Every fatal opioid overdose means our system has failed to provide treatment. A patient of mine — I’ll call him John — overdosed and almost died last year. After missing a visit in our addiction treatment clinic, he was brought in to the emergency department after being found nonresponsive in his car.
John’s close call could have been avoided. When he had first come to our clinic months before, worn-down from years of addiction to heroin and prescription opiates, he was ready to change his life and get treatment.
At that visit John decided against starting buprenorphine-naloxone, otherwise known as Suboxone, a proven effective treatment. The reason: he knew if he ended up in jail, he wouldn’t get the Suboxone and he would be forced to go through the misery of withdrawal behind bars.
John’s fear is common. Many patients engaging with addiction treatment choose against starting methadone or buprenorphine because of fear that they will go through withdrawal if put behind bars where they can’t receive that treatment. Their fear is well-grounded: in most states, including Connecticut, most of these patients are taken off treatment if they are incarcerated.
It doesn’t have to be this way. My patients should not have to make a decision against accessing the treatment most likely to be successful because of fear of losing access if jailed. A bill now being discussed in Connecticut’s General Assembly, SB-172, proposes to do just that: to offer the best evidence-based addiction treatment for people in our state’s prisons and jails.
Bending the curve of the opioid overdose epidemic will require increasing access to treatment and making it available in places where people need it. Because people with addiction overwhelmingly end up in our criminal justice system, it is where we need to offer them the best chance of treating their addiction and saving their lives.
Rhode Island, which like Connecticut is struggling with an opioid overdose epidemic, is already doing this with successful results. In 2016, Rhode Island implemented a state-wide program to screen all people entering the criminal justice system for addiction and offer all FDA-approved medications for opioid use disorder including methadone, buprenorphine-naloxone (Suboxone), and naltrexone (Vivitrol).
This approach makes sense as approximately half of inmates in state prisons meet criteria for substance use disorder. Furthermore, forced abstinence in correctional settings is a set-up for a fatal overdose. As people are released back into the community, without access to medical treatment and with their tolerance lowered, they are at a high risk of relapse and accidental overdose. The numbers bear this risk out; in Connecticut, half of the people who die from overdoses have a history of incarceration.
Since Rhode Island made this change, overdose deaths in the state have dropped by 12 percent and overdose deaths in people released from Rhode Island’s prisons and jails were cut in half.
To be sure, given our current state budget situation, it may seem like the wrong time to introduce a program that adds to the budget. That said, offering buprenorphine and methadone has consistently been shown to be a cost-effective and as Rhode Island has shown, it works. We need to have the resolve to offer the most effective treatment to the most vulnerable in our state, especially when thousands are dying every year.
It is hard for me to not see that John’s overdose could have been avoided if he was less reticent to start Suboxone at that initial visit. If John, and all the patients like him, knew they would continue on treatment if incarcerated they would be more likely to start the treatment that had the greatest likelihood of successfully treating their addiction.
Dr. Benjamin Howell is a post-doctoral fellow at the Yale School of Medicine’s National Clinician Scholars Program.