Lack of access to methadone and burprenorphine, lifesaving opioid use disorder medications, for vulnerable incarcerated populations has long been a stain on the US criminal justice system.
On April 3, a groundbreaking open letter—signed by 58 current or former elected sheriffs, district attorneys and other law enforcement and criminal justice officials and leaders from across the US—called for this situation to end in jails and prisons, and for naloxone distribution on release.
Incarcerated populations are hugely important in the context of addressing the opioid-involved overdose crisis. A 2018 CDC report indicated that in around 10 percent of overdose deaths, there was evidence of the person being released from an institutional setting in the month prior.
Law enforcement voices have the potential to be powerful influences on mainstream and government opinion. The letter was organized by Fair and Just Prosecution and the Law Enforcement Action Partnership (LEAP)*, two pro-reform advocacy groups.
“For too long we have tried to punish people into abstaining from drugs rather than expanding access to strategies that work,” said Miriam Krinsky, executive director of Fair and Just Prosecution. “Requiring people to be cut off from medically assisted treatment while in custody flies in the face of proven best practices and increases fatal overdoses when people reenter the community. It’s time for a different way forward.”
“Society demands that [jails] also serve as a hospital, mental health institution, school and rehabilitation center,” said Richard Van Wickler, Superintendent of the Cheshire County Department of Corrections in New Hampshire and a speaker for LEAP. “Providing adequate and responsible healthcare to treat addiction through medication-assisted treatment is a requirement, not an option.”
“A prosecutor’s role does not end at the prison door,” said signatory Sarah George, Chittenden County State’s Attorney. “We are obligated to use our voices to ensure in those instances when people absolutely must be incarcerated, they leave custody in a position to safely reenter their communities.”
As Filter has reported, a few encouraging signs of increased MAT availability for incarcerated people have emerged in recent months—with a federal judge in Massachusetts ruling in favor of a defendant receiving methadone, and a pilot program for injectable burprenorphine announced by Pennsylvania’s Department of Corrections. It is to be hoped that the new letter will increase this momentum.
Here is the full text of the letter, which attorney and Filter contributor Rory Fleming played a role in drafting, with the full list of signatories below:
As current and former elected local sheriffs and current elected prosecutors, as well as other law enforcement professionals, we are committed to protecting public safety and the safety of individuals in our custody. We believe that providing medication-assisted treatment (MAT) like methadone and buprenorphine in jails and prisons, as well as ensuring that individuals released from custody have naloxone and a continuing care plan, is part of that duty.
Medical research shows that many people who are unable to stop illegally using opioids through abstinence-based treatment are able to stop when using methadone or buprenorphine as a part of medication-assisted treatment (MAT). While abstinence-based heroin treatment has a 5 to 15 percent long-term success rate, MAT program success rates exceed 50 percent. In addition, most people relapse at least once before they successfully enter recovery. People on MAT are much less likely to die of an overdose if they relapse.
Decades of studies show that MAT use decreases illicit drug use, crime, and health costs to communities. Continuing MAT care in county jails and prisons is essential to ensuring that formerly incarcerated people do not relapse and reoffend upon release.
Forcing people in jail to detox is difficult and dangerous. Withdrawal brings vomiting, diarrhea, and low blood pressure. People can die from dehydration while detoxing in jail—and a number have.
Those forced to detox in jail or prison are also more likely to die from overdose upon release. According to a report last August by CDC researchers on overdose deaths, “Approximately one in 10 decedents had evidence of having been released from an institutional setting in the month preceding the fatal overdose . . . [T]he most common settings being jail, prison, or detention facilities when only illicit opioids were involved (4.9%). . . These data suggest a need . . . to expand treatment in detention facilities and upon release.” Fortunately, research shows that providing MAT in correctional facilities reduces the risk of overdose death post-release by 85 percent.
In order to reduce overdose and improve recovery success, we also believe in ensuring that individuals struggling with addiction should be provided with naloxone and a continuing care plan upon release.
