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Methadone Maintenance Programs In Prison

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

March 12, 2019

To reduce harm within prisons and reduce recidivism rates, prisons across the US are implementing methadone maintenance programs as part of an overall harm reduction strategy within the prison system. In some cases, these programs help to transition opioid-addicted individuals into other treatment following their release from prison.

There are more than two million people currently held in US prisons and it has been estimated that upwards of 15 percent of those individuals has a current or previous heroin addiction. Those with a history of heroin or other opioid addiction, left untreated, are likely to relapse within 90 days of release from prison, making them more vulnerable to the crimes and pathogens like HIV and Hepatitis B and C, associated with IV drug use.

Unfortunately, for years, someone who had gotten clean from heroin using a methadone maintenance program, when arrested, were often forced to stop the program during their incarceration. For the majority, this inaction on part of the federal and state jurisdictions lead inevitably to relapse upon release from prison. In-prison methadone maintenance programs have been shown to cut this relapse rate by more than half.

Effectiveness Of Prison-Based Methadone Maintenance Programs

A number of studies have been conducted in prisons worldwide and each has demonstrated similar positive outcomes in release outcomes and institutional behavior as well as in reduced drug use within the prisons and an overall reduction in the spread of needle-related pathogens. Some of these programs are successful in transitioning prisoners out of the prison system and into treatment, where they can receive comprehensive care for the addiction disease.

Prisons who implemented a methadone maintenance program for addicted populations saw:

  • Improved release outcomes
  • Improved institutional behavior
  • Reduced in-prison drug use
  • Reduced pathogen spread due to shared needles
  • Aided in transitioning prisoners out of prison and into treatment

These prison-based methadone maintenance programs require solid communication and assessment skills on part of intake staff in evaluating prisoners, and in establishing an appropriate dose for participants.

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One study examining willing participants in a prison-based methadone maintenance program indicated 95 percent of those individuals followed up with drug rehabilitation services at a treatment facility post-release as compared with just eight percent of those individuals who withdrew or abstained from a maintenance program during their incarceration.

When left untreated, heroin addiction can lead to immense and insatiable cravings for the drug. Upon release from prison, individuals who have not been treated for their addiction are far more likely to experience a relapse resulting in overdose and possibly death. Individuals who participate in methadone maintenance programs are more likely to continue treatment following release and are less likely to overdose.

Why Methadone Maintenance Programs Work

Unlike counseling alone, methadone maintenance programs work by blocking the effects and the cravings for opioids. Regular methadone treatment gives the body time to adjust to the withdrawal period following cessation of heroin-use. These programs also reduce the extreme mood changes and physical pain of withdrawals, lessening the aggression of inmates going through detox while in prison. Behaviors are improved, and moreover, the cravings that can lead to illicit drug use while in prison, and subsequent needle sharing, reduce the spread of bloodborne pathogens.

Why Prisons Are Hesitant To Include Methadone Maintenance Programs

Despite the evidence in support of use of methadone maintenance programs in reducing drug use and prison recidivism rates, there is still a long way to go before maintenance programs are initiated on a large scale. This is due largely in part to the fact that methadone is an addictive substance in its own right, in some cases producing withdrawal symptoms on par with heroin. The major difference between a drug like heroin and methadone is that heroin generates the euphoria people seek out when taking the drug, while methadone blocks these effects while relieving the symptoms of heroin withdrawal.

In May, the National Institute on Drug Abuse released findings from a study that demonstrated the effectiveness of methadone maintenance programs for inmates, again emphasizing the importance of follow-up treatment for opioid addiction to prevent accidental overdose deaths upon release. The study also highlighted the significance of programs that transition inmates from prison into a more comprehensive treatment facility following their release. Additionally, the study found that individuals who continued methadone maintenance while incarcerated fared better than those who went through a methadone taper during their six months to one year in prison.

Free Yourself From Drug Addiction is an online resource designed to connect you with the professional support and comprehensive, evidence-based care you need to treat the disease of addiction. Contact us today to learn more about methadone recovery programs in and out of prison and about which options will best meet your individual needs. Take the first step. Get free from addiction today and discover a new and rewarding life in recovery.

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