Suboxone in Jails & Prisons: Current Laws, Benefits & Arguments Against

May 5, 2022

Table of Contents

Suboxone is a prescription medication proven to treat opioid use disorders (OUD). Suboxone therapy can and should be continued for individuals during incarceration, and should also be offered to new inmates with OUD to treat their withdrawal symptoms while incarcerated. Unfortunately, less than 1% of jails and prisons offer Medication-Assisted Treatment (MAT).[1] 

As the benefits of MAT become clearer and clearer, legislation mandating MAT becomes more common and more accessible within the prison system. But ensuring that every inmate has access to MAT is unfortunately still not a reality. 

Benefits of MAT for Incarcerated Individuals 

MAT can help incarcerated individuals maintain abstinence while in prison. Experts say more than 50% of all incarcerated people meet the criteria for a substance use disorder compared to just 5% of the general population.[2] Incarceration may be an optimal time to help patients with SUD recover - they do not have access to illicit substances and may also be at a point in their lives where they are at “rock bottom” and willing to consider a real lifestyle change. 

Moreover, Comprehensive drug treatment programs, including those that offer MAT, may reduce incarceration costs.[3] People working on recovery are healthier, less likely to cause others harm, and easier to assist. Ignoring an OUD can cause significant suffering. People moving through opioid withdrawal and struggling with cravings face mood swings, and those lows can lead to suicide attempts. Suicide is a leading cause of death in a correctional setting, and withholding  MAT and other medically necessary treatments for inmates with SUD could be a factor in increasing suicide risk[4] 

Studies About MAT in Prison Populations

Plenty of studies have shown how MAT helps people in prisons and jails. These are a few key results from those studies. 

MAT & Crime Rate After Release 

People given MAT while incarcerated are less likely to be arrested again when compared to people not given MAT. Researchers followed two sets of prisoners in one study and saw a 32% reduction in probation violations, court charges, and arrests in those given MAT.[5]

When people are sober at release, they're less likely to commit crimes to obtain drugs. Therefore, MAT has the potential to reduce rates of recidivism. 

MAT & Sobriety After Release 

People given MAT remain engaged in therapy during their incarceration..[6] The lessons they learn in jail or prison about taking medications on schedule and sticking with therapy appointments stick with them when they are released. 

MAT & Overdose Risks 

Incarcerated people can’t always get the drugs they want or need, and their drug tolerance drops while serving their sentences. If they return to drugs on release and take the same doses they took before they were arrested, they are at high risk of overdose. In one study, researchers found that released prisoners’ overdose risk was 100 times higher than the general population.[1] If these people had MAT, they would be less likely to seek out drugs on release. 

Arguments Against offering MAT To Inmates 

If MAT is proven effective, why isn't it part of all prison and jail systems? The stigma and legal/financial barriers to obtaining MAT still persist, although that is rapidly changing as society and the medical community learn more about the benefits of MAT, particularly for incarcerated populations. 

Some facilities don't include MAT due to the following:

Outdated opinions

Some people firmly believe that MAT substitutes one addiction for another. They don't see medications like Suboxone as therapies for OUDs. They see these medications as another form of drugs, and this is incorrect. Almost all medical experts condone the value of MAT as a life saving treatment for patients with OUD.

Trafficking concerns

Jails and prisons typically have strict rules about drugs. Prisoners can buy and sell drugs from one another, and that habit can lead to overdoses. 

Misuse is also relatively common. In one study, 63% of prisoners took opioids without a prescription.[7] Some administrators keep MAT out of their facilities to avoid diversion. This however, punishes unnecessarily those who really require the medication for a legitimate medical condition. 

Procedures and processes

The First Step Act, passed in 2019, required the Bureau of Prisons to treat "more" patients. But the bureau is a massive organization that runs 200 facilities in 36 states.[8] 

It will take time for this decision to trickle down to every single facility. In the mean time, the medical field continues to push for reforms that expand access to MAT for all eligible incarcerated individuals. 

The Future of MAT in prisons 

Advocacy groups, legislators, and prominent individuals continue to discuss MAT for use in prison populations, and they push correctional organizations to change their policies to make MAT more accesible. More jails and prisons will likely add MAT capabilities in the coming years. 

We already see changes: Between 2016 and 2021, MAT increased 224 fold in jails and prisons.[9] If this trend continues, more people will get the help they need while incarcerated. 

In 2019, a judge in Maine ruled that an inmate had the right to MAT while serving her sentence.[10] More court cases like this could speed up MAT adoption yet more. 

If you're facing incarceration, talk with your lawyer and doctor about either starting or continuing MAT during your sentence. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons. National Council for Behavioral Health. https://www.vitalstrategies.org/wp-content/uploads/2020/01/Medication-Assisted-Treatment-for-Opioid-Use-Disorder-in-Jails-and-Prisons.pdf. January 2020. Accessed April 2022. 
  2. Opioid Use Disorder Treatment in Jails and Prisons. Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons. April 2020. Accessed April 2022. 
  3. Jail-Based Medication-Assisted Treatment. Advocates for Human Potential. https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf. October 2018. Accessed April 2022. 
  4. Over-Jailed and Untreated. American Civil Liberties Union. https://www.aclu.org/sites/default/files/field_document/20210625-mat-prison_1.pdf. 2021. Accessed April 2022. 
  5. Offering Buprenorphine Medication to People with Opioid Use Disorder in Jail May Reduce Rearrest and Reconviction. National Institutes of Health. https://www.nih.gov/news-events/news-releases/offering-buprenorphine-medication-people-opioid-use-disorder-jail-may-reduce-rearrest-reconviction. January 2022. Accessed April 2022. 
  6. Effectiveness of Medication Assisted Treatment for Opioid Use in Prison and Jail Settings: A Meta-Analysis and Systematic Review. Journal of Substance Abuse Treatment. https://pubmed.ncbi.nlm.nih.gov/30797392/. December 2018. Accessed April 2022. 
  7. Use of Nonprescribed Buprenorphine in the Criminal Justice System: Perspectives of Individuals Recently Released from Incarceration. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/pii/S0740547221000751. August 2021. Accessed April 2022. 
  8. These Meds Prevent Overdoses. Few Prisoners Are Getting Them. The Marshall Project. https://www.themarshallproject.org/2021/08/10/these-meds-prevent-overdoses-few-federal-prisoners-are-getting-them. August 2021. Accessed April 2022. 
  9. Trends in Buprenorphine Use in U.S. Jails and Prisons from 2016 to 2021. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787100. December 2014. Accessed April 2022. 
  10. Setting Precedent, a Federal Court Rules Jail Must Give Inmate Addiction Treatment. National Public Radio. https://www.npr.org/sections/health-shots/2019/05/04/719805278/setting-precedent-a-federal-court-rules-jail-must-give-inmate-addiction-treatmen. May 2019. Accessed April 2022.

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