Treating Substance Abuse in Prisons Presents Challenges

Sixty-eight percent of prison inmates have a diagnosis of drug and alcohol abuse or dependence, but treatment is relatively rare. Only about 17 percent of those with problems are treated while they’re in jail or prison, said Frank J. Vocci, PhD, President and Senior Research Scientist, Friends Research Institute, Inc.

Dr. Vocci, will discuss the benefits of pharmacologic treatment for incarcerated populations during Workshop 7, “Treatment of Substance Use Disorders in the Criminal Justice System,” from 4:30 to 6:30 pm today in Williford A on the third floor of the Hilton Chicago. The other speakers will be Robert Schwartz, MD, Medical Director and Senior Research Scientist at Friends Research Institute, Inc., and Terrence Fitzgerald, MD, Medical Director at Glenwood Life Center, Baltimore.

The results of nonintervention are stark. A study in Washington state showed that the mortality rate for former prisoners in their first two weeks after release was more than 10 times the mortality rate of the general population—with many of those deaths coming from drug overdoses.

“That’s an incredible signal,” Dr. Vocci said. “This is a period of time when these individuals are especially vulnerable to going back to using, overdosing. If they don’t overdose, then they’re at risk to be re-addicted, re-arrested, and incarcerated. There’s an opportunity here to treat people at a point when you can turn things around.”

The speakers will talk about treating opioid dependence with methadone, buprenorphine, or naltrexone. Dr. Schwartz said opioid agonists such as methadone and buprenorphine are “rarely” used in U.S. prisons. “It’s a challenge, even though these medications are used in prisons throughout the world.”

Despite a recent meta-analysis showing that treatment with opioid agonist medications is more effective than non-pharmacologic treatment, many corrections officials are hesitant to use agonists. Medications often are not used because of philosophical concerns about treating drug addiction with more drugs or because officials simply don’t understand the treatments, he said, calling the lack of treatment a “missed opportunity.”

“My issue is, as in other areas of medicine, people with opioid addiction should be informed of treatment options, and their risks and benefits by their physicians. They should have all the options available to them, and then decide with their physicians which one they want to use at that particular time.” Dr. Schwartz said.

Additionally, some prisoners balk at the idea of being treated with agonists, Dr. Vocci said. “They feel it cuts their edge, and they feel vulnerable. They’re feeling that someone’s going to take advantage of them.”

Another consideration with pharmacologic treatment of prisoners is funding. Researchers rely on grants and pharmaceutical companies for support. But even though prison officials won’t foot the bill for new studies, Dr. Vocci said they are watching for results.

“They’re interested,” he said. “They want to see if there’s something that we should be doing in terms of changing the system.”