Access To Suboxone and Methadone In Jails And Prisons

Access to medication-assisted treatment (MAT) for opioid addiction in prisons and jails remains critically limited despite growing recognition of its importance. The federal prison system and many state facilities have historically provided minimal addiction treatment services, leaving incarcerated individuals with opioid use disorder without access to proven medications like methadone, buprenorphine, and naltrexone. Some progress has been made expanding MAT programs in correctional settings, but implementation remains slow nationwide.

Providing MAT in prisons and jails is life-saving, reduces recidivism, improves quality of life, ensures continuity of care upon release, and helps people overcome addiction. Research shows individuals who receive MAT while incarcerated and continue treatment after release have significantly better outcomes than those who receive no treatment.

What Is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) is an evidence-based treatment for opioid abuse and addiction. This means that research shows MAT can effectively treat opioid addiction, including addiction to heroin, prescription opioids, and other illicit opioids.

MAT is an integrated treatment that involves the use of certain medications for opioid use disorder, paired with substance use counseling or behavioral therapy.

Medications that are FDA-approved for opioid addiction include:

• methadone: A synthetic opioid agonist that has, for decades, been used to relieve opioid withdrawal and drug cravings for people addicted to opioids.
• buprenorphine: Also known as Subutex or Suboxone, this is a partial opioid agonist that can relieve drug cravings and help treat opiate withdrawal.
• naltrexone: Also known as Vivitrol, this is an opioid antagonist that can reduce opioid cravings. It does not alleviate opioid withdrawal symptoms.

Medications for opioid use disorder, or MOUD, are prescribed to be taken either daily, several times a week, or, in the case of Vivitrol, administered monthly. Within a treatment setting or carceral setting, these medications are typically taken under the direct supervision of a licensed healthcare professional, such as a doctor or nurse practitioner.

Benefits Of MAT In Jails And Prisons

Providing addiction treatment in prisons and jails is not simply a moral issue. According to research, MAT in jails can offer a number of benefits for individuals, families, and communities.

What research on the benefits of MAT shows:

• Reduced recidivism: Medication-assisted treatment can reduce recidivism, or repeated crime and arrests.
• Safety and survival: Medication-assisted treatment can improve safety in the event of an overdose, should a person relapse, and improves survival rates of those with OUD.
• Employment: Medication-assisted treatment can also increase a person’s ability to find and maintain employment, provided individuals have access to relevant social services.
• Reduce societal costs: Access to treatment can help reduce societal costs of addiction, including healthcare costs, criminal justice costs, and work-loss costs.

Are Jails And Prisons Required To Provide Opioid Treatment?

According to the American Civil Liberties Union (ACLU), some courts have ruled that denying MAT to incarcerated people with OUD is “cruel and unusual punishment” under the Eighth Amendment. Denying this treatment, or restricting which medications for OUD are offered in a jail or prison, has also been characterized as a violation of the American Disabilities Act (ADA), a federal law.

But there is no clear consensus on this, and as a result, the laws for MAT for incarcerated people vary by state and the type of correctional facility.

Substance Abuse Treatment In Federal Prisons

Legally, the Bureau of Prisons, which is an agency of the Department of Justice, is required by law to make substance abuse treatment available for eligible inmates in federal prisons.

In practice, the rollout of this requirement has been slow. According to the GAO, only 268 of 15,000 of those eligible for MAT in the federal system, and less than two percent receive medication for opioid dependence.

Opioid Treatment In State Prisons

At least 20 states offer either methadone or buprenorphine treatment in their state prisons, according to research from Georgetown University. More than 15 offer limited drug treatment services, meaning there are stringent eligibility requirements, services are time-limited, or only Vivitrol is offered.

At least eight states do not offer any MAT services of any kind. This includes Idaho, Wyoming, Florida, Alabama, North Carolina, New Mexico, Nebraska, and Iowa.

Alcohol And Drug Treatment In Jails

Unlike prisons, jails are short-term correctional facilities that are operated by city or county governments, not state or federal governments. While hundreds of jails today do offer full or limited MAT programs, the majority do not.

However, a growing number of bills are introduced in state legislatures each year to address a lack of MAT services in both jails and prisons.

Why Is There A Lack Of Available Opioid Treatment In Correctional Facilities?

There are a number of reasons to explain the slow rollout of treatment options for people within the criminal justice system—and the limitations of MAT programs that have been implemented.

According to recent reporting from The Marshall Project and the ACLU, these include:

• Treatment providers: There is a lack of qualified treatment providers within jails, prisons, and halfway houses.
• Bias: A history of opposition to medications for treating opioid use disorder, driven by misconceptions about these medications, has affected MAT program rollout.
• Eligibility: Stringent eligibility requirements for accessing MAT in jails and prisons have served as barriers to care within facilities that offer MAT.
• Planning: According to the GAO, inadequate planning by the U.S. Bureau of Prisons has affected the expansion of MAT program implementation using federal dollars allocated by the U.S. government for this use.
• Discretion: Individual discretion of city and county governments in expanding or offering treatment services within local jails has also affected rollout on a local and community level. This can be influenced by a number of factors.

