Do incarcerated individuals with OUD receive treatment?

The American Society of Addiction Medicine (ASAM) reports that approximately 19% of inmates were regular heroin or opioid users before serving a sentence. Unfortunately, they also observe that the absence of comprehensive drug treatment programs in prisons dramatically increases the risk of overdose upon release¹.

Given that April is Second Chance Month, which seeks to raise awareness of the challenges former inmates face, read on to understand how correctional facilities address opioid use disorders (OUD).

How are people with substance use disorder treated in prison?

Cold turkey

Since there are so many individuals with substance use disorders in prison, it leads many to wonder if treatment options are available. However, these opportunities are rare. Most incarcerated individuals with an OUD are forced to go cold turkey once they enter the system, despite this practice going against best medical practices.

Going cold turkey triggers withdrawal symptoms. For those with heroin or opioid dependency, this can mean intense nausea, vomiting, and muscle pain. The experience can also cause significant psychological distress, with many people reporting bouts of insomnia and anxiety.

While opioid withdrawal isn't often life-threatening, it's an unpleasant experience. Most of all, it's unnecessary when prescriptions like Suboxone® can address OUD without triggering withdrawal symptoms — helping make the experience far less traumatic for individuals.

Correctional facilities simply aren't designed to help people with an OUD. Addiction alters brain chemistry and drives drug-seeking behavior, and these changes persist long after an individual stops using them. The correctional approach to substance use disorders is punitive rather than therapeutic, which makes recovery more challenging.

Traditional therapies

Other prisons may have what is considered traditional treatment offerings (like group therapy, 12-step programs, and educational classes). Still, they aren't guaranteed at every facility, especially at smaller institutions or those located in remote or rural areas. Although traditional approaches are valuable components of a comprehensive treatment plan, they might not work as a standalone option for OUD.

Substance dependency is still stigmatized in correctional settings, leading to punishment rather than treatment². Other factors, like prison overcrowding, understaffing, and limited resources, mean medical treatment is often reactive rather than proactive. Individual care isn't common,  so mental health conditions that frequently co-occur with OUD go undiagnosed or untreated — further complicating recovery prospects.

The lack of standardized protocols for OUD in correctional settings creates a randomized approach to treatment that varies from state to state and from facility to facility. This inconsistency means that an individual's access to evidence-based treatment is primarily determined by geography, institutional policy, and luck instead of medical need.

Environmental factors

Incarceration doesn't always mean an individual stops using substances. About 50% of individuals with an OUD continue to use drugs while imprisoned. In some cases, addiction can even begin in prison, with roughly 35% of inmates abusing substances while detained³.

The fact is, many correctional facilities have underground drug economies that make illicit substances (including opioids) accessible, though at higher prices and greater potential risks⁴.

Do jails give Suboxone®?

As with many questions on this topic, there isn't an easy answer. Suboxone is composed of two substances: buprenorphine and naloxone.

The buprenorphine activates the same receptors in the brain as opioids and heroin, but not as intensely, and it has proven to help minimize cravings and withdrawal symptoms.

Meanwhile, naloxone reverses overdoses. In Suboxone, naloxone is combined with buprenorphine as an abuse-deterrent. It remains inactive when taken as prescribed, but if the medication is misused, the naloxone becomes active and can prompt withdrawal symptoms, discouraging misuse. Additionally, Suboxone is a pill or a strip dissolved under the tongue, making it ideal for medication-assisted treatment (MAT) strategies.

Unfortunately, Suboxone treatment in jails isn't standard because there aren't many drug treatment programs in prisons to begin with. While some facilities have implemented comprehensive MAT programs, the vast majority haven't followed suit⁵ despite their many potential advantages⁶.

MAT programs are usually limited to specific populations or circumstances. For example, pregnant women may have access due to the significant risks that opioid withdrawal poses to fetal development.

In other cases, individuals enrolled in MAT programs before being incarcerated might be allowed to continue their medication regimen, though it's still an inconsistent practice.

What happens when an OUD goes untreated?

When OUD goes unaddressed during incarceration, the repercussions are felt in the short- and long-term, such as:

‍Overdose Risks: Research shows that recently released individuals are at least 40 times more likely to die from opioid overdose in the first two weeks following release compared to the general population⁷.

‍Recidivism likelihood: Untreated OUD significantly increases the probability of recidivism, creating a seemingly endless loop of substance use, legal consequences, and repeated incarceration⁸.

How can we improve drug treatment programs in prison?

1. Intake screenings

Comprehensive intake screenings are crucial for identifying incarcerated individuals with an OUD. These assessments should evaluate the severity and specific nature of dependency issues alongside any co-occurring mental health conditions. That way, correctional facilities can develop personalized treatment plans that address each person's unique needs from day one.

2. MOUD/Medication-Assisted Treatment

Expanding access to Medications for Opioid Use Disorder (MOUD) represents one of the most promising approaches for treating substance dependency in correctional settings. Offering Suboxone treatment in jails can minimize withdrawal symptoms and cravings and help lower the risk of recurrent opioid use and overdose upon release.

3. Non-drug talk therapy

Talk therapy and counseling address the psychological aspects of dependency. Speaking with professionals can help individuals identify their unique triggers, develop coping strategies, and address root causes that may contribute to their substance use. Talk therapy can complement medication-based treatment and support ongoing recovery.

4. Re-entry support

The transition from incarceration to the community represents a particularly vulnerable period for individuals with substance use disorders. Having a support network in place makes matters easier. Other factors, like employment and housing assistance, can also make reintegration less stressful. Continuity of care is essential, especially at this turning point. Individuals should have uninterrupted access to MAT programs to improve the chances of positive outcomes.

5. Continued research

While there is existing research into drug treatment programs in prison, there's still a significant knowledge gap. Since this is still something of a new frontier, most current studies provide information on short-term outcomes. Ongoing research is necessary to understand these measures' impact in the long term.

That said, some research suggests that comprehensive OUD treatment during incarceration has positive results. Studies indicate potential reductions in recidivism and substantial decreases in overdose risk. If true, the widespread adoption of OUD treatment during incarceration can make a difference in many lives⁹.

Ongoing care is available with Ophelia

If you're experiencing an opioid use disorder, you don't have to go it alone. Ophelia's teams will help you with everything from developing a treatment plan and getting a Suboxone prescription to receiving ongoing support. We're with you every step of the way.