By The American Civil Liberties Union (ACLU)

This report focuses on an ongoing crisis in many of America’s jails and prisons: the near total denial of medication for addiction treatment (MAT) for people with opioid use disorder (OUD). Despite a crisis of overdose deaths, which have spiked further in the wake of COVID-19, many jails and prisons are ignoring a vital public health tool that is proven to curb the deadly effects of the opioid epidemic. MAT is basic healthcare for individuals with OUD. There are three MAT medications approved by the Food and Drug Administration (FDA): methadone, buprenorphine, and naltrexone. Methadone and buprenorphine are proven to be effective, while the evidence supporting the effectiveness of naltrexone is more limited. In far too many jails and prisons around the country, none of these medications are available to incarcerated people with OUD, or only naltrexone is available. OUD is common in jails and prisons, affecting nearly a quarter of the incarcerated population. This denial of treatment leaves people with OUD at a much higher risk of relapse and overdose upon release from incarceration. MAT is a practical solution to this problem. MAT reduces the risk of death from any cause by 85%, and the risk of death from an overdose by 75% in the weeks following release.5 As discussed herein, there is a growing consensus among policy makers, medical professionals, and corrections officials that MAT is appropriate for incarcerated people with OUD. And many of the jails and prisons that have implemented MAT programs report that it is affordable and can be safely administered.

New York: ACLU, 2021. 32p.

By Donata Favretto, Cindi Visentin, Anna Aprile, Claudio Terranova, Alessandro Cinquetti

The most effective therapy for people with opioid use disorder (OUD) involves the use of Food and Drug Administration-approved medications—methadone, buprenorphine, and naltrexone. Despite evidence that this approach, known as medications for opioid use disorder (MOUD), reduces relapse and saves lives, the vast majority of jails and prisons do not offer this treatment. This brief examines what policymakers should consider when exploring how to best manage OUD in incarcerated populations.

It helps to first answer this question: How common is OUD in incarcerated populations? Data from 2007-2009 (the most recent available) showed that more than half of individuals in state prisons or those with jail sentences met the criteria for a non-alcohol and nicotine-related substance use disorder (SUD), meaning a problematic pattern of using a drug that results in impairment in daily life or noticeable distress, compared with only 5 percent of adults in the general population.

The gold standard of care is MOUD. In community-based settings, such as opioid treatment programs and primary care facilities, methadone and buprenorphine have been proved to reduce overdose deaths and illicit opioid use as well as the transmission of infectious diseases such as HIV and hepatitis C. A growing body of literature also exists on the benefits of naltrexone, the third Food and Drug Administration-approved medication.

Philadelphia: Pew Charitable Trusts, 2020. 22p.