This article was first publishing in the Pittsburgh Post-Gazette
By Adrienne Abner
The opioid crisis brewing in the United States over the last decade continues to be a growing problem, and the impact hits especially hard in jails and prisons. The failures of jails to provide adequate medical care for opioid use disorder often leads to needless suffering and disastrous consequences, including death.
In this crisis, Black and Latino communities are struck even harder. Systemic racism has led to mass incarceration, especially for Black and Latino people, who also face systemic inequities in health care access.
Opioid use disorder is not the result of moral weakness, moral failure or a lack of discipline. Opioid use disorder is a complex medical condition that hijacks multiple brain parts, including the part that controls cravings. Addiction occurs when opioids actually rewire biological pathways in the brain that control the body’s system of reward and preservation.
Like diabetes or heart disease, opioid use disorder is a serious medical condition where the disease has damaged or changed how certain organs function. Denying a diabetic person insulin or withholding stroke-preventing medications from a person with heart disease is harmful, cruel and degrading. The same is true for denying medication to a person with opioid use disorder.
Medication for Opioid Use Disorder (MOUD), sometimes referred to as Medication Assisted Treatment (MAT), is the standard of care in the medical field. The medications used include buprenorphine, buprenorphine/naloxone (Suboxone) and naltrexone (Vivitrol). MOUD can be a lifeline in helping individuals refrain from illicit opioid use and allows patients to pursue normal activities of daily living without debilitating drug cravings.
On March 16, 2021, Jerome Maynor, a 71-year-old man with opioid use disorder, was incarcerated on a technical probation violation. The Allegheny County Jail’s blanket policy of denying access to methadone for anyone other than pregnant women abruptly forced Mr. Maynor into painful opioid withdrawal. Methadone is a maintenance medication used to prevent withdrawal so the patient can focus on recovery.
Mr. Maynor suffered from nausea, vomiting, diarrhea, agitation, anxiety, pain and lack of concentration for weeks. Many tell of the agony their bodies go through withdrawing from opioids and for Mr. Maynor, these symptoms were exacerbated due to his advanced age. It is traumatic enough for an elderly individual in poor health to be subjected to incarceration, but when that is combined with the effects of withdrawal, the effects are tortuous.
Any disruption in receiving MOUD has devastating long-term consequences. When released from incarceration, people often experience difficulty in resuming treatment and a loss of opioid tolerance. This dramatically increases the risk of fatal overdose upon re-exposure to even small amounts of drugs. Formerly incarcerated people within the first two weeks of release have been shown to be 129 times more likely to die from overdose than the general population.
County jails, which tend to house people for shorter periods of time than state and federal prisons, could play a particularly important role in overdose prevention. Yet, many are resistant to recognize medical science, relying on a punishment-based mindset rather than on treatment and rehabilitation. Consequently, many county jails deny much-needed MOUD.
Multiple courts have held that denying medication for opioid use disorder is considered discrimination against people with disabilities in violation of the Americans with Disabilities Act. Courts have also found that denying this recognized medical care violates the U.S. Constitution, which prohibits cruel and unusual punishment and provides that incarcerated people must receive proper medical care.
Providing medication for opioid use disorder is not a revolution in correctional health care, but is a significant step towards human decency, compassionate care, and aiding successful reentry back into society. Medication Assisted Treatment for opioid use disorder is not “one size fits all.” Jails and prisons should depart from blanket policies prohibiting any level of treatment and provide people with needed medications.
Adrienne Abner is an attorney with the Pennsylvania Institutional Law Project, a statewide legal organization seeking to advance the civil rights of incarcerated people. She previously had a career as a nurse leader and in health care administration.