Barriers to addiction treatment and mental healthcare in the criminal justice system can vary widely by region. And unfortunately, this isn’t a new issue. Formerly addicted and incarcerated individuals and their families have, in recent years, been at the forefront of efforts to expand treatment options, in partnership with advocacy organizations and grassroots activist networks.

Long-Term Consequences Of Unavailable Opioid Treatment

The consequences of failing to provide addiction treatment for incarcerated people can be substantial, affecting physical health, mental health, recidivism, and public health.

Drug Overdose

Research shows that drug overdose is a leading cause of death among formerly incarcerated people who are released into the community. Within jails and prisons, overdoses have also skyrocketed. Over the last two decades, drug overdose deaths have increased more than 600 percent in prisons, and 200 percent in jails.

According to a recent report from the ACLU, MAT can reduce the risk of fatal overdose by up to 75 percent in the weeks following release, and reduces the risk of death by any cause by 85 percent.

Public Health Effects

Returning to opioid use after incarceration can have public health effects, including those that seep into local communities.

Public health effects of not providing treatment can include:

• repeat crime
• domestic violence
• transmission of infectious diseases (e.g. HIV)
• burden on the healthcare system
• increased jail and prison costs
• other societal costs

Drug addiction isn’t just an issue that affects individuals. Addiction, and the broader ‘War on Drugs,’ affects families and communities just as much.

Why Treatment In Jails And Prisons Is Important Today

Drug overdose deaths in the United States continue at crisis levels, with over 107,000 Americans dying from overdoses in 2023 according to preliminary CDC data. Opioids, particularly synthetic opioids like fentanyl, remain the leading cause of overdose deaths, accounting for the majority of fatalities. The overdose crisis shows no signs of slowing, making access to treatment in all settings, including correctional facilities, more critical than ever.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people released from prison or jail face dramatically elevated overdose risk, with rates 10 to 40 times higher than the general population in the weeks following release. Providing treatment for incarcerated individuals is literally a life-or-death issue.

Treatment Options For Opioid Addiction In Jails And Prisons

Over the last several years, prisons and jails nationwide have moved to expand access to treatment options and full treatment programs for people addicted to drugs or alcohol.

What treatment programs inside jails and prisons may offer:

• medications for opioid use disorder (MOUD)
• mental health services
• support groups
• psychiatric services
• individual and group counseling
• halfway house coordination (prior to release)

The number of jails that now offer MAT has increased substantially, but still accounts for just a fraction of the jails operating in the country.

MAT Medications In Jails And Prisons

The types of treatment services offered within the criminal justice system vary widely. Not all jails and prisons offer the same treatments or MAT medications. Methadone, the oldest MAT medication, and buprenorphine are generally the preferred treatments for MAT, in part due to their cost, compared to naltrexone.

According to the National Institute on Drug Abuse, monthly Vivitrol (naltrexone) injections can cost upwards of $1000 per shot, while methadone treatment costs about $126.00 per week.

Success Stories And Model Programs

Despite widespread challenges, several jurisdictions have successfully implemented MAT programs that serve as models for expansion nationwide. Rhode Island became the first state to offer all three FDA-approved medications throughout its entire prison system in 2016, resulting in a 60% reduction in overdose deaths among formerly incarcerated individuals in the year after release.

Other successful programs include Massachusetts’ statewide jail MAT initiative, New York City’s Rikers Island complex providing buprenorphine and methadone to thousands annually, and Philadelphia’s jails offering all three MAT medications with connections to community providers for continuity of care. Vermont, Maryland, and California have also made significant strides expanding MAT across their correctional systems.

What Can Be Done To Increase Opioid Treatment Availability

Federal and state legislators, as well as treatment and advocacy organizations, are working to provide pathways towards expanding opioid treatment in carceral settings.

Key initiatives for the expansion of MAT include:

• addressing obstacles that are preventing quicker rollout of MAT programs in the federal prison system, such as improved documentation of required resources
• expanding eligibility for MAT to ensure people who have a substance use disorder are able to receive treatment in a timely manner
• increasing staff education about the benefits of MAT and substance use disorders
• improving data collection on a community level and within correctional facilities to identify the scope of the unmet need of individuals affected by addiction
• advocating for legislation that mandates correctional facilities’ provision of this life-saving treatment of inmates with drug and alcohol use disorders

The road toward expanding MAT for people who are incarcerated, and ensuring continuity of care for people on probation or following release, is a long one. Through efforts in advocacy, education, and improved utilization of local, state, and federal resources, solutions to address this issue can be realized.

Written by the Addiction Resource Editorial Staff