I

f you have type 1 diabetes and wind up behind bars, you’ll get the insulin injections needed to control your blood sugar. If you don’t, there will be public outrage over this violation of your human rights. But if you have an opioid addiction — like type 1 diabetes, a disease that could rob you of your life — and are taking an opioid agonist medication like buprenorphine or methadone to stay sober, it’s virtually guaranteed it will be stopped the day you step foot inside your cell.

Over the next few days you’ll go through a brutal withdrawal and your risk of relapsing will soar. Once you’re released, there’s a good chance you’ll use opioids almost immediately, along with the possibility that you’ll accidentally overdose and die.

This barbaric practice happens across the country every day. As an addiction psychiatrist, I’ve heard horror stories from patients who’ve been through it, most recently my patient Shawn (I’ve changed his name for privacy).

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I had been treating Shawn for six months. One day he didn’t show up for an appointment. Unexplained absences aren’t unusual for patients struggling with addiction, but Shawn had always been there, on time, when he said he would. His addiction was in remission, thanks to his diligence, group therapy, and the combination of buprenorphine and naloxone (Suboxone) I prescribe for him. Like methadone, this medication is taken daily to stave off withdrawal symptoms and cravings for opioids.

Worried, I left Shawn a message, but didn’t hear back from him. As the days passed with no word from him, anxiety gnawed at me. Had he overdosed? Was he still alive? He hadn’t given me an emergency contact, so I searched online for an obituary, a morbid ritual that has become commonplace among addiction specialists. The search turned up nothing.

Two weeks later, I spotted Shawn slouched in a chair in the waiting area outside my office. He looked tired and anxious. He explained that he’d been pulled over by a police officer while driving, then arrested on an outstanding warrant for unpaid court fees dating back to when he was actively using heroin. He was taken to a Massachusetts jail, where the rules didn’t allow him to take Suboxone.

Without this medication, he was forced to endure the agony of withdrawal over several days.

“I just laid on the floor moaning and puking everywhere. I was hurting so bad I couldn’t sleep at all. I thought I was going to die,” he recounted. “I told the guards to call you, but they didn’t care.”

An opioid addiction condemns an individual to a vicious cycle that starts with euphoria that is soon replaced by withdrawal symptoms. They can be avoided only by taking more opioids. Stopping cold turkey, by choice or by force, without an appropriate detoxification process leads to extreme bouts of anxiety and severe pain accompanied by repeated episodes of nausea, vomiting, and diarrhea. Cravings for opioids to relieve these symptoms occur over and over. The experience won’t usually kill, but its victims often wish for the mercy of death. Those who have gone through withdrawal and started using opioids again will often do whatever they can to get their hands on the drug so they don’t have to repeat the suffering.

Shawn was lucky. He was in jail for only a little more than a week. And immediately after being released, he started taking the Suboxone he had at home.

Most prisoners with opioid addictions who have their medication stopped don’t have any of it waiting at home for them after their release. Instead, they turn to the streets for illicit opioids to alleviate their cravings. This often leads to overdose and death, because they’ve lost their tolerance to the drugs while incarcerated.

The Massachusetts correctional system isn’t alone in needlessly inflicting the misery of opioid withdrawal on prisoners and putting them at risk of relapsing on heroin — the commonwealth’s actions reflect standard practice around the country.

The U.S. Department of Justice has opened an investigation into whether the treatment of prisoners like Shawn by Massachusetts correctional officials violates the Americans with Disabilities Act. The American Civil Liberties Union recently filed a similar lawsuit against a county sheriff’s office in Washington state. These legal actions reflect the growing awareness that addiction is a disease of the brain and not a moral failing of the soul, so it should be treated like diabetes or any other chronic illness.

The cinder-block buildings and razor-wire fences of correctional facilities across the U.S. hide thousands of opioid-addicted prisoners from the public eye. An estimated 60 percent of prisoners in the U.S are addicted to opioids or other substances.

