Denying Inmates Methadone May Reinstate Opioid Addiction After Release

Almost all opioid addicts on methadone maintenance treatment (MMT) are cut off from the medicine when incarcerated, but this interruption reduces their inclination to seek addiction treatment after release.

A new study published in The Lancet examined 223 individuals on MMT at the time of arrest and incarcerated for 6 months or less in the Rhode Island Department of Corrections between June 2011 and April 2013. In the study, 114 of the inmates were allowed to continue MMT while imprisoned, and the remaining 109 underwent the forced tapered withdrawal process all Rhode Island prisoners experience. All participants were offered financial and logistical assistance to obtain MMT after release.

“What we are doing with methadone in our correctional system is we are systematically taking people off it,” said study lead author Josiah Rich, MD, MPH, in a press release. “It's the only medication that is summarily stopped upon incarceration. This study questioned that policy to find out what happens.”

More than 97% of those allowed to continue treatment in prison visited an MMT clinic within a month after release, compared with only 71% of those in the tapered withdrawal group, the researchers found. A statistical analysis of these data revealed that inmates who remained on MMT while incarcerated were twice as likely to resume treatment after release as those denied it.

Additionally, 18% of those cut off from MMT in prison admitted to resuming opioid use after 1 month, compared with 8% of those who continued treatment. The researchers also deemed MMT retention more cost effective than tapered withdrawal, as inmates denied treatment accrued higher medical costs following release.

However, the study authors noted many inmates in the tapered withdrawal group were released before they had been fully weaned off the medication. A further analysis conducted in light of this factor revealed that inmates who stayed on MMT were 6 times more likely to seek treatment after release than those completely withdrawn, with only 48% of the latter group returning to a MMT clinic.

Dr. Rich said depriving inmates of MMT is counter-productive to fighting addiction, as previous studies have demonstrated many opioid addicts avoid MMT out of fear they will be cut off from it later. Offering MMT in prisons may encourage more addicts to seek treatment before, during, and after incarceration, potentially reducing drug-related criminal activity, he explained.

“For most of these people, the very reason they are caught up in the criminal justice system is related to their addiction to begin with,” Dr. Rich said.

As a result of the study’s findings, prison officials in Rhode Island recently extended the time period prior to tapering MMT, from 1 week after imprisonment to 6 weeks, according to Dr. Rich.