State considers anti-addiction drugs for prisoners

July 22--BOSTON -- Prisoners locked up with their addictions to heroin and prescription drugs often face a painful withdrawal.

Besides giving inmates a shot of non-narcotic Vivitrol before releasing them, prison officials have largely resisted calls from addiction specialists, public health officials and others to expand medication-assisted treatment for addicts while they serve time in state correctional facilities.

The state is coming under increasing pressure to change its policy.

On Beacon Hill, lawmakers have approved a proposal to create a two-year pilot detox project in six prisons that would offer three FDA-approved anti-addiction medications -- methadone, buprenorphine and the long-acting drug known as Vivitrol -- to help inmates get clean.

Both the House and Senate tacked the provision onto a rewrite of Gov. Charlie Baker's latest proposal to combat opioid addiction.

The effort is getting an unlikely push from the U.S. Justice Department, which is investigating whether the state violates the Americans with Disabilities Act by shutting off inmates who were taking those medicines when they entered prison.

Lawmakers who support the plan say it will save lives, curb rampant addiction and reduce recidivism.

"If we can offer that to inmates before they are released, their chances of success are greatly improved," said Rep. Paul Tucker, D-Salem, a member of the Legislature's Judiciary Committee who co-sponsored the bipartisan proposal. "The time to get them into treatment is while they are incarcerated."

Rep. Ann-Margaret Ferrante, D-Gloucester, also backs the idea and points out that the state provides medication to inmates to treat other illnesses, like diabetes.

"If we're going to consider drug addiction a disease, we should be providing this type of medication once someone is incarcerated," she said.

County program

Under the proposal, the Department of Corrections will be required to get the pilot started in a half-dozen, yet-to-be-determined prisons by next year.

In addition to offering medication-assisted treatment to those inmates who qualify, the state would be required to provide the medications to new prisoners who were receiving treatment before they were incarcerated.

Inmates taking the medications would have to agree to participate in the detox programs, which would be administered by a qualified specialist licensed to provide the drugs. The program would include counseling and behavioral therapy, and physicians would review each inmate's progress every 90 days.

To be sure, the state must still figure out a way to pay for the project, as the legislative proposal didn't fund it.

If Baker signs off on it, the program would mirror initiatives such as one run by the Essex County Sheriff's Department for the past several years. The sheriff operates a 84-bed detox at the Middleton jail, with separate units for male and female prisoners dealing with substance abuse disorders.

Essex County Sheriff Kevin Coppinger said the program has proven effective at reducing recidivism, and roughly 4 in 5 prisoners who start it complete it.

The detox unit, which is separate from the regular jail population, provides addiction treatment for non-violent offenders awaiting sentences.

"We don't take violent offenders, drug dealers or long-term felons in the detox program," he said. "These are folks with severe addictions who need help."

Prisoners who've gone through the 28-day program get a Vivitrol shot within 48 hours of release, and they're offered access to recovery coaches and counselors.

Still, Coppinger said he has concerns about allowing the use of methadone and buprenorphine -- also known by the brand name Suboxone -- behind bars.

"That is the No. 1 smuggled drug into correctional facilities," he said. "Once they get it inside, it's worth big bucks."

Drug treatments

Unlike other drugs used to treat opioid addiction, Vivitrol is non-narcotic. It is injected monthly and works by blocking opioid receptors in the brain.

The U.S. Department of Health and Human Services says it has "no potential for abuse" -- unlike buprenorphine and methadone.

Methadone, which is usually dispensed to addicts who visit clinics for a daily dose, has been used for decades to treat heroin addiction. Until recently it was one of the only options for medication-assisted therapy.

The medication, which also acts to block the brain's opioid receptors, can ease withdrawal symptoms that may trigger a relapse.

Suboxone, which is typically prescribed by a doctor and can be taken at home, has become a preferred treatment, but it doesn't come cheap.

While methadone treatments can cost up to $3,500 a year per patient, even the generic form of Suboxone costs two to three times as much, according to the National Association of State Alcohol and Drug Abuse Directors.

State corrections officials say in addition offering inmates access to Vivitrol upon release, they provide them with a "continuum of substance use treatment from prison to the community" that includes a case manager, post-release referrals and connections to community-based treatment programs.

In addition, the state operates the Massachusetts Alcohol and Substance Abuse Center in Plymouth, a women's detox unit at MCI-Framingham, as well as Correctional Recovery Academies in several prisons. In those, inmates recovering from alcohol and drug addiction live together and participate in structured programs.

But the state currently doesn't allow the use of methadone and buprenorphine -- despite recent studies suggesting their effectiveness.

Long-term treatment

In fact, only a handful of states -- Hawaii, New Jersey, New York, Vermont and Washington -- provide methadone and buprenorphine to inmates in prisons or jails.

To date, only Rhode Island allows all three FDA-approved medications to inmates.

Individuals who are incarcerated in the state's correctional facilities -- all of which are located in a sprawling complex in Cranston -- are screened for opioid addiction once they arrive. Those with addictions are matched with the most appropriate, individualized treatment.

A recent study found that opioid overdose deaths dropped by nearly two-thirds among recently incarcerated people in the first year of Rhode Island's program.

In Massachusetts, more than 2,000 people died of opioid overdoses last year, according to the state Department of Public Health.

Recent studies have shown inmates leaving prison with a lower tolerance and nothing to curb their drug cravings are more susceptible to a deadly overdose.

Coppinger said for the state's initiative to be successful, leaders need to devote resources to prevention and long-term recovery.

"You can give them all the medication in the world on the inside, but once they leave, they're really at risk," he said. "Long term treatment is the key."

Christian M. Wade covers the Massachusetts Statehouse for The Eagle-Tribune. Email him at cwade@cnhi.com.

___

(c)2018 The Eagle-Tribune (North Andover, Mass.)

Visit The Eagle-Tribune (North Andover, Mass.) at www.eagletribune.com

Distributed by Tribune Content Agency, LLC.