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Reviewed By: Peter Manza, PhD -

Offering Suboxone in Prisons and Jails

Buprenorphine/naloxone (Suboxone) Medications For Addiction Treatment (MAT) Treatment

Suboxone is an effective medication for opioid use disorder (mOUD) that is shown to improve outcomes for incarcerated individuals.

Close to two-thirds of all people in jail battle a substance use disorder, and opioid addiction is common.[1] Around three-quarters of those with an OUD who are released from prison or jail experience a relapse to opioid use within three months of their release. 

This population is at a much higher risk for dying from an opioid overdose than the general public. Their risk is as much as 10 to 40 times higher.[2] 

This risk is especially great within the first two weeks of being released. They are more than 100 times more likely to die from an overdose than the general public during this time.[3] 

Medications for OUD, which include Suboxone, are clinically proven and effective treatments for opioid dependence and OUD.[4] Taking Suboxone can reduce the risk of relapse and overdose as well as lower rates of reoffending and reincarceration.

Current State of MAT in Prisons & Jails

Unfortunately, even though medications have proven effective to treat OUD, of which there is a high rate within prisons and jails, it is not commonly offered within the criminal justice system. Only approximately 3.6% of incarcerated individuals with an OUD received buprenorphine, the active component in Suboxone, as of May 2021.[5] 

On a positive note, as OUD is increasingly recognized as a medical and chronic disease that can benefit from medications for treatment, the use of mOUD is increasing. Between 2016 and 2021, buprenorphine use in prisons and jails spiked 224-fold, for example.[5] 

Funding for mOUD is increasing, and policymakers and activists are working to reduce the stigma and barriers to the use of mOUD within the criminal justice system.

Benefits of mOUD in Prisons & Jails

The use of mOUD within jails and prisons has many positive effects for both criminal justice executives and incarcerated individuals alike. 

From a criminal justice executive standpoint, mOUD can help to keep inmates more stable and healthier, which can contribute to a safer environment for staff and the prison population. 

Suboxone is also a cost-effective treatment method for OUD. The use of mOUD can help to break the cycle of drug misuse, arrest, release, and rearrest. 

Offering Suboxone as a therapy during incarceration can literally be lifesaving. It can reduce the rate of overdose in the weeks following release by 75% and the rate of death by any cause by 85%.[6] 

When people are in jail or prison, they are cut off from their typical drug supply, which can mean that their opioid tolerance dips. If addiction is not addressed while incarcerated, they may return to using drugs at the same rates that they did before. Since their tolerance has dropped, the same dose could overwhelm their brain and body, resulting in overdose.[7]

Taking Suboxone while in jail or prison can keep the opioid receptors mildly activated, without an associated high, and help to reduce cravings and withdrawal symptoms. This can decrease the desire to return to illicit opioid use, thereby lowering rates of relapse.

Additional benefits of mOUD include the following:

  • Better engagement in opioid misuse treatment programs and support groups
  • Fewer rates of re-offense and rearrest after release
  • Easier transition back into society
  • Fewer health and mental health concerns

Barriers to Treatment

Medications are proven to be effective in treating OUD Use of the FDA-approved medication Suboxone is considered one of the gold standards of care. 

Despite the evidence supporting its use, there is still a high level of stigma surrounding mOUD, especially within the prison and jail population. This can result in less access, ultimately creating a barrier to care. 

Suboxone is often incorrectly viewed as a “replacement” opioid drug or seen as another potential drug of abuse. While Suboxone can potentially be misused, the active component buprenorphine is only a partial opioid agonist, which means that it does not create the same high that full opioid agonists do even when taken in high doses due to its ceiling effect. 

The naloxone component of Suboxone is activated if the drug is misused, which can cause difficult withdrawal symptoms. This serves as a deterrent for misuse. 

The cultural perception of Suboxone as a dangerous opioid drug with a high rate of misuse is simply false.[8] Any perception that mOUD are merely facilitating opioid misuse needs to be addressed through education. Stigma serves as a barrier to treatment, and it can prevent people who need help from getting it.

The structure, funding, and staffing abilities of a prison or jail can also hinder the ability to provide Suboxone to inmates. These are additional barriers to mOUD in the criminal justice setting. 

Suboxone use needs to be monitored, and care needs to be coordinated throughout the entire criminal justice system as inmates are moved. Staffing levels need to be maintained and mOUD access needs to be managed after release from incarceration in order to effectively serve the criminal justice population.

How Jails & Prisons Treat Addiction

Prisons and jails treat addiction differently depending on the setting and the severity of the condition. Not all individuals are appropriately screened when entering the criminal justice system. 

Among those with a known OUD, one of the most intensive and common forms of treatment in prisons and jails is the therapeutic community (TC) model. This provides a highly structured environment and a separate living area within the prison or jail to support and offer intensive addiction treatment programming. 

Additional methods of treating addiction in prisons or jails include:

  • Group and individual counseling sessions
  • Behavioral therapy sessions and life skills workshops
  • Educational programming
  • Peer support groups
  • Medications for opioid use disorder (mOUD)
  • Relapse prevention training 
  • Dual diagnosis treatment for co-occurring medical or mental health conditions

Opioid use disorder is a complex disease that benefits most from a comprehensive treatment model that incorporates both medications and therapeutic care. Whether in a traditional setting or in a prison or jail, treatment should be individualized to the needs of the specific person.

Reviewed By: Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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  1. Jail-Based Medication-Assisted Treatment. National Sheriff’s Association. October 2018. Accessed August 2022.
  2. Breaking the Cycle: Medication Assisted Treatment (MAT) in the Criminal Justice System. Substance Abuse and Mental Health Services Administration. March 2019. Accessed August 2022.
  3. Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit. National Council for Mental Wellbeing. February 2022. Accessed August 2022.
  4. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. November 2016. Accessed August 2022.
  5. Trends in Buprenorphine Use in US Jails and Prisons from 2016 to 2021. Substance Use and Addiction. December 2021. Accessed August 2022.
  6. Over-Jailed and Un-Treated. American Civil Liberties Union. 2021. Accessed August 2022.
  7. A conceptual model for understanding post-release opioid-related overdose risk. Addiction Science and Clinical Practice. April 2019.
  8. Is the use of medications like methadone and buprenorphine simply replacing one addiction with another? National Institute on Drug Abuse. January 2018.

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