Rhode Island Leads The Way With New Approach To Treatment For Inmates

By Beth Leipholtz 03/16/18

Rhode Island is the first state to offer three different forms of medication-assisted treatment to inmates with opioid addiction.

rear view of prison officer leading prisoner in handcuffs in corridor

For the first time in 16 years, Casey isn’t struggling with a substance use disorder (SUD)—and he says he owes his success to the treatment he received in prison. 

According to Vox, Casey is one of the individuals who has benefited from Rhode Island’s new approach to SUD treatment for inmates in prisons and jails. 

The state is now taking a medication-assisted treatment (MAT) approach and provides three medications for those struggling with opioid use. The medications—buprenorphine, methadone and naltrexone—have been proven by research to decrease the mortality rate among patients struggling with opioids by 50% and sometimes more.

Additionally, they have been proven more effective when it comes to keeping people in treatment. 

When it comes to this approach, Rhode Island is the exception rather than the rule. According to Vox, Rhode Island is the only state that credibly reported “providing full access to all three kinds of medication.”

Most states either do not provide any medication, or allow only naltrexone, which Vox claims is backed by the least evidence when it comes to effectiveness. 

Because very few states provide good access to treatment options, inmates are often at risk upon their release from prison. 

In fact, according to a 2007 study in the New England Journal of Medicine, in the two weeks following release, a former inmate has "a risk of a fatal drug overdose [that] is 129 times as high as it is for the general population." Additional studies have similar findings.

“Globally, there is no more high-risk period and no more high-risk population than those leaving incarceration,” Traci Green, a researcher at Brown University, told Vox. “It’s during those first two weeks and out to four to six weeks that people are at greatest risk of overdose death.”

While still in the early stages, Rhode Island's approach to treatment in prison seems to be effective, according to a study stating that it has cut in half overdose deaths among released inmates. 

Still, the fact remains that most state prisons do not offer medication-assisted treatment for inmates. In fact, Vox reached out to 50 agencies behind state prison systems and inquired as to whether they offered buprenorphine, methadone or naltrexone. If they said yes, they were asked whether there were restrictions. 

Of the 45 states that responded, Rhode Island was the only one to give full access to the three medications. Hawaii reported that it allows buprenorphine and methadone, while 16 other states offer only naltrexone. The other 27 states do not offer any type of medication to those with opioid use disorders. 

Those states that do not offer medication-assisted treatment could be contributing to overdose deaths in two ways, according to Vox

The first is an increased risk of overdose in prison. But because it is harder to obtain drugs while in prison, the bigger concern is the risk of overdose once an inmate is released. 

“The minute people leave, they’re facing tremendous stressors,” Sarah Wakeman, medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, told Vox. “They cross over this threshold of leaving this very artificial environment, going back to their usual environment, and with the incredible stress and burden of having just experienced incarceration and trying to pick up relationships and dealing with barriers with housing and employment and insurance. Not surprisingly, cravings come back, and people often relapse very quickly.”

One of the reasons Rhode Island has been successful in limiting overdose deaths is because they offer MAT. People respond differently to medications, and what works for one may not work for another.

According to Vox, “Many people may do well on methadone, others may prefer buprenorphine, and yet some may find the best results with naltrexone or even no medications at all.”

“It’s critical to have all three of those components available,” Jody Rich, a researcher in Rhode Island involved with the state’s program, told Vox.

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.