Study: Prisons fall short in addiction treatment

For four decades, methadone has been the treatment of choice for opiate addiction, and in recent years, the drug buprenorphine has gained wide acceptance. But in about half the nation’s prison systems, heroin and other addicts still have to quit cold turkey.
In addition, only 23 states refer inmates for follow-up addiction treatment upon their release. On both fronts, the prisons are going against guidelines from the World Health Organization and the U.S. Centers for Disease Control & Prevention.
Those are the findings of a new study by researchers at The Miriam Hospital, Brown University and their affiliated Center for Prisoner Health and Human Rights, published online by the journal Drug and Alcohol Dependence.
The researchers surveyed all 50 state prison systems, plus Federal Bureau of Prisons and the District of Columbia prison, asking about their opiate replacement therapy (ORT) prescribing policies and about their post-release referral programs. They received 51 responses.
Only 28 of the systems said they offered methadone to any prisoners, the study found that more than half of them only provided it to pregnant women or for chronic pain management. About 45 percent of facilities offered referrals to methadone programs post-release.
Only seven prison systems said they offered buprenorphine to at least some inmates, and 15 said the offered referrals to community buprenorphine providers upon inmates’ release.
“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, the study’s lead author and an assistant professor of medicine at The Warren Alpert Medical School of Brown University.
“Improving correctional policies for addiction treatment,” she added, “could dramatically improve prisoner and community health as well as reduce both taxpayer burden and reincarceration rates.”
Dr. Josiah Rich, co-director of the Center for Prisoner Health and Human Rights, noted that opiate addiction causes long-term changes to the structure and functioning of the brain, which is why it is classified as a disease.
“Addiction requires treatment just as other chronic diseases, like diabetes and cancer, do,” he said. “Unfortunately, there is a large gap between the number of prisoners who require addiction treatment and those who actually receive it.”
The United States has the world’s highest incarceration rate, with about 10 million people incarcerated each year. More than half of inmates have a history of substance use, including more than 200,000 with heroin addiction.
Asked why they don’t offer ORT to inmates, the majority of survey respondents said they prefer drug-free detoxification, and several cited security concerns. But 27 percent of medical directors said they didn’t know how beneficial methadone is for opiate addicts, and half said they were unaware of the benefits of buprenorphine.
“In spite of overwhelming scientific evidence demonstrating that pharmacological treatment for addiction has greater health and social benefits than abstinence-only policies, many prison directors are philosophically opposed to treating substance use,” said Nunn, noting that many also don’t make community referrals. Interviews with prison medical directors, she added, suggest that changing those policies “may require an enormous cultural shift within correctional systems.”
The study was supported by grants from the National Institute of Health’s National Institute on Drug Abuse and Center for AIDS Research and the Tufts Nutrition Collaborative.