Methadone in prisons: Productive success or expensive failure?
Forty milligrams of methadose. Image via Wikipedia
New study released from PsyOrg via Drug and Alcohol Dependence:
According to new research from The Miriam Hospital, Brown University and their affiliated Center for Prisoner Health and Human Rights, just half of all federal and state prison systems offer [opiate replacement therapy (ORT)] with the medications methadone and buprenorphine, and only in very limited circumstances. Similarly, only twenty-three states provide referrals for some inmates to treatment upon release from prison. These policies are counter to guidelines issued by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention, which say prisoners should be offered ORT for treatment of opiate dependence.
Pretty jarring. And quotes from the study’s lead author is jarring as well:
“Pharmacological treatment of opiate dependence is a proven intervention, is cost-effective and reduces drug-related disease and reincarceration rates, yet it remains underutilized in U.S. prison systems,” said Amy Nunn, ScD, the study’s lead author and an assistant professor of medicine (research) at The Warren Alpert Medical School of Brown University. “Improving correctional policies for addiction treatment could dramatically improve prisoner and community health as well as reduce both taxpayer burden and reincarceration rates.”
So why aren’t prisons using methadone more to their advantage?
For one thing, apparently it’s a space issue (“Jails in Scotland could hold an extra 1,400 prisoners if it wasn’t for the high number of inmates needing daily doses of the drug.”). But according to Josie Bahnick, head nurse at Lehigh County Prison in Allentown, Pa., the reasons are even simpler than that.
“The population is the population,” she says. “If they’re using then they’re using. Giving them methadone isn’t really any kind of deterrent.”
This is a pretty significant statement, considering her job and placement: Lehigh County was one of three in the state of Pennsylvania to institute a methadone policy for “inmates who had been on methadone maintenance before being incarcerated.” (Lehigh outsources a methadone maintenance program to a third party clinic.) It was considered revolutionary in 2007. Bahnick says, based on her observations in the two years since the program’s initiation, she could take it or leave it.
“For the people who stick to it, it’s a good thing,” she says. “And we have people who have been on it for years. But for those who use it as an excuse to do drugs, it’s not much different that if they were doing [some other illegal drug] instead.”
What are your thoughts on this? Are the supposedly reduced drug-related diseases and reincarceration rates worth the potential overpopulation problems and concerns that methadone may simply be a state-funded substitute for heroin? Or is Bahnick’s experienced apathy toward the program unwarranted?
Thanks, Kate, for the link.
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Hi Matt
Yes, of course MMT should be offered in jails and prisons, to both established methadone pts and those who could benefit from becoming methadone patients. MMT is far and away the most successful treatment for opioid addiction, with a success rate that far surpasses that of abstinence based treatment. COnversely, for those who leave (or are forcibly removed from) methadone treatment, the relapse rate is sky high–about 90%. Not to mention the fact that untreated, abrupt methadone withdrawals can kill, as evidenced by many cases including two female inmates in Orlando, Florida who died within months of each other from methadone withdrawals. The jail was sued by the family members and lost 5 million dollars, and henceforth put into place a more humane methadone withdrawal, but still has no maintenance program.
Those who consider MMT to be simply trading addictions would do well to consider this–long term opiate use/abuse often causes the brain to cease producing natural opiates (endorphins). When such use is discontinued the patient experiences severe depression, anhedonia (inability to feel pleasure), anxiety, restlessness, irritability, etc. This may gradually improve with time. However, in many pts, this condition may be permanent–the brain chemistry may be forever altered and will never again produce endorphins normally. Additionally, many scientists and MD’s theorize that the brains of many opioid addicts may never have produced this chemical normally to begin with, making them especially vulnerable to opioid addiction as they attempted to “self medicate” a severe depression. Methadone, in such cases, acts in the same way that insulin does for a diabetic–it replaces the endorphins no longer being produced in the brain, just as manufactured insulin replaces the natural insulin no longer being produced in the pancreas. It works well but only if it is adequately dosed, and only for as long as it is continued. That is why, for many, it may be necessary to continue MMT long term.
There is no excuse on earth to condemn any human being to the unmitigated tortures of untreated opioid withdrawal in jail. Methadone WD’s are especially dangerous due to the very long acting nature of the drug–lasting weeks instead of days. Inmates can–and have–died from strokes due to high blood pressure caused by the withdrawals, or from cardiac arrhythmias caused by severe dehydration and electrolyte imbalances due to vomiting and diarrhea.
A mother ot one of our local clinics wrote to a counselor there telling them of her own son’s experience (he was a pt at said clinic). He had to do 30 days in jail for a minor violation and the jail refused to medicate him. She went to visit him after about 10 days, having become worried when he stopped phoning her. She stated that he was brought to the visiting area tied into a wheelchair. He was slumped over in the chair, drooling, pale, and extremely emaciated. He was completely confused and disoriented and did not recognize her. His pants were wet with urine. Ten days previously he had been a robust 19 year old boy. There is absolutely no excuse for allowing someone to get into such a condition as a result of refusing to provide them with their legally prescribed medication–none.