Prisons’ Refusal To Medically Treat Opioid Addiction May Be a Human Rights Violation
December 13, 2019
Although there is still some debate within the larger addiction treatment community over the use of methadone and buprenorphine maintenance as treatment for opioid use disorder, the medical community is pretty much settled.
Numerous studies have confirmed that both medications are highly effective at lowering incidents of drug use, common substance-use related infections like hepatitis C and HIV, and overdose death. They are recommended by a number of medical licensing bodies, and are considered frontline, evidence-based treatments for opioid addiction. But stigma over these medications is still rampant in legal settings. Because methadone and buprenorphine are opioid-based medications, many law enforcement and other criminal justice authorities mistakenly believe they get users high. Most correctional facilities refuse to induct opioid addicted inmates, and many refuse to continue prescriptions for non-pregnant people who are arrested while already enrolled in a medication assisted treatment (MAT) program. But that refusal might represent a human rights violation.
Jails and prisons in the United States are legally required to provide healthcare equal to community standards. That means incarcerated people have the right to evidence-based healthcare that adequately treats their medical needs. Those who argue against the use of methadone and buprenorphine in correctional settings state that these medicines are preferred treatments—to which inmates are not entitled. They claim that it is enough to offer alternatives that range from naltrexone (a non-opioid based medication treatment) to supervised detoxification and in-house peer support groups.
Several lawsuits springing up across the United States, however, argue that denying opioid addicted people access to methadone and buprenorphine while incarcerated is a violation of their rights because these are the only proven treatments for opioid use disorder. Naltrexone does have an emerging evidence-base, but is still not comparable to methadone and buprenorphine because it does less to reduce cravings, is more difficult to begin, and is associated with a higher risk of fatal overdose after discontinuing treatment. Many of these lawsuits are seeing success via settlement or adjudication based on the fact that opioid use disorder is classified as a disability under the Americans with Disabilities Act. “For the federal prison system to pick and choose who gets to continue medical treatment and who doesn’t is unsafe and discriminatory,” ACLU-WA Staff Attorney Lisa Nowlin was quoted as saying in a news release by the ACLU.
The cost of denying opioid addicted inmates these medications is enormous. Anyone engaged in illicit opioid use is at risk of fatal overdose. But people who have been recently released from jail or prison are at especially high risk of fatal overdose in the first 12 weeks after release, according to several U.S. and international studies. And, while opioid withdrawal is traditionally considered medically safe, United States’ correctional facilities have experienced a recent rash of withdrawal related deaths. These deaths are especially brutal because they are preventable; dehydration from vomiting and diarrhea, for example, is easily treated, but when jail staff ignore pleas for water, it becomes fatal.
The reality is that detoxification from opioids is not an effective treatment for addiction. Instead, it decreases a user’s tolerance without addressing the underlying causes of their substance use. This leaves them vulnerable to relapse, which is particularly dangerous for people who are no longer aware of the amount of opioid they can safely tolerate. Methadone and buprenorphine are proven, effective treatments for opioid addiction that can be easily and safely administered in jail and prison settings. Until more correctional facilities recognize these medications as necessary, and not replaceable by less-effective methods, the criminal justice system will remain responsible for the preventable deaths of people struggling with opioid use disorder.
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