A first-in-the-nation program offering a range of medications to Rhode Island inmates who are addicted to opioids appears to have lowered the number of overdose deaths among people recently released from jail and prison, researchers reported Wednesday.

Experts have long advocated for expanding the use of medication-assisted treatment, or MAT, in correctional facilities, but for the most part, jails and prisons remain treatment deserts. Starting in the middle of 2016, however, Rhode Island started rolling out its program and making available to all inmates the three medications approved to treat opioid use disorder.

To gauge the early results of the program, researchers compared overdose deaths in the first half of 2016 with those in the first half of 2017. They reported in the journal JAMA Psychiatry Wednesday that 26 of the 179 people who died in the state of an overdose during the 2016 period were recently incarcerated, while only nine of the 157 people who fatally overdosed during the 2017 period were recently incarcerated. (They defined recently incarcerated as being released from a correctional facility in the prior year.)

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The researchers calculated that officials needed to treat only 11 inmates to prevent one overdose death.

“We took action, and now we’re beginning to see some of the results,” said Eric Beane, Rhode Island’s health secretary.

People leaving correctional facilities without treatment face incredibly high overdose risks because their tolerance to drugs has dropped and they often reenter the same settings with the same triggers where they used drugs previously. One previous study found that former inmates overdose at rates nearly 130 times as high as the general population in the two weeks after they are released.

The researchers acknowledged their data were preliminary and that it was a small study, but said they could not identify other factors that could have contributed to the drop in overdose deaths among former inmates. The number of inmates being released was about the same in the two time periods, and the number of people using drugs did not seem to change. Plus, the opioids available on the street are only becoming more potent, which increases the risk of overdose, they said.

“The MAT program at the prison may be providing us with really good news,” said Traci Green of Brown University and Rhode Island Hospital, who led the new study.

Rhode Island has had some advantages as it has developed its program. The state has budgeted about $2 million for it annually, and there are no county jails. All inmates are housed at one campus, which allows them to continue treatment if they move from jail to prison, for example. The program also helps inmates get insured and transition to treatment providers upon their release.

The program offers inmates methadone and buprenorphine (opioids that reduce cravings and ease withdrawal symptoms), as well as naltrexone, which blocks people from getting high.

Many law enforcement officials have resisted giving methadone and buprenorphine to inmates because they are also opioids — despite the evidence that shows they are effective medications to treat opioid use disorders — and because they worry about the diversion of the medications, particularly buprenorphine, which is also known as Suboxone.

Dr. Jennifer Clarke, the medical programs director for the state corrections department, said authorities initially saw some diversion of buprenorphine when the program was providing tablets, but have seen less since they switched to giving inmates a dissolvable film.

Rhode Island officials have emphasized the best treatment is the one that an inmate wants to take and will stick with, which is why they offer all three.

The researchers reported that in the first half of 2017, 119 inmates received buprenorphine on average each month, 180 took methadone, and four were given naltrexone, also known by the brand name Vivitrol.

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  • Alan was one of the first Yale many many years ago and the early 2000s to start treating prisoners with methadone before their release now they’ve gone statewide instead of just their pilot program. They were instrumental in getting Connecticut to follow. There was a time in Connecticut when I was an advocate and men were dying from suicide due to opiate withdrawal they were in pain and they couldn’t take it, we met with Connecticut officials at the DLC and we’re going to file a discrimination lawsuit because all women were treated with methadone at least for detox I want kept on methadone but they were detox. Now their rulers anything two years and under for certain men and certain jails to be a methadone if you’re not lucky enough to get one of the few slots they have their still being treated in this barbaric manner women also if you have over a six-month sentence for detox and you’re not kept on methadone. it causes less fights, it causes less inmates to suffer, truly I don’t think that the dealsea officials care about that, but Connecticut antiquated the only reason that they are getting some then opiate treatment is due to places like the APT foundation which is going into the New Haven correctional system and giving men and a small number of slots is there allowed to methadone to stop these horrible withdrawal symptoms. Connecticut go she needs to get with the program, the money they’re spending irony incarcerating inmate for simple drug possession and for being drug users rather than giving them treatment is utterly ridiculous. It happened to me I got sentenced to 5 years for drug possession charge of one bag of drugs. I was made to detox 115 mg of methadone in a month I didn’t sleep honestly one full night for 28 month I was in agony I’ve done a methadone clean for 15 years straight. Thank you for this great article and I certainly hope the Connecticut DLC can get with the program and get these people medicated like they should be

