Multiple leaders across the nation have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails.
Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely to die from overdose than members of the general population.
This is despite the fact that we have robust evidence showing that we can decrease the incidence of relapse, overdose, drug-related health complications like HIV transmission, criminal activity after release and recidivism by offering treatment. A study published recently in the journal Addiction showed that offering medication-assisted treatment in prisons reduced drug-related overdose deaths by 85 percent in the four-week period following prisoner release and reduced mortality from all causes by 75 percent over the same period. Few other medical interventions have demonstrated such success.
Unfortunately, however, the majority of correctional facilities in the United States do not offer programs for people addicted to opioids. This is not a problem of resources. Many incarcerated patients currently receive appropriate care for other chronic conditions, including diabetes, HIV, cancer and even more-newly-recognized disorders, like gender dysphoria. Our federal and state corrections systems have the capacity to offer this treatment — a treatment defined as “essential medicine” by the World Health Organization.
Skeptics will argue against such treatment by asserting that it is too expensive, or that it will be “diverted” and used inappropriately, or that the people with addictions who end up incarcerated should have taken more personal responsibility. But these interventions have been shown to be cost-effective. As a primary care physician who has worked with formerly incarcerated patients, I have seen first-hand that suboxone allows many people to concentrate on their lives instead of their addictions upon their release from jail or prison. And if we want to save lives on the streets, we cannot send people out of prisons untreated and abandon them when they are the most vulnerable to overdose. If we’re serious about addressing the opioid epidemic, we have to pay attention to the evidence demonstrating that opioid treatment in jails and prisons is highly effective, and we must act by quickly expanding such treatment to many more facilities around the country.
Current programs offering in-facility treatment should guide the nation, serving as examples of how we can provide vulnerable, disenfranchised people with the care they deserve as fellow humans and members of our society.
Dr. Justin Berk is a combined internal medicine/pediatrics resident in urban health at Johns Hopkins Hospital.