A prison system offered all inmates addiction treatment. Overdose deaths dropped sharply

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Experts have long advocated for expanding the use of medication-assisted treatment, or MAT, in correctional facilities, but for the most part, jails and prisons remain treatment deserts. Starting in the middle of 2016, however, Rhode Island started rolling out its program and making available to all inmates the three medications approved to treat opioid use disorder.

To gauge the early results of the program, researchers compared overdose deaths in the first half of 2016 with those in the first half of 2017. They reported in the journal JAMA Psychiatry Wednesday that 26 of the 179 people who died in the state of an overdose during the 2016 period were recently incarcerated, while only nine of the 157 people who fatally overdosed during the 2017 period were recently incarcerated. (They defined recently incarcerated as being released from a correctional facility in the prior year.)

The researchers calculated that officials needed to treat only 11 inmates to prevent one overdose death.

“We took action, and now we’re beginning to see some of the results,” said Eric Beane, Rhode Island’s health secretary.

People leaving correctional facilities without treatment face incredibly high overdose risks because their tolerance to drugs has dropped and they often reenter the same settings with the same triggers where they used drugs previously. One previous study found that former inmates overdose at rates nearly 130 times as high as the general population in the two weeks after they are released.

The researchers acknowledged their data were preliminary and that it was a small study, but said they could not identify other factors that could have contributed to the drop in overdose deaths among former inmates. The number of inmates being released was about the same in the two time periods, and the number of people using drugs did not seem to change. Plus, the opioids available on the street are only becoming more potent, which increases the risk of overdose, they said.

“The MAT program at the prison may be providing us with really good news,” said Traci Green of Brown University and Rhode Island Hospital, who led the new study.

Rhode Island has had some advantages as it has developed its program. The state has budgeted about $2 million for it annually, and there are no county jails. All inmates are housed at one campus, which allows them to continue treatment if they move from jail to prison, for example. The program also helps inmates get insured and transition to treatment providers upon their release.

The program offers inmates methadone and buprenorphine (opioids that reduce cravings and ease withdrawal symptoms), as well as naltrexone, which blocks people from getting high.

Many law enforcement officials have resisted giving methadone and buprenorphine to inmates because they are also opioids — despite the evidence that shows they are effective medications to treat opioid use disorders — and because they worry about the diversion of the medications, particularly buprenorphine, which is also known as Suboxone.

Dr. Jennifer Clarke, the medical programs director for the state corrections department, said authorities initially saw some diversion of buprenorphine when the program was providing tablets, but have seen less since they switched to giving inmates a dissolvable film.

Rhode Island officials have emphasized the best treatment is the one that an inmate wants to take and will stick with, which is why they offer all three.

The researchers reported that in the first half of 2017, 119 inmates received buprenorphine on average each month, 180 took methadone, and four were given naltrexone, also known by the brand name Vivitrol.

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