  • I watched the program last evening on this program. I am wondering, if there is a way to ween these persons off of the alternative drug over a period of time?

    They did not touch upon this in the article or the documentary. Does anyone know?

    Thanks,
    Sincerely
    Ken Karasiuk

    • Yes, a medically supervised taper is available, but please note that this is a long term treatment. This treatment is meant to be a maintenance that last an average of 3-5 years, and for some a lifetime. This allows someone suffering with a substance disorder to begin to work on the pain, trauma, or mental health related concerns that are associated with the start of the “numbing” and addiction.

    • Hi Ken, yes there is a standard for reducing methadone dose and titrating down to a lower dose or off totally there are people have successfully done it. I was on high-dose 120 and I wean down to 53 so I definitely can be done but that’s got to be the addicts choice was it they feel safe enough and secure enough to get off there methadone that probably saving our lives right now but yes that is always a goal for methadone patients to be free of having to take a drug every day. We also have to remember that addiction is a disease just like diabetes for example is it disease and people don’t stop taking their insulin or wean off of it so why would we want an attic to wean off of their medication?

  • medically assisted treatment is NOT treatment.,it’s only a band aid. Prisons should offer real recovery services to inmates including 12 steps, counseling, yoga, job skill and life skill training WHILE they have housing and food in prison. Recovery from addiction is multifaceted and long term. Substituting one drug for another keeps them addicted AND fuels pharmaceutical companies profits. This is not a solution!

    • I think the best chance is to combine the MAT with all the behavioral strategies you suggest. I would love to see a both/and approach with addiction rather than an either/or. Addiction is a chronic disease and like most others is best treated with a combination of medication and behavioral changes.

    • Your comment is simply wrong and it is irresponsible. Methadone is treatment. When you look at the evidence and outcomes Methadone is the GOLD STANDARD for treatment as well as provides A protective factor for overdose. 12 step treatment has less than a 5% success rate and by most standards would not and is not considered a medical treatment. People who are detoxing and then binging are at extremely high risk for overdose death. I know all too well what happens when people believe that methadone and or suboxone are some form of second-class recovery/treatment. PEOPLE DIE. The evidence is very clear about MAT. It works. We don’ say to people how did you overcome your depression. Did you take Celexa or some other antidepressent?? Well that is not real recovery….!!! No one cares how you show up for your life, your family, etc. They are just glad you did. Harm Reduction strategies saved my life and I know they have the power to help others make positive changes. Recovery is about the process, not some final destination. Celebrate the small victories because life is tough.

    • A Band-Aid? do you know how many lives methadone had saved? Before you make comments like this? Do you realize how many people hold jobs now? Do you realize how the crime rate is going down? And for your information these prisons do also offer 12-step programs if you’re one of the lucky few to get your name on the waiting list which is months-long. Please, please before making a comment be informed as to what you’re commenting about.

  • Typical misleading justification for giving opiates to people in prison. As a detox drug? Fine, but putting them on methadone and then claiming a great success in that they don’t overdose when released is misleading. The reason they don’t overdose is because their tolerence – their dependence on opiates has been upregulated so high they wont overdose. So what then? Opiates forever? I escaped from the false promise of Methadone 30 years ago and I know what harm it does. It took several years before I felt halfway normal again.

    • You are completely incorrect asserting suboxone prevents OD through tolerance. The smallest dose of suboxone occupies the nerve receptor so thoroughly other opioids are unable affect the user and, suboxone is a partial agonist.