A staggering one-third of those with opioid addictions — hundreds of thousands of people — are imprisoned each year in the U.S. I have worked as a psychiatrist in a prison and a jail, where I’ve seen far too many individuals undergoing agonizing withdrawals from heroin and other opioids that could have been alleviated with Suboxone or methadone. It infuriated me that I wasn’t able to help them, handcuffed by regulations forbidding the use of these lifesaving medications.

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Even after withdrawal subsides, many inmates with opioid addictions experience continual cravings throughout their confinement, magnifying their addiction. Among inmates with untreated addiction, almost all (95 percent) return to using drugs within three years. During the first two weeks after release, the risk of dying — mostly from drug overdose — is nearly 13 times higher than it is among non-incarcerated state residents.

Among people with opioid addictions, taking an opioid agonist reduces the odds of relapsing into drug use and dying from an overdose. Individuals who have already overdosed on opioids are at a significantly increased risk of death from future overdoses, while starting on medication halves that risk. Medication-assisted treatment with Suboxone, naltrexone, or methadone should be available to every opioid-addicted inmate in our criminal justice system. Incredibly, most correctional facilities in the U.S. don’t allow the use of any of these medications.

Individuals with addictions who receive treatment during incarceration are at a much lower risk of relapsing and committing crimes after their release, which helps protect the society at large and saves taxpayer money in the long term. With a re-arrest rate of 67 percent within three years of release among drug offenders, we should be using any available means to reduce recidivism.

Rhode Island is currently the only state using all available medication treatments for opioid addiction in its jails and prisons. Post-incarceration overdose deaths there have plummeted more than 60 percent, contributing to a 12 percent reduction in overdose deaths statewide.

While most state governments are hesitant to support such a radical policy change, the treatment-during-incarceration approach is not new. Many countries in Europe and elsewhere, such as Canada, Australia, and Iran, have long been treating opioid-addicted inmates, in some cases for decades. In the U.S., however, strong opposition from corrections officials and their lobbyists has been one of the most significant barriers to making treatment during imprisonment a reality.

Cost is a primary consideration for them. While it is cheaper in the short term for facilities to simply let inmates suffer, society bears a much larger expense for this strategy later on. There’s also concern about methadone and Suboxone being misused by prisoners, since they are sometimes smuggled in for purposes of intoxication or self-treatment of withdrawal. Yet many countries have navigated the misuse challenge and found that the medications have far more benefits than downsides.

A few U.S. prisons are starting to use naltrexone to treat opioid cravings, since it doesn’t have the potential for causing intoxication and has no street value. That’s a small step forward. Naltrexone doesn’t ease withdrawal symptoms and isn’t effective for cravings in all patients, so it is just one piece of the treatment puzzle.

Seeing just one inmate go through opioid withdrawal without treatment was more than enough to open my eyes to the cruelty of how we treat prisoners with addiction. I’m not sure how correctional officers can bear watching it happen again and again. I’m even more puzzled that state officials think that forcing addicted prisoners to go through withdrawal on their own is the right thing to do, when we have so much data demonstrating the horrific downstream consequences.

We need to get opioid-addicted inmates into treatment and maintain them in it after release.

As the opioid epidemic consumes a generation of Americans, it’s clear that a change in our strategy is badly needed. It’s time for us to expand our efforts inside jails and prisons and open a new front in the battle against this scourge, so we can finally start to subdue it.

Brian Barnett, M.D., is an addiction psychiatry fellow at Harvard Medical School and Partners HealthCare.

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  • If Suboxone has been taken to prevent withdrawal, the individual had ALREADY GONE through withdrawal, WHY, GO BACK & RE-START TAKING IT AGAIN???!!! For many or (at least) some, staying AWAY from opioids or ANY ADDICTIVE substance should be the best choice and ADVICE.

    • Magdy – let me explain it this way – you have a diabetic, whom takes insulin. They take a shot of insulin, and their blood sugar normalizes. Why would we need to give more insulin…. sounds pretty silly does it not???

