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Medication-assisted treatment in corrections facilities shows promising results—and some are suing to obtain it.

According to a 2018 study, an innovative medication-assisted treatment (MAT) program in Rhode Island prisons has reduced post-incarceration overdose deaths, highlighting the role that U.S. correctional facilities can play in combating the opioid crisis.Traci C. Green, Jennifer Clarke, and Lauren Brinkley-Rubinstein, “Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System,” JAMA Psychiatry 75, no. 4 (2018), 405-07.

The Rhode Island Department of Corrections program, which became fully operational in January 2017, promotes referrals to MAT for individuals with opioid use disorders and maintains treatment regimens for those who had received MAT prior to their incarceration, as well as providing transitional care so that individuals can continue MAT post-incarceration.

According to the JAMA Psychiatry study, the state saw a “large and clinically meaningful reduction in postincarceration deaths” after implementation.Traci C. Green, Jennifer Clarke, and Lauren Brinkley-Rubinstein, “Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System,” JAMA Psychiatry 75, no. 4 (2018), 405-07. Researchers compared the total number of overdose deaths in Rhode Island from January 1 to June 30, 2016, against the total from January 1 to June 30, 2017. During the 2016 period, 14.5 percent of Rhode Islanders who died from an overdose had been recently incarcerated. This percentage dropped to 5.7 percent during the 2017 period—a statistically significant change.Traci C. Green, Jennifer Clarke, and Lauren Brinkley-Rubinstein, “Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System,” JAMA Psychiatry 75, no. 4 (2018), 405-07. This reduction contributed to overall declines in overdose deaths in the state, emphasizing the role correctional institutions can play in promoting community health.Jackson Beck and Vedan Anthony-North, “Rhode Island Tackles Opioid Addiction Behind Bars; Saves Lives Outside,” Vera Institute of Justice, March 2, 2018. Also see Erick Trickey, “How the Smallest State is Defeating American’s Biggest Addiction Crisis,” Politico, August 25, 2018.

There is burgeoning support for MAT in jails amongst sheriffs nationwide; in October, the National Sheriffs’ Association, in conjunction with the National Commission on Correctional Health Care, published a best practices report for jails that seek to initiate an MAT program.National Sheriff s’ Association (NSA) and the National Commission on Correctional Health Care (NCCHC), Jail-Based Medication-Assisted Treatment: Promising Practices, Guidelines, and Resources for the Field(Chicago: NCHCC, 2018). But correctional spaces have the potential to remain a major treatment void. The U.S. Department of Justice’s investigation into the Boyd County Detention Center in Kentucky beginning in 2016 has spotlighted some of the ways in which untreated substance use disorder leads to tragic consequences, including four deaths since June.Zachary Siegel, “Overdoses, Riots, and Escapes Roil a Rural Kentucky Jail,” The Appeal, January 2, 2019.

Where correctional facilities fail to provide treatment, incarcerated people are turning to litigation to require access it, often using the Americans with Disabilities Act as grounds. A lawsuit filed in Maine by the ACLU resulted in a settlement in September granting access to treatment for one incarcerated man who uses buprenorphine, marketed under the brand name Suboxone to manage his opioid use disorder; the state is now planning a pilot program for MAT in several jails.Smith v. Fitzpatrick, No. 18-cv-00288-NT (D. Me., filed July 26, 2018) (complaint). Also see Susan Sharon, “Following ACLU Lawsuit, Maine State Prisoner Will Receive Medication-Assisted Treatment,” Maine Public, October 17, 2018. Another ACLU suit, in Whatcom County, Washington, is challenging the Whatcom County Jail’s blanket policy of refusing access to MAT.Kortlever v. Whatcom County, Washington, No. 2:18-cv-00823 (W.D. Wash., June 6, 2018). Also see ACLU, “ACLU of Washington Lawsuit: Whatcom County Jail Violating ADA by Refusing Medication to People with Opioid Use Disorder,” press release (Washington, DC: ACLU, June 7, 2018). And a November preliminary injunction in a Massachusetts lawsuit requires that MAT be provided to a man entering the Essex County House of Correction.Pesce v. Coppinger, No. 18-cv-11972 (D. Mass., November 26, 2018) (memorandum and order); and Felice J. Fryer, “Court Orders Essex County to Provide Methadone to Inmate,” Boston Globe, November 27, 2018. The decision, which is the first that mandates MAT for incarcerated people who have opioid use disorder, has been hailed as a “landmark.”Mark Goidell, “The Developing Right to Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons,” New York Law Journal, December 14, 2018. Also see Fryer, “Court Orders Essex County,” 2018.