    • So you do agree that all inmates should be given methadone as a detox drug? Well at least we’re getting somewhere because most jails and prisons don’t even do that. I don’t blame you for your opinion I think you’re just not up to date on the new statistics this is what we used to hear in the late 90s that methadone was a Band-Aid oh, that would giving addicts a replacement drug. Methadone is not replacing heroin. Methadone does not give you see you for feeling that heroin does. Methadone keeps you from getting sick, methadone allows you to leada normal life and it is one of the most studied drugs in the history of America. And just a question of personal matter oh, why do you care if people stand methadone in jail? How in any way does that affect your life? I can easily answer that question because I don’t want to see people die when they leave jail. What’s your answer?

  • I was a correctional nurse for 5 years. Before smoking was stopped the inmates would crush any medication and put it in their cigarettes. They had it all figured out how to abuse drugs. One thing they were not allowed was opiates. I don’t doubt that there was a problem with over doses. Why in he world would you give them opiates ? If you asked all of them were in terrible pain but during rec they could get out there and play basketball. Sounds to me like you were asking for trouble.

    • Relapse is a very real and deadly threat for addicts leaving prison. Of those in from the civilian population who quit opioids cold turkey, less than 5% are still abstinent 5 years later. Why would those statistics change for inmates? Suboxone (and methadone) offer a way to prevent over dose death and, of those that do quit using these medications, 65% are still abstinent 5 years later. In answer to your question, you give them opiates to save their lives.

    • Why does it matter if they are in pain or pretending to be in pain. The bottom line is Methadone and suboxone save lives, same money due to less crime bring committed and in my personal opinion (i was a heroin addict for 10 years and i have been on suboxone for 10 years, and trust me when i tell you my life is far more productive on bup.)
      I truely feel that it is a grave miscarrige of justice to use the criminal “justice system ” to force this insane american, puritan and immoral quest to dictate to other wise non criminal citizens to abstain from “drugs” and dictate to them what they should and should not consume into thier bodies.
      Its just plane WRONG
      NOBODY SHOULD TELL ME WHAT I CAN ABD CAN NOT DO WITH MY BODY.
      IT IS NOBODY’S BUSINESS (LEAST OF ALL SOME LAWMAKER)

  • My wife have been on suboxon for years doing great she got locked up in jail for something she did in past she the jail is refuseing to give her anything she calls me crying suffering I love my wife so much I need help please anyone that can help

  • MAT indeed. This is called “Giving dope to addicts”. Note that Naltrexone, which is not an opiate, had 4 — 4 — prisoners using it.

    I don’t object to giving dope to addicts. In a lot of cases, it is the most useful option. I’ve worked in both abstinence oriented and maintenance programs, and can see virtues in each. Calling it MAT is a bit much. What we are seeing is the result of the complete medicalization of the addiction cycle, from beginning to end. We now believe that most opiate addicts start their careers with prescription meds; we now also believe that the best way to stop those careers is with prescription meds. Ironies abound.

    Our thinking about addiction is now less helpful than it was 50 years ago.

    • MAT indeed. Methadone isn’t “dope.” Suboxone is a partial agonist and respiratory failure is almost unknown. The quality of life when comparing those in a MAT program to those using street drugs speaks for itself. This article discusses a population that is significantly more at risk for overdose death then the average addict and the use of MAT has cut that potential in half.

    • A Band-Aid? do you know how many lives methadone had saved? Before you make comments like this? Do you realize how many people hold jobs now? Do you realize how the crime rate is going down? And for your information these prisons do also offer 12-step programs if you’re one of the lucky few to get your name on the waiting list which is months-long. Please, please before making a comment be informed as to what you’re commenting about.

    • Yes in this crisis where nearly 150 people a day are dying we need every option. Sadly RI has criminalized a plant that is helping millions stay clean. Kratom is a lifesaver but is being demonized by the FDA because it will take away from big pharma. I know someone who was able to be free from opiates and heroin and then a year of suboxone with kratom and medical cannabis. His life is now one of hope health and happiness. #keepkratomlegal

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