      Dependency re wires the brain in such a way they do not feel “right” with out some Mu receptor agonist action. (talk to people dependent to learn this)

      Also, as we have learned by doing it wrong for decades, the physical side of w/d will last anywhere from 3 days to 6 months (easy to verify, just check T levels with a person on chronic opioids and wait for it to normalize after d/c of the medication)

      So Bup or Methadone are not the “advil for a head ache” but instead the “insulin for the diabetic patient”

      I must say it is amazing how much lack of education is out there even among the providers about what dependency and addiction truly are. If we are not capable to learning and advancing the medical knowledge then we will just be stuck in the past…..

    • Magdy,

      I suppose that advice, well-meaning or not isn’t what’s really the answer.
      What’s at stoke is personal freedom.
      Getting better or well for anyone suffering from a substance use disorder is a concept that rings hollow to an addict or alcoholic.
      Every day and even moment, is just anothe time that this disease keeps up the insistence that “We don’t have it!!”. It’s the only disease humans have that tells us this lie.
      Also, just for arguments sake, look at one attribute given to us forever; Free Will. That includes making choices and taking action on thoughts we have. Unfortunately, the scientific evidence shows that the mind of even the potential addicts a very very complex and busy place.
      He or she is predisposed to a number of other medical-psychological conditions, making no-brainer rational decisions a real crapshoot.
      Also, people just don’t understand addiction at all. It seems society and government make up the prevailing views of those people predetermined to agree to be led or brainwashed.
      It’s a travesty of humanity that the hatefulness and isolationist ideas are so easily whipped out stripping the “dirty criminals and addicts” of basic human dignity.
      Wow. It’s an almost “God-like” display of arrogance. I wonder what hidden fears are at play here?
      From my own experiences I’m certain that evil exists in the world. I also know that no disease is inherently evil; therefore, by nature of having it a person suffering under it doesn’t become bad. They’re simply very ill. Usually they never receive help so they die, are imprisoned, or otherwise institutionalized.
      Getting better is an inside job, the same as it is for getting sick. The Creator gave free will. In addiction there’s a LOT of doubt we’d use it when we could or should have. Hence, there’s a huge number of us kicking around still.
      However, with just a little assistance, the helpless and hopeless person who’s often near death can receive real hope.
      Who is anyone that can make this decision with impunity? I’m for certain no “jack-booted thug” willing to throw away my free wills ability to use empathy and compassion for my suffering fellow man.
      For me, my always growing sense of responsibility in life lends me insights sometimes to say just “Do the right thing”. I’m decided that for me now “Walking the walk” means just doing what’s right as often as I can. It trumps “Talking the talk” in importance.
      If we simply did no harm; even praying that the answers for this heartless and devastating illness will come in time? There’s no harm there.
      I’ve been there. But for the Grace I undeservedly received, I’d most certainly be dead.
      Hard as it is for these suffering people who’ve given up on everything in life; selling themselves and everyone else out chasing a lie. Why condemn them out of utter ignorance, spewing hate-filled assessments while justifying their suffering??
      Again, there’s ultimately no acceptable excuse to defend evilly contrived behavior. As a medical professional, I’ve countless times done everything within my power to protect and treat a critically ill and/or suffering fellow human being.
      Utter shame on soulless and mindless policies created artificially by irresponsible governments; then left to lowbrow jackbooted thugs to administer their proscribed “just” punishments. I can’t envision a more contemptible class of “upstanding citizens and heroes” than these cowards.
      Those lacking forgiveness, empathy, and compassion will be most harshly judged.
      Therefore; but, by the Grace of God go I.
      Some things just can’t be explained or understood; until,or unless there occurs something so ruinous that someone can’t go on, and “surrenders to win” (another paradox).
      Only then can a person agree to accept help. It’s an inside job getting better. Same as getting sick.
      Problem is: it can’t ever be done alone.

      Remember, an addicts “best thinking got him addicted”. Interesting paradox, I guess. Irrelevant to believe we had that much control or power, right?
      Why not leave the judgments, resentments, and fears aside to do “The next right thing?”.
      I applaud the authors humanity and heartfelt dedication. He’s walked where most of you fear to even imagine. much less tread. He’s a rare phenomenon in this ever-darkening world.
      Hope that helps. I know it’s helped me!

