A recent report by the Pennsylvania Institutional Law Project (PILP) has highlighted major improvements to addiction treatments in jails and prisons across the state — an encouraging sign that court decisions and opioid settlement dollars are actually making an impact.
Medication assisted treatment (MAT) programs are the current gold standard for opioid treatment, helping patients live longer and have a higher chance of achieving lasting recovery. Medications like methadone or buprenorphine stave off withdrawal symptoms by mimicking the effects of opioids, but without the “high.” These pharmaceutical interventions are often supplemented by other treatments, such as cognitive behavioral therapy.
But even if institutions can’t put together a full MAT protocol, medication alone (medication for opioid use disorder, or MOUD) is still effective at improving outcomes for people in custody.
Yet prisons and jails have been slow to adopt MAT or MOUD programs, forcing most inmates to go through anguishing withdrawals without any relief. This is despite the fact that roughly 65% of inmates have substance or opioid use disorders.
Luckily, within the last two years, jails and prisons have felt pressure from public officials and nonprofits to implement proper OUD treatment — just as money from nationwide opioid settlements has entered communities. Between 2022 and 2024, the number of prisons and jails that continue or induce medication treatment programs jumped from 32% to 84% — massive strides towards properly helping those with OUD.
The effects are also felt locally. The Department of Justice ruled in late 2023 that Allegheny County Jail had violated the Americans with Disabilities Act by withholding opioid withdrawal medications from inmates. As a result, the jail, and many others across the Commonwealth, overhauled treatment programs this year.
There’s still more work to do. The PILP report found that many jails still have strict treatment requirements that are unrelated to the patient’s medical needs. For example: Some facilities may withhold medication on disciplinary grounds, or offer “continuation” treatment only if a patient has been on medication for a set period of time. The behavior of an inmate or the date he or she began a program should have no impact on a medically-necessary addiction treatment.
Additionally, MAT and MOUD, like any medication program, must also be tailored to each individual. Methadone is only effective for some patients, and the same is true for buprenorphine. Jails and prisons that offer only one or the other inevitably leave some inmates without effective treatment. The Pennsylvania Department of Corrections, which only offers buprenorphine continuation, is the biggest offender, and should expand its offerings of proven treatments.
During this crucial time, when MAT and MOUD programs are being implemented and expanded as federal regulations ease, facilities should also re-evaluate their own best practices for treatment. This should include offering both methadone and buprenorphine, and offering treatment continuation as well as treatment induction.
Addiction is a painful and difficult disease, one that often leads people to illegal or otherwise antisocial behavior. Our correctional institutions serve their rehabilitative and protective functions best when they use every available tool to help those suffering on the path to healing.
— Pittsburgh Post-Gazette via TNS