We recognize that this epidemic of drug overdose requires a new approach. Over 70,000 Americans died from drug overdose in 2017, more than have ever died in a single year from the epidemics of crack cocaine, H.I.V., car crashes, or gun violence.
We will work within our own jurisdictions to respond effectively to the new realities of the opioid crisis. By doing so, we will avoid needless fatalities, reduce the use of illicit opioids, and improve safety in our communities.
Sheriff, Albany County, New York
Commissioner, Cambridge Police Department, Massachusetts
District Attorney, DeKalb County, Georgia
Patrick J. Cahillane
Sheriff, Hampshire County, Massachusetts
John T. Chisholm
District Attorney, Milwaukee County, Wisconsin
Jerry L. Clayton
Sheriff, Washtenaw County, Michigan
Former Chief, Albany Police Department, New York
District Attorney, Dallas County, Texas
District Attorney, Durham County, North Carolina
Christopher J. Donelan
Sheriff, Franklin County, Massachusetts
Thomas J. Donovan, Jr.
Attorney General, Vermont
District Attorney, 20th Judicial District, Colorado
Former Deputy Sheriff, Park County, Montana
Wendell France, Sr.
Former Deputy Secretary, Department of Public Safety and Correctional Services, Maryland
Circuit Attorney, City of St. Louis, Missouri
State’s Attorney, Chittenden County, Vermont
District Attorney, Salt Lake County, Utah
Sheriff, Harris County, Texas
District Attorney, Nueces County, Texas
District Attorney, Winnebago County, Wisconsin
District Attorney, Berkshire County, Massachusetts
Former Corrections Officer, Hampden County Sheriff’s Department, Massachusetts
City Attorney, Seattle, Washington
Former Commissioner, Department of Corrections, Pennsylvania
District Attorney, Deschutes County, Oregon
Attorney General, Delaware
Lawrence S. Krasner
District Attorney, Philadelphia, Pennsylvania
Karl A. Leonard
Sheriff, Chesterfield County, Virginia
Chief, Tucson Police Department, Arizona
Former Sheriff, Flagler County, Florida
District Attorney, Second Judicial District, Colorado
District Attorney, Fort Bend County, Texas
Former Detective and Deputy Sheriff, Los Angeles County Sheriff’s Department, California
Marilyn J. Mosby
State’s Attorney, Baltimore City, Maryland
Attorney General, Rhode Island
Michael J. Neustrom
Former Sheriff, Lafayette Parish, Louisiana
Former Sergeant, Richmond County Sheriff’s Department, Georgia
Former Jail Director, Hillsborough County Sheriff’s Office, Florida
Sheriff, Boulder County, Colorado
Karl A. Racine
Attorney General, District of Columbia
Former Sheriff, King County, Washington
Former Corrections Officer, Department of Corrections, Colorado; Former Deputy Sheriff, Arapahoe County Sheriff’s Department, Colorado
District Attorney, Suffolk County, Massachusetts
Marian T. Ryan
District Attorney, Middlesex County, Massachusetts
Prosecuting Attorney, King County, Washington
Carol A. Siemon
Prosecuting Attorney, Ingham County, Michigan
Former Chief, Fulton Police Department, New York
Former Chief, Seattle Police Department, Washington
Richard W. Stanek
Former Sheriff, Hennepin County, Minnesota
David E. Sullivan
District Attorney, Northwestern District, Massachusetts
Chief, Newtown Police Department, Ohio
J. Scott Thomson
Chief, Camden County Police Department, New Jersey
Former Deputy Sheriff, Clackamas County Sheriff’s Department, Oregon
Richard N. Van Wickler
Superintendent, Cheshire County Department of Corrections, New Hampshire
Cyrus R. Vance, Jr.
District Attorney, New York County, New York
Chief, Chatham Police Department, New York
Andrew H. Warren
State Attorney, 13th Judicial Circuit, Florida
Sheriff, Ingham County, Michigan
*LEAP is the fiscal sponsor of The Influence Foundation, which operates Filter.