  • The writer has a very one sided, liberal view of things. I do not think that the benefit to society is worth the cost here. These arrested people are criminals, rare indeed is someone put in prison for unpaid parking ticket as the author implies with “unpaid court fees” – yeah, sure

    • Hi, W ~

      People are often held in jail (not prison) for minor crimes because they can’t post bail.

      This is a national scandal because pleading guilty in exchange for “time served” may often result in less jail time than demanding a trial and being found Not Guilty.

      This pre-trial detention is used as a way to subvert the Constitutional right to a trial, which the courts don’t want you to have because it takes up too much court time. So they have this corrupt bargain where pleading guilty in exchange for your freedom is set against the prolonged wait in jail for a trial.
      ————

      You are correct to point out that these people are criminals arrested for crimes that don’t include “being a drug addict” or “being under the influence of a drug.”

      I don’t know if people can be jailed while awaiting a hearing about a warrant for “unpaid court fees,” but I suppose they can be.
      —————–

      Obviously it is mandatory that they be given whatever medical care is recommended.
      I can’t even think of a reason why they wouldn’t be.
      —————-

      I’m still trying to find out what they expected the outcome would be.
      What were they basing their decision on to get themselves self-addicted while they still had a choice, before they became addicted?

      > They knew for a dead fact that if they injected themselves with that first dose of opioids, they were from that moment on destined inescapably to become self-addicted.
      > They knew for a dead fact that they will live a horrifying life.

      At least, when they end up with outstanding warrants charging them with crimes, and the police stop them leaving the AIDS clinic on their way to burglarize their parents’ home for their dead father’s wristwatch and wedding ring, and they end up in jail hoping to die, “[lying] on the floor moaning and puking everywhere … hurting so bad I couldn’t sleep at all. I thought I was going to die … ”

      At least when this happens (and worse), they can’t feel surprised.
      What did they think was going to happen?

    • I’m going to give a brief explanation of prison vs. jail. Jail is a facility run by a county or a city to incarcerate people for traffic violations, ordinance violations, parole or probation violations or people waiting for trials that have not been able to bond out for various reasons. Some people sentenced for some misdemeanors will be sentenced to up to a year in jail. Prison is strictly for sentenced individuals convicted of higher level misdemeanors or felonies. People in prison have been through trial and have been convicted and sentenced to time (2 years to life or death). Someone being held for traffic tickets or a bar fight is in jail, not prison.

  • @Ann – In my family, there is a genetic predisposition to addictions. My grandfathers were both chronic alcoholics as was my dad. My cousins have been drug addicts. One of my cousins currently is residing in prison under a three-strike sentence, for production and usage of meth. His words to me on the meth were striking. He stated: I used booze and pot and other meds, but meth changes something in you. From the first day, you can’t live without meth. It’s like a rat’s inside your body. Some days, it’s a small field mouse. Other days, it’s an angry wharf rat. But all the time, the rat’s chewing you up from the inside out, and the only way you can get him to leave you alone is to feed him. But all he wants to eat is meth. And when I get out, I’ll have to feed him.’
    You can state your “don’t start” diatribe all you wish. This mantra goes all the way back to Reagan and is just as worthless today as it was in the 1980s. But the fact is that people ARE starting and they ARE addicted. It becomes the responsibility of our system to then assist them in fumigating their rat out of their system, once and for all.

    • I wonder what makes people start in the first place?

      They know for a fact that they will self-addict themselves and live a degraded life of misery and crime and incurable sickness.

      But they are not addicted in the last hour before they start.
      So at that moment, it is still a choice.

      Once they elect to self-addict themselves, it is no longer a choice.

      I wonder what outcome they had anticipated in those last few minutes when they had a choice.
      The article describes some of their dismay at their circumstances as addicts.

      What did they expect to happen if they began self-addicting themselves?

