Medication Assisted Treatments in Prison and Jail Populations

Medication Assisted Treatments (MATs) are a central component of Opioid Use Disorder (OUD) treatment, and are especially vital to the prison and jail populations who struggle with addiction at a disproportionately higher rate than the general population, according to a study called Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. by The Department of Health and Human Services.

“Correctional Facilities showed that 23% of state prisoners and 18% of federal prisoners report lifetime use of heroin and other opioids,” the study wrote.

Because people are forced to remain sober throughout their time in correctional facilities, their tolerance levels often increase and they are therefore more likely to overdose when they are released.

“Within two weeks of being released, former inmates overdose at rates nearly 130 times as high as the general population,” according to an article by Stat News.

Because of this, it is especially important that treatment is administered prior to their release.

MATs, in this study, is a term used in reference to methadone, buprenorphine, and naltrexone – three drugs used to counteract the effects of opioids. Methadone is one of the most widely used forms of opioid addiction treatment, and it is a full opioid agonist which reduces the symptoms of opioid withdrawal and increases treatment retention. Buprenorphine is a partial agonist which is effective in reducing illicit opioid use and addresses opioid withdrawal and cravings, similarly to methadone. Naltrexone is an antagonist that has not been thoroughly researched or approved by the U.S. Food and Drug Administration, but studies show that it also increases treatment retention and reduces illicit opioid use.

Despite the positive effects that MATs can have on a person’s battle with addiction, these treatments are rarely used in correctional facilities, depriving inmates of the opportunity to rehabilitate while incarcerated.

This study investigated the effects of MAT treatment during incarceration on inmate substance use and treatment initiation post-incarceration. Results showed that participants who used any of the aforementioned treatment drugs throughout incarceration were more likely to engage in community-based substance use treatments post-release, as compared to those who solely used methadone for detox purposes.

“Pooled effects from the meta-analysis suggest that inmates who received methadone during incarceration were more than 8 times as likely to engage in community-based substance use treatment compared to those who did not receive methadone during incarceration, and there was consistent support for engagement in treatment across observational studies.”

Studies examining the effects of buprenorphine and naltrexone found similar results. Participants on buprenorphine were more likely to engage in treatment post-incarceration compared to participants receiving methadone. Additionally, individuals with a naltrexone implant were more likely to participate in treatment six months post-release compared to a control group receiving methadone.

This is a method proven to be effective in reducing illicit opioid usage, and working to incorporate it into prison systems should be a leading priority for criminal justice officials.

Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43.

Stress and Isolation Can Impact Substance Use

People who have a history or are currently dealing with addiction are especially vulnerable to relapse when faced with isolation, and this is especially worrisome given the intensity and duration of isolation associated with the COVID-19 crisis. With restrictions on travel and unusually stressful economic and social changes, people across the world are forced to find ways to pass time and to cope with stress. Substance use can be a maladaptive coping strategy that many people may fall back on during these difficult times.

A Forbes article noted that the sales of spirits spiked about 50% the week of March 21, a week when the onset of the pandemic began to overwhelm the United States.

“Nationally, tequila saw the biggest spike, up more than 75%, underscoring its status as the fastest growing spirits segment in the U.S,” said Forbes contributor, Joseph V Micallef. “It was followed closely by gin. Wine sales were up 66% and beer sales, in a reversal of the usual recession consumption pattern, lagged even though they still rose 42%.”

A study was conducted by the Pacific Neuroscience Institute (PNI) on the effects of stress and isolation on relapse. The results indicated that the effects of people who struggle with drug or alcohol use are at increased risk of relapse in isolation. “Preclinical studies show that animals kept in isolation are more likely to press a lever to receive a dose of drug or alcohol than animals able to interaction with other animals.”

The connection between isolation and an increased need for stress-relieving rewards is proven to be a chemical reaction. The PNI recommends that those who are struggling seek out regular social interactions with sober family members, friends or other people who can offer support. There are online platforms set-up to support individuals who are struggling and cannot receive in-person help during the pandemic.

AA and SMART Recovery are two recovery platforms that have online services including specialized group forums, peer support groups, meetings, and other events designed to create remote support systems for individuals in need.

Doctors and mental health specialists are also accessible throughout this time and available to ensure that everyone has the resources they need during this global health crisis. Personal health is of the utmost priority during this time and is something we could all focus more time on.

Reach out to any people or organizations who can help you get through this difficult time, and don’t forget to make your support available to others as well. We’ll all get through this together.