite promising, innovative programs in relatively few locations, neither jails nor prisons are likely to offer medication-assisted treatment (MAT), which use drugs like methadone or buprenorphineto treat inmates entering with substance abuse problems. MAT treatment is not only more likely to keep them alive while incarcerated, but has also been found to reduce such post-release problems as later illegal drug use, new crimes, and HIV and hepatitis C.
One studyfrom 2009 showed when opioid-dependent inmates lacked access to MAT or other medical care, they engaged in various “unhealthy behaviors designed to relieve withdrawal symptoms.” This not only made conditions worse for other inmates, but made inmates denied rehabilitation care less likely to seek MAT after their release. And with few offering opioid-dependent inmates any real rehabilitation services, it’s not surprising the weeks right after release is when former inmates are most likely to relapse.
A recommended, but infrequently offered, way to help inmates being discharged is to provide them with the opioid antagonist drug naloxone, which can reverse overdoses. In April this year, U.S. Surgeon General Jerome Adams issued an advisory urging greater use of that drug and having it available for persons at high risk. Yet it’s rarely offered to inmates being discharged.
A few states – notably Rhode Island and Vermont – and a handful of communities have worked to develop programs that keep recently released ex-inmates aware of, and involved with, the range of resources available to them, and have worked to ensure those resources include such useful components as job training or placement, mental health services, and others. If we as a nation are truly serious about dealing with the opioid crisis, isn’t it time that others, many others joined them?
Christopher Zoukis is the author of Federal Prison Handbook: The Definitive Guide to Surviving the Federal Bureau of Prisons, (Middle Street Publishing, 2017), and College for Convicts: The Case for Higher Education in American Prisons (McFarland & Co., 2014). He regularly contributes to New York Daily News, Prison Legal News and Criminal Legal News. He can be found online at ChristopherZoukis.com, PrisonEducation.com and PrisonerResource.com.