When Children’s Scribbles Hide a Prison Drug
I was intrigued by an article I saw on my internet homepage. It was titled: “When Children’s Scribbles Hide a Prison Drug”
This article describes unique ways Suboxone is being smuggled into jails. Law enforcement officials associated with both state and county jails from Maine and Massachusetts were interviewed. They say prisoners and their accomplices make Suboxone into a paste and smear it over the surfaces of papers sent to prisoners from their families. The article mentions the paste being spread over children’s coloring book pages, and under stamps. Suboxone films have been placed behind stamps or in envelope seams. Correctional officers now have to inspect material coming in the mail to prisoners much more closely.
I had several thoughts. First, yet again, I’m struck by the creativity and cleverness of addicts. If only they could channel this energy in the right direction, amazingly good things could come to them, instead of the continued hardships brought by addiction.
Then I felt sad that such actions described in the article would taint the reputation of a medication that has the potential to save lives, when used appropriately. Such illicit use of Suboxone gives ammunition to those who would prefer that office-based treatment with Suboxone didn’t exist.
Then I wondered, how many of these prisoners have a legitimate prescription for Suboxone, but are denied their medication by prison officials? How many are legitimate patients of methadone clinics, also denied their medication while imprisoned, who know that Suboxone will alleviate some of the opioid withdrawal they are feeling? How many of these people are addicted to opioids, not in any kind of treatment, but who know Suboxone will treat their withdrawals?
At least one study supports the idea that many people use Suboxone illicitly not to get high, but to prevent withdrawal. Dr. Schuman-Olivier studied 78 opioid addicts entering treatment. Nearly half said they had used Suboxone illicitly prior to entering treatment. Of these people, 90% said they used to prevent withdrawal symptoms. These addicts also said they used Suboxone illicitly to treat pain and to ease depression.
Many law enforcement personnel and members of the legal community have strong biases against medication-assisted treatments. They don’t understand that addiction is a disease, and that methadone and buprenorphine are legitimate, evidence-based treatments. They have difficulty letting go of their idea that addiction is a choice that deserves blame, and have a punitive stance towards addicts. They have low opinions of addicts who are using drugs, but often have no better opinion of a recovering addict who has sought treatment and is doing well on replacement medications, like methadone or buprenorphine.
But no matter what law enforcement personnel think they know, when they deny prescribed, life-saving medications, I believe they’re practicing medicine without a license.
The article mentions one woman who, with the aid of the Maine Civil Liberties Union, sued because her Suboxone treatment had not been continued while she was in jailed for a traffic violation. She settled out of court, but her lawyer made the excellent point that if inmates are denied their medications, they will try unlawful means to get it.
Other patients and their families have brought successful lawsuits against the jail facilities. In at least two cases, in the same Orange County, Florida jail, patient/prisoners were allowed to go through withdrawal for so long that they died. The estate of one person won a three million dollar judgment against the county.
I’m glad to see these lawsuits. I’ve heard appalling stories from many methadone patients, who were denied their medication while incarcerated. I’ve heard tales of jailers taunting these prisoners, when they became sick. There is no defense for such cruelty.
Orange County now works with local methadone clinics. If a prisoner is a current patient of a clinic, his clinic will send a week’s worth of medication in a locked box via courier. Nurses at the jail have the key to the box, and administer each day’s dose. The jail doctor consults with the medical director at the methadone clinic. Prisoners still have to pay out of pocket to get the medication, so the only cost to the jail is the time required for personnel to administer the medication. It’s certainly much cheaper than paying three million to the estate of a dead prisoner, not to mention much more humane.
I wish the county jails around the methadone clinic where I work would approach the problem of opioid addiction and treatment in a collaborative way. Sadly, only seven state prison systems offer medication-assisted treatment with methadone or buprenorphine.
Rikers Island, in New York City, gives us another example of how such a system could work. There, opioid-addicted prisoners charged with misdemeanors or low grade felonies can be enrolled in a program known as KEEP (Key Extended Entry Program). This program treats opioid addicts with methadone and counseling. Upon release from Rikers Island, these patients are referred to methadone treatment centers in the community. Seventy-six percent have followed through with their treatment, post-release. The results of this program show significant reduction in reincarceration and significant reduction in criminal activity. (3)
Drug courts trying to save money would be well-advised to look at the Rikers Island program. Studies have shown a cost savings of at least four dollars for every one dollar spent on methadone treatment. This money is saved because methadone patients require fewer days of hospitalization and other healthcare costs, and also because of reduction in criminal activity and incarceration costs. (3, 4)
I know from comments written to this blog that there are many more people abusing Suboxone than I previously imagined. For sure, some of the prisoners getting smuggled Suboxone are misusing it. But I don’t think the majority are using for anything other than prevention of withdrawal, since they are usually not offered any other effective treatment for this medical condition.
