The White House Office of National Drug Control Policy (ONDCP) released its first press release of 2024, promoting a January 29 op-ed on medication for opioid use disorder (MOUD) access in prisons and jails. Ostensibly it’s a call not to ignore the prison population, just one so focused on re-entry that most of the prisoner population is ignored for the entirety of the article.
“Imagine if every jail and prison across our great nation were equipped to provide medications for opioid addiction and provide people with the tools they need to succeed after reentry,” wrote co-authors ONDCP Director Dr. Rahul Gupta and Senior Advisor to the President and Director of the White House Office of Intergovernmental Affairs Tom Perez. “Imagine a brighter future where people leaving the criminal justice system enter the workforce, contribute to our nation’s economy and build stronger communities.”
Despite the federal government’s insistence that everyone who uses drugs is supposed to stop, prisoners might be the one group it’s not concerned with getting into recovery. If you’re on your way out of prison or jail then that’s one thing, but ONDCP isn’t interested in MOUD access for anyone currently incarcerated without an imminent release date.
Same goes for overdose prevention. People need naloxone access while in prison, not just on their way out the door, but weirdly the ONDCP’s understanding of “prisoner population” is just the latter.
“Today, there are approximately 2 million individuals in federal, state, local, tribal or territorial correctional facilities, with up to 65 percent of them battling a substance use disorder,” Gupta and Perez continued, citing a statistic the federal government remains fond of even though the data is about 20 years old.
“Only a small portion receive the treatment they need … People who lack access to medication for opioid use disorder are 120 times more likely to succumb to an opioid overdose in the first few weeks after release. It’s a crisis we cannot ignore.”
Though 16 states have applied for the Medicaid waiver to cover prisoners’ MOUD, only two have been approved so far.
Sure we can. And if these press releases are supposed to do more than make ONDCP look busy, it wouldn’t have hurt to mention any of the MOUD by name. Or any drugs besides opioids, since they’re referencing SUD and not just OUD anyway.
In Washington State, for example, most SUD diagnoses among prisoners aren’t for opioids. They’re for methamphetamine, which doesn’t yet have Food and Drug Administration-approved medications and which dominates the supply in many state prison systems.
Meth is a much smaller overdose risk factor than it’s presented as these days, but a much larger recividism factor. Meanwhile, incarceration has been linked to disproportionate rates of tobacco-related deaths while prison cigarettes themselves are becoming more harmful. We ignore harm reduction alternatives for those populations too.
The authors note that many corrections departments want to provide MOUD but “concerns about cost have held them back.” Corrections departments have managed to overcome this concern for the most-expensive and least-useful MOUD, naltrexone. Methadone initiation, for people who weren’t already in a program when they were arrested, is expanding at a rate that feels like standing still. Not that corrections departments are being required to do anything here either way.
Though 16 states have applied for the waiver allowing them to cover prisoners’ MOUD through Medicaid, only two—California and Washington—have been approved so far. The only prisoners eligible for coverage in the first place are those at the very end of their sentence; usually at 90 days out from release, sometimes less. Restoring their right to Suboxone maintenance during longer periods of incarceration would be more expensive, which is a barrier ONDCP could have mentioned the way they did for people nearing release, rather than just ignoring the fact that people in prison use drugs.
Photograph via North Carolina Department of Adult Correction
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