      It always kind of reminds me of a guy jumping off a tall building, and then wishing he didn’t get any damage when he hits the ground, or someone setting all their money on fire, and then sorrowing that their money is all burned up.

      I wonder what they anticipated?
      Did they say, “I have a genetic predisposition to addiction, and this is an incurably addictive drug. I think I’ll just inject myself with this illegal drug. What could go wrong?”

      All the misery and crime and HIV and Hepatitis and TB suffering cannot be cured.
      But it can be absolutely prevented.

      I wonder what causes addicts to initiate the process? To jump off the building, or to hold the match to their money, or to self-inject themselves with these addictive drugs?

      There is no hope for them after they do it.
      The pavement is hard down there, money burns to a crisp, and a person who addicts himself becomes a hopeless addict.

      Their only hope is to NOT START.
      That’s what they should do — NOT START.

    • @Milinda ~

      Your graphic description of the consequences of addicting yourself to incurably-additive drugs makes it all the more incomprehensible that addiction-prone people START addicting themselves in the first place.

      You mention that they do it — which is not news.
      Obviously they do voluntarily choose to initiate the process that will rapidly take them into a miserable and squalid life of crime, suffering, disease, and shame.

      What I can never understand is WHY they choose to do it.
      What stops them from NOT STARTING when they still have a choice?

      It seems to me that the very best thing they could possibly do is to emulate almost the entire population of the world, all of whom consider that addicting yourself to incurably-addictive drugs is a BAD IDEA, and NOT START.

      Have any of the people in your family ever answered the question: Ever since you already knew that this was a BAD IDEA that is guaranteed to lead you a life of degradation, misery, addiction, crime, disease, and shame — why did you volunteer to even start in the first place?
      What did you anticipate the outcome would be?

  • I think it should be allowed in all states it sure would save a lot of lives I would love to see this happen!!

  • @Will

    Yeah yeah. AFTER people voluntarily self-addict themselves to opioids, then they become incurable. I get that.

    But that’s the principle reason that people should not voluntarily initiate the first act of self-addicting themselves — they will become incurably addicted.

    You picture this:
    A teenager or young adult has sought out and found a group of addicts. They are lying around in various states of dilapidation, rousing themselves only to burglarize their grandmothers’ homes for items they can fence for drug money.

    Their major fear is incarceration, where they cannot get their daily doses of opioids, and therefore will suffer the withdrawal effects of their incurable addiction.

    The never-before user bums a dirty needle from one of the people in the filthy den, and has someone “Hold my arm! Hold my arm!”

    He hovers the now-blunted point of the needle above his vein. He knows that like his friends, he will eventually use veins in his foot or penis, but for now, the vein in his arm is fine.

    He thinks, “I wonder if this is really a good idea? After I persist in doing this, at a great deal of effort and money, I will become incurably addicted like the living testimony of these collapsed people.”

    But then he thinks, “Well, I am certain to have a miserable life in the near future if I only START TODAY, but it is a good idea in my best interests to go ahead and get myself self-addicted anyway. What could go wrong?!”

    Then, EVEN THOUGH HE KNOWS IN ADVANCE what will happen next, he injects himself anyway.

    Yes, you are correct that in the near future, he will be a suffering and incurable person.

    You’re not the only person who knows this.
    I know it.
    And the soon-to-be addict knows it.

    And everyone also knows that the prevention of all this imminent woe is to NOT START.

    They go through substantial EFFORT and EXPENSE to voluntarily self-addict themselves, bringing down on themselves a miserable future.

    Really, you’d almost think that knowing all this would suggest to them that the first injection of Hep C opioids is possibly a BAD IDEA.

    Possibly they might even realize that the best way to avoid the horrors of a life as an addict is to NOT START self-addicting themselves.

    • @Ann
      Sad you seem intelligent but you are oh so wrong

      Do you hold diabetics to the same standard as we know with out a doubt abdominal obesity leads to insulin resistance(the hallmark of type 2 dm). So do you harbor the same animosity towards an obese person at a fast food restaurant? What about the smoker who is slowly destroying their lungs and will end up 9n O2 or getting lung cancer. Or what about the person with self induced metabolic syndrome whom needs a CABG, are they as slowly killing yourself and worth your distance? What about the asthmatic who smokes? Or the obese person needing knee replacement? Or how about, as you already pointed out, the drinker from a Native American family that chooses to drink?

