The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies, brings its readers insights and commentary on current issues of drug use.
A STRATEGY TO REDUCE SOARING OVERDOSE FATALITIES IN PRISONS AND JAILS
As the U.S. confronts an unprecedented overdose crisis—12 individuals die every hour, or more than 108,000 per year—a shadow epidemic receiving far less attention is growing in the nation’s prisons and jails. According to the Pew Charitable Trusts, the drug overdose death rate in prisons increased fivefold from 2009 to 2019, outpacing the national drug overdose rate that itself tripled in the same period.
Blame the increase on the misguided policy of locking up individuals for drug offenses (currently estimated at one in every five, or more than 406,000, of the country’s 2.3 million inmates). Equally troubling, an estimated 65 percent of the prison population has an active substance use disorder. Yet, very few prisons and jails offer treatment of any kind, thereby forcing inmates into harsh detox conditions without services or support. For example, only 12 percent of prisons and jails offer medication-assisted treatment (MAT), which has proven to be a particularly effective method that combines medications such as methadone and buprenorphine that ease cravings with behavioral therapies and peer-based counseling.
The same methods, along with harm reduction, can be used throughout the criminal justice system. First, drug users should be diverted from entering the criminal justice system altogether, where they don’t belong in the first place, as nobody should be arrested and imprisoned for being an addict. Diversion strategies such as drug courts that offer those arrested a choice between jail and treatment are a good starting point. Meanwhile, individuals with opioid use disorder remanded in jail for short-term processing should begin MAT immediately, as they will soon begin to experience withdrawal.
Second, prisons must establish a continuum of care starting with being administered overdose-reversal drugs, followed by MAT programs that serve as a bridge to peer counseling with former addicts. Doing this requires training programs for both inmates and outside staff in recovery to work with those in prison who identify as addicts. Peer counselors function as role models who can help lead substance users to self-understanding and, eventually, long-term sobriety. We know this works: An MAT-focused program in California—the largest of its kind in the U.S.—has reduced the overdose death rate by nearly 60 percent over the past two years.
Finally, we must help released inmates reintegrate into communities. Studies show that the formerly incarcerated with substance use are up to 40 times more likely to die of an opioid overdose than are the general population. Re-entry services must include job and vocational training, transitional housing, and, most importantly, continued access to long-term drug treatment and recovery counselors.
As a society, we must help the incarcerated struggling with substance abuse. Let’s make sure they don’t suffer in isolation, despair, and loneliness. We need a more humane approach that helps inmates attain sobriety—both in prison and after they’ve served their time.
