As the U.S. confronts an unprecedented surge in overdose deaths to a record 108,000 last year, a shadow epidemic receiving far less attention is causing a spike in fatalities in our nation’s prisons and jails. According to the Pew Charitable Trusts, the alcohol and drug overdose death rate in prisons increased fivefold from 2009 to 2019, outpacing the national drug overdose rate, which tripled in the same period.
Our criminal justice system is contributing to this steep rise in drug-related deaths as we continue the misguided policy of locking up individuals for drug offenses (currently estimated at one in every five of the country’s 2.3 million inmates. Equally troubling, an estimated 65 percent of the prison population has an active substance use disorder.
As a society, the strategies we successfully used to treat addiction — harm reduction measures to reverse overdoses and save lives, followed by treatment programs to change lives — should also be used to help the incarcerated with substance abuse disorder.
Yet, only around 12 percent of America’s prisons and jails currently offer medication-assisted treatment (MAT), one of the most effective methods to help those struggling with substance abuse. Instead of forcing inmates into harsh detox conditions, as many facilities do, MAT combines medications such as methadone and buprenorphine that ease cravings, along with behavioral therapies. And equally important, MAT must include peer-based counseling from former addicts that engages inmates both in the facility and post-incarceration.
First, we can divert drug users from entering the criminal justice system altogether, where they don’t belong in the first place, as nobody should be arrested and imprisoned for being an addict. Diversion strategies such as drug courts that offer those arrested a choice between jail and treatment are a good starting point.
Meanwhile, individuals with opioid use disorder remanded in jail for short-term processing should begin MAT immediately as they will soon begin to experience withdrawal. Several programs using MAT at this early stage in jail have proven effective at guiding more people into long-term recovery and thereby reducing recidivism for drug-related crimes.
Second, prison administrators must establish protocols for the use of overdose-reversal drugs in their facilities, followed by MAT programs that serve as a bridge to peer counseling. Doing this requires training programs for both inmates and outside staff in recovery to work with those in prison who identify as addicts. In my experience as an addiction psychiatrist, these peer counselors become valuable and supportive role models who can help lead substance users to self-understanding and eventually, long-term sobriety.
We know that MAT and peer counseling in prisons work: A MAT-focused program in California — the largest of its kind in the U.S. for addicted prisoners — reduced the overdose death rate by nearly 60 percent over the past two years.
Finally, we must help former inmates reintegrate into communities. According to a North Carolina study, the formerly incarcerated with substance use are up to 40 times more likely to die of an opioid overdose than the general population within two weeks of release. Reentry services must include job and vocational training, transitional housing and, most importantly, continued access to long-term drug treatment and recovery counselors.
To accomplish this shift in drug policy, we must overcome a longstanding reluctance to help the incarcerated that are addicted. Let’s commit to making sure they don’t suffer in isolation, despair and loneliness. With an ever-growing prison population and spiraling rates of overdose death, we need a more humane approach that helps inmates attain sobriety — both in prison and after their release.
Mitchell S. Rosenthal, M.D., is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for Addiction Studies in New York City.