      You see you have a logic flaw that you are to closed minded to acknowledge. You apply a different standard to opioid addiction and that is exactly what our society needs to learn to break the stigma.

      Please at least try to educate yourself before ranting silliness on a web page.

      I am done.

    • @Will

      The trolling and angry tone of your posts is concerning, as is your knowing and willful pretense that you are chronically unable to distinguish between “Wait! Don’t start!” vs the plight of those for whom it is already too late.

      1) Smoking is a better analogy than eating. The temptation to smoke is fueled by the fact that the penalties are very far in the future, and not at all certain.
      “As many as one-third of heavy smokers age 35 will die before age 85 of diseases caused by their smoking.”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646951/
      The entire force of society is bent toward preventing teenagers from starting to smoke, which according to you is dastardly — mere ranting silliness.

      2) Overeating is a bad example because everyone must eat all the time, so there is no way that “Wait! Don’t start!” can apply.
      The actual causes of obesity behavior are not known, but they are certainly not a choice in the way that choosing to inject yourself with addictive drugs is a choice.

      I’m unable to remember saying that those already lost should not get whatever futile care is available, and whatever pain relief they need.
      My only observation is that a life of suffering and disease can be avoided entirely by NOT STARTING.

      Your conflation of PREVENTION with (useless) REMEDY is caused by your own self-interests.

      If those poor miserable losers decided to go to college instead of hanging around a vermin-infested drug house deliberately self-addicting themselves with addictive drugs, then you would be out of a job purveying quack fake non-remedies.

      Your failure to encourage potential victims to practice PREVENTION may not be a clean way to treat others, but hey — it’s a living.

    • @Danny

      This is the first time I have ever heard anyone say that PREVENTION is a stupid idea.

      I think it’s almost a little heartless of you to be so angry about preventing a lifetime of wretched misery over a lifetime of useless “treatments” and relapses.

      I will encourage my children NOT TO START.
      It’s the best way to not get yourself self-addicted to addictive substances.

      What will you tell your children about “Wait! Don’t start!”
      I know you don’t want to advise this, but I wonder what you do advise?
      Maybe you can tell them to avoid getting arrested in Massachusetts because they can’t get enough medically-supervised withdrawal there?

    • @Anne

      I’m sure if you spoke with some of them they’d come up with all sorts of different reasons or justifications for their first time obviously. Clearly most had/have underlying issues of some sort so maybe for them it was more about escaping? Call it a soft suicide?
      I think it’s important that we don’t forget that they’re human beings who genuinely need help. Before they were plotting to steal grandmas purse and addiction infested them completely, they were somebody’s innocent children. Someone’s sons, daughters etc.
      Totally agree that we need to focus more on prevention in the first place. More education.

    • @Jay

      What if the government put up posters advertising — not places to get “treatment” once it’s too late — but places to go to get support in NOT STARTING.

      Maybe a poster like this:
      “Thinking about becoming a drug addict?
      Wait one minute.
      Don’t start yet.
      There is hope for preventing this horrible condition.
      Join DON’T START today
      and live a normal life tomorrow.”

  • @lorene

    Oh, baloney.

    My life experience is that these people are playing you.

    At least an addiction to alcohol has genetic roots, and alcohol consumption is nearly universal.

    But addicting yourself to opioids is far more deliberate and intentional than the teenager who defies God and his father by drinking a beer (which is a legal substance) and finds that he is unusually prone to alcohol addiction.

    EVERYONE is unusually prone to opioid addiction.

    It’s not like the addict didn’t know that using opioids was going to end up with becoming addicted. He had his role models right before his eyes to watch the outcome for himself.

