Inmates Denied Methadone Less Likely to Seek It After Release

U.S. prison inmates who are forced to discontinue methadone maintenance treatment (MMT) are less likely to resume treatment after their release, according to new trial results from Brown University and Miriam Hospital published in the journal The Lancet. This study is the first randomized trial to test the effect of allowing inmates to continue MMT during their incarceration. Approximately 90 percent of U.S. inmates will be cut off from methadone treatment when they enter prison. The Centers for Disease Control and Prevention (CDC) reports that methadone maintenance treatment reduces drug-seeking behaviors and risk behaviors that result in higher incidences of crime and a higher risk of exposure to blood-borne illnesses like HIV and hepatitis. In all, data gathered by the CDC shows that the death rate among opioid drug users who receive MMT is only 30 percent of the death rate among users who do not receive such treatment. Many public health experts fear that interrupting MMT for opioid-dependent inmates will not only reduce the likelihood of recovery but put inmates at greater risk post-release than they were before their incarceration. This is because inmates lose the drug tolerance that they have built up, but return to taking the same amount upon release, putting themselves at serious risk for a fatal overdose.

Inmates on Methadone Upon Release Continue Treatment

In some state prison systems, inmates undergo a phased withdrawal before MMT is totally discontinued, but in many others, inmates are taken off treatment immediately upon incarceration. The new trial was conducted in the Rhode Island Department of Corrections, which is one of the jurisdictions in which prisoners are permitted a phased withdrawal. The researchers divided 223 opioid-dependent inmates into groups of 114 inmates and 109 inmates. All of the inmates who participated in the study had sentences of six months or less. The 114 inmates in the first group were allowed to continue with MMT, while the 109 inmates in the second group went through phased withdrawal as usual. Following their release, every inmate in the study was offered financial and logistical support in order to continue or resume methadone treatment The researchers discovered that 97 percent of the inmates who were still receiving methadone treatment opted to continue with MMT. In contrast, only 71 percent of those who had been phased off the treatment completely chose to obtain MMT. Of the 109 inmates in the phased withdrawal group, 45 were released from prison before their withdrawal from methadone was complete. The researchers also looked at the results among these former inmates and found that 100 percent of those who were still receiving even a greatly reduced dose of MMT pursued treatment after release, while only 48 percent of those who were off MMT entirely opted to resume it when they were released. Using statistical analysis of the three groups, the researchers determined that people still on MMT after release were six times more likely to continue to MMT than those who had discontinued MMT.

Upfront Treatment Is Cost-Effective

Most federal and state prisons cite financial limitations as the reason that more opioid-dependent prisoners are not given access to MMT. However, critics of this approach have long maintained that providing inmates with treatment is the more cost-effective approach in the long term, and the results of this study support that conclusion. The researchers found that higher medical costs among those who did not resume MMT, for things such as emergency room visits, more than equaled the cost of providing MMT for opioid-dependent inmates during incarceration.

Scroll to Top