::::::::::::::Followup by Dr. Frank Vocci, PhD, President of Friends Research Instistitute::::::::::::::::
In the United States today, there are more than two million jail and prison inmates, of whom about 15 percent have histories of heroin dependence. Few inmates receive drug abuse treatment while incarcerated or immediately upon release. Research has shown that this population, once released from incarceration, is at high risk of relapse to heroin use, criminal behavior, HIV infection and of overdose death, resulting in a terrible toll on the individuals, their families and our communities.
The World Health Organization supports the international standard that prisoners have the right to access the health services that would be available to them in the community. Health care in prisons is then a human rights issue and treating drug-dependent prisoners in jail and prison is consistent with the spirit of that standard. However, the correctional systems in the U.S. have been slow to embrace this notion and have shown even less comfort with providing medications to treat addictive disorders.
There are now several FDA-approved medications available in the U.S. to treat opioid dependence. Methadone has been available to treat opiate dependence since the early 1970s. Buprenorphine (Subutex and Suboxone) has been available since 2003. Oral naltrexone, an opioid antagonist, has been available since 1984 and the recently-approved Vivitrol, a long-acting, injectable form of naltrexone, is now available.
Unfortunately, these medications are infrequently provided to opioid-dependent adults in U.S. jails and prisons and in the community under parole or probation supervision.
There are multiple barriers impeding the improved treatment of opioid-dependent inmates, probationers and parolees. There is an inherent contradiction between custodial and treatment goals. Moreover, many correctional officials may not be aware of the strong evidence supporting the effectiveness of medications in reducing drug use and criminal activity. They may be philosophically opposed to the use of medications or reluctant to increase their budgets to include medical services for addiction treatment. Moreover, many corrections officials in charge of jails and prisons feel their responsibilities end when the inmate is released from their facility.
The question can then be asked: How can change be affected in the criminal justice system to improve the treatment of opioid-dependent prisoners? The answer may lie in current research, the majority of which is funded by the National Institute on Drug Abuse (NIDA).
Two different approaches are being used. The first is to test medications in opioid-dependent prisoners and those newly released from jail or prison. A recent study by Dr. Timothy Kinlock and colleagues at the Friends Research Institute established that adding methadone to counseling in prison increased the likelihood that a prisoner, upon release, would continue to receive drug abuse treatment in the community, reaping the benefits of this medication; e.g., reduced risk of drug use and of overdose. An ongoing multi-site study led by Dr. Charles O’Brien at the University of Pennsylvania is underway among adult probationers and parolees to evaluate the effectiveness of long-acting naltrexone, which protects from relapse and overdose for one month. The research team at Friends Research Institute is also conducting a study of the effectiveness of Suboxone in prisoners with histories of opioid dependence.
The second approach is to forge better linkages and enhance collaboration between the criminal justice systems and the treatment clinics where effective medications for the treatment of alcohol and/or opioid dependence are available. The Criminal Justice-Drug Abuse Treatment Studies initiative of NIDA is currently funding a multi-city study. Its intent is to improve service coordination between parole and probation agencies and drug treatment clinics that provide medications for addiction treatment through an intervention aimed at improving knowledge and attitudes among community corrections (CC) staff and enhancing inter-organizational relationships. It is anticipated that improved knowledge and attitudes among CC staff will increase the number of criminal justice referrals to the treatment clinics.
Everyone wins by bringing the power of science to bear on the challenges of drug dependence in the criminal justice system. The opioid-dependent individuals reduce their likelihood of relapsing and dying of drug overdose upon release. A reduction in criminal and HIV-risk behavior improves public safety and protects the public health, and avoided episodes of reincarceration save the taxpayers money.
Frank Vocci, PhD, is President of Friends Research Institute, which promotes health and well-being through research, grants administration, education and treatment.
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