    The sad family backgrounds (even when they are true) cannot account for the far greater use of illegal addictive substances in men than in women, unless you are willing to claim that boys are more frequently sexually abused than girls.
    https://www.aeaweb.org/content/file?id=5558

    • Ann. So uniformed it is sad. Addiction is not a choice. I suspect the same/similiar genetic disposition

      Certainly family social supports plays a role, but not how you think. I have had kids and parents admit it was “learned from dad”. Or “I got high the first time with dad”. These kids have literally zero chance of success.

      Although oxymoron. “Medical Detox”. Yeah great ideas, make some want to die, while incarcerated, then watch them die after realease. This is what chapter 52 data is showing, but by the sounds of you comments you don’t really care what data and evidence shows.

      To realize how silly your arguments are please think of this statement:
      We medically detox people by taking way their insulin while we monitor their diabetes. Now just replace insulin with MAT drug. Sounds really stupid right!

      Opioid addiction is a hard rewiring of the brain. Addicts no longer are getting high, but instead just attempting to feel normal. Ann you may want to give up on all these people but those of us in the medical field, following the latest medical knowledge now understand more then ever about addiction and are refusing to allow these people to be disposable.
      You never hear about the success stories because no one talks about them but I can almost guarantee you have a friend or family member who has battled this horrible disease.
      Please allow the trained medical professsionals handle this epidemic and try to learn what the disease process truly is instead of strongly held misbeliefs.

    • @Danny

      Hi, Danny ~

      I’m intrigued with a couple of things that you have posted.

      > You say you “never said that prevention is a bad idea,” but you seem to oppose someone saying it’s a good idea? Or saying that prevention is better than electing to self-addict yourself and choosing to face all the terrible consequences?
      ————–

      > The person posting under the name “Will” says that medical help for the people who voluntarily decided to inject themselves for the first time with drugs that they knew were going to addict them — Will says that medical care is dangerous.

      He wrote: “Medical detox. Is truly any oxymoron.
      The mass chapter 52 data shows a 120 TIMES risk of death with in two weeks of release from incarceration. This is MASS data in exactly 5he same system. Medical detox is killing some of your patients.”

      This really makes it seem that people who are about to self-addict themselves by electing to self-inject themselves with addictive opioids would be better off it they never do go ahead and start.

      That’s what you think too, right?
      Or do you think that it is wrong and bad to tell people “NEVER START! Don’t start! You will become addicted and will face a horrible life of addiction that is nasty, brutish, and short! Wait! Stop! DON’T START!”
      ————-

      I wonder if you may please tell me what makes you so emotional about a recommendation that a person holding his VERY FIRST NEEDLE hovering over a vein in the webbing between his toes, or a vein under his tongue, or in his penis, should “STOP! Don’t start!”

      This recommendation gives you a lot of negative emotions, but it’s kind of hard to see why.
      It’s almost like you think it’s bad and wrong to advise people to practice prevention.
      ————–

      I always wonder what outcome people anticipate when they are right on the verge of injecting themselves for the first time with a hopelessly addictive drug.
      As they sit there probing their flesh for a good vein, what do they think will happen? Do they think that intentionally self-addicting themselves to an incurably addictive drug will end well?
      Do they realize that in weeks they will be stealing their sister’s television set to raise money for illegal addictive drugs?

      What are they thinking at that moment — the last chance they will have to PREVENT themselves from choosing a terrible fate?

      > Will says that

  • The MA women’s state prison at Framingham which is also the county jail for several counties in MA does do medical detox. The vast majority of men do not enter the MA state system from the community. They go to county facilities often for extended periods of time. Each county facility operates on their own rules regarding detox and is usually in charge of determining the policy.

    • Medical detox. Is truly any oxymoron.

      The mass chapter 52 data shows a 120 TIMES risk of death with in two weeks of release from incarceration. This is MASS data in exactly 5he same system. Medical detox is killing some of your patients.

    • @Danny

      I bet you made some good points there, but the way they are phrased makes your ideas impossible to understand.

      All I really got out of it is that you believe that prevention is a bad idea, and that you wish great harm on anyone who advocates for the idea that PREVENTION by not starting to self-addict yourself is better for potential victims than futile quack remedies.

