ARI SHAPIRO, HOST:
We wanted to get some perspective on those suspected prison overdoses, so we called on Dr. Sarah Wakeman. She's an addiction medicine specialist at Massachusetts General Hospital, who has studied opioid use among people who are incarcerated.
SARAH WAKEMAN: I'm not surprised to hear about ongoing drug use in the setting of incarceration. You know, in this country, people who use drugs overwhelmingly experience some involvement with the criminal justice system in large part because of our policies around drug use. You know, if you look at some estimates, as many as 85 percent of prisoners are in some way substance related in terms of the reason for their incarceration. And the rates of opioid use disorder and of all types of substance use disorder are much, much higher behind bars. And we often don't offer any sort of treatment or certainly not effective treatment. And so unsurprisingly when you don't offer effective treatment for someone with severe addiction, people often find a way to continue to use drugs.
SHAPIRO: You say they often find a way to continue to use drugs.
WAKEMAN: Yeah.
SHAPIRO: How difficult is it for people behind bars to get access to opioids?
WAKEMAN: So they have obviously less access than when they're in the community, but there is still access. And often the prices are much higher, and the risk is much greater. So people who do use end up using often in riskier fashions because they're having to do so, of course, in secrecy and at greater risk to themselves. And I think the most important thing to note is that opioid addiction is an entirely treatable condition, and it can be treated effectively even in correctional settings. And so I think the most important takeaway is really that we need to be offering lifesaving and effective treatment.
SHAPIRO: Do many prisons and jails have medication-assisted therapies, like Suboxone, methadone, to help treat inmates?
WAKEMAN: No, not in this country. The vast majority do not, with the exception of pregnant women. So pregnant women with opioid use disorder are all offered treatment generally with methadone because we recognize that the risk of addiction not only puts the woman at risk but also puts the fetus at risk. And so there's sort of an interesting issue there where we're willing to offer treatment when it involves a pregnant woman. But when it involves a nonpregnant adult, we don't offer treatment in almost all settings across the country.
SHAPIRO: So it sounds like you're saying people behind bars are either going to have to find illegal ways to obtain drugs in prison, or they're going to go through what can be pretty horrific withdrawals.
WAKEMAN: Totally horrific withdrawals, and that obviously causes undue pain and suffering to the person. It also means that that individual - we know, for example, people who come into prison, who are on effective medication treatment with medications like methadone or buprenorphine, are forced to undergo withdrawal when they get incarcerated. And that actually leads to differences in how people think about treatment when they come back to the community. So there's been some interesting studies that people who've had to go through painful withdrawal from methadone, for example, when they're in prison are actually less likely to want to engage in treatment when they come back into the community. And so there's very real implications for community-based care as well.
SHAPIRO: You said in the U.S., there is not a lot of treatment for people struggling with addiction behind bars. Are there other good models in other countries that you might encourage the U.S. to adopt?
WAKEMAN: Absolutely. I mean, first, in the U.S., just to call out a model here is the state of Rhode Island, which has recently implemented offering all three types of medication treatment for opioid use disorder. And in the year following that, they saw a 60 percent decline in fatal overdose after release, so really dramatic findings. Additionally, Rikers Island has been offering medication for opioid use disorder for decades actually. There are many other countries that do and make this a routine part of care. And if you think about the fact that people who are imprisoned are - should be guaranteed access to the same community standard of care as anyone else, really we shouldn't be withholding what we know is lifesaving and effective treatment for people with opioid use disorder just because they're in a correctional facility.
SHAPIRO: Dr. Wakeman, thanks so much for talking with us.
WAKEMAN: Thank you very much.
SHAPIRO: Dr. Sarah Wakeman is medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital.
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