      I hope that you and yours never experience the consequences of not preventing an addiction by not starting in the first place.
      I hope you encourage them to not even start making themselves hopelessly addicted.
      I wish you and yours all the best.
      ——————–

      I realize that you don’t even know it yourself, but your posts are almost starting to sound a little bit like trolling.

  • I currently work in a jail. I support allowing all 3 MAT drugs in jails/prisons.

    The issue is not medical knowledge, it is the Sheriff’s and law enforcement that run the jails and prisons whom prohibit the use of buprenorphine and methodone that are injuring patients. I have heard or sheriff will “never let those drugs in my facility”. When did a sheriff earn a medical degree? When does a lay person get to determine how I manage my patients? Where does society stand up and mandate that the PA, NP, DO and MD’s be allowed to practice the way we are trained instead of letting a non medical person make these decisions? There MUST be national level legislation mandating that the correctional providers be allowed to deliver the care that is needed.

    • @Will
      Evidently, even “the best and the brightest” do not anticipate that using illegal and addictive drugs will eventuate in addiction.

      Too bad we don’t throw as much energy advising people NOT TO START as we waste on futile efforts to fix them once it’s too late.

      Oh! Wait! No, we DO throw a lot of energy at advising people not to start taking addictive drugs … because they will (Surprise!) end up addicted.

      The way to avoid these doleful outcomes is NOT TO START.
      And that includes not accepting doctors’ light-hearted prescriptions of opioids.

      Big Pharma has finally found the way to fulfill its heart’s desire:
      A legal way to sell heroin.

      Solution:
      Don’t start taking opioids.
      If you do, you can confidently expect that about 15% of users will become addicted.
      And once you’re addicted, you will be incurably damaged, and you will suffer grave and unfixable consequences.

    • I want to clarify:

      About 15% of medically-prescribed users will end up addicted.

      Almost all of recreational users of opioids will end up addicted.

      So don’t even start,
      This is kind of a no-brainer.

      If you start using opioids (especially recreationally), you will end up addicted.
      I never knew what part of “Don’t start” was hard to understand.

  • I wonder what outcome addicts anticipate when they elect to addict themselves to illegal drugs.

    All this woe could be easily prevented by their declining to get themselves addicted in the first place.

    • Ann. Your comment shows a startling lack of medical knowledge. You obviously have no medical training or understanding. Would you want a car mechanic doing surgery on you? Then why are you as a person with no medical knowledge of opioid addiction making such comments on medical treatment. Opioid dependence and addiction are a chronic disease state just like diabetes, where the brain is permanently physically retired. It is not a choice and it happens to some of the best and brightest people.

    • @Will

      I don’t doubt that most users become medically addicted.

      My comment was about their initial decision to begin behavior that was doomed to end badly.

      Anyone who doesn’t want to become addicted to illegal drugs has the solution at hand:
      Don’t start.

      What did they think was going to happen on the first day they elected to give themselves addictive drugs?

      All this woe could have been easily prevented by declining to start using illegal addictive drugs in the first place.

    • Just say no never worked. If we could eliminate the issues that predispose people to use addictive substances such as childhood sexual abuse, physical abuse, depression and severe trauma, then we would not be seeing large numbers of persons wanting to numb themselves to the pain. Nearly every drug addict I counseled over the life of my career had been sexually and physically abused as a child.

    • @Danny

      I understand that you and your friends are opposed to prevention.
      You prefer letting the addicts become addicted in the first place by choosing their own ill-advised self-administered self-addicting drugs.

      As I have said many times, I am referring to the moments before the first step in making themselves addicts — which is while their behavior is still voluntary.

      So I understand that you don’t advocate prevention.
      But I think it’s cruel and heartless to advocate becoming addicts in the first place so you can race in and “cure” them.

      What percent of the victims of this terrible disease — which is 100% preventable — get cured once it is too late to prevent it?
      ——————-

      You may not realize it yourself, but sometimes some of your posts almost sound a little bit abusive and trolling

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