Methadone behind bars keeps addicted inmates off drugs when released

Newly incarcerated inmates who are allowed to continue taking methadone to treat addictions to heroin and associated opiods are significantly more likely to stay on that treatment when they’re released from prison or jail, according to a study published Thursday.

The study added that keeping inmates on methadone likely prevents fatal drug overdoses once they’re free.

In what the researchers say is the first-ever randomized, controlled study of what happens if prisoners stay on methadone while they’re behind bars, inmates were more likely to return to a community methadone clinic within a month of their release if they could maintain their methadone regimen, according to the study published in the journal The Lancet.

“Methadone can prevent overdose death,” said lead author Dr. Josiah Rich, co-director of the Center for Prisoner Health and Human Rights in Providence, Rhode Island.

But stopping methadone maintenance treatment, or MMT, drastically lowers opioid tolerance. That makes newly released prisoners particularly prone to fatal drug-related overdoses in the first two weeks they’re set free.

In fact, they’re between three and eight times more likely to die of an overdose during those two weeks than during any other time, according to studies, and 129 times more likely to die of a drug overdose than people in the general population.

About 10 percent of the people receiving MMT, end up behind bars each year, amounting to about 30,000 people in the U.S., the study said. Yet 90 percent of them are either forced to taper off the treatment, or — far more likely — to halt it all at once.

“Most correctional facilities across the country the policy and practice is not to taper off,” Rich said. “It’s to stop abruptly.”

In his decades of work with incarcerated populations, Rich observed that the prisoners who were treated for their addiction problems tended to continue those treatments once they were released.

And the inmates who didn’t have their addiction problems addressed behind bars fared much worse. “I would see them back at the intake, back at the jail,” Rich said. “In my mind, there was a clear link between the drug use and the incarceration.”

He was doubly interested in examining what would happen if prisoners could stay on methadone, which he said has consistently been shown to reduce the abuse of illegal opioid drugs as well as all the other problems that go along with it, like crime, overdose and death.

So between June 2011 and April 2013, Rich and his team recruited more than 200 opioid-addicted inmates in the Rhode Island Department of Corrections who entered the system on MMT. The prisoners were randomly assigned to one of two groups, one of which was allowed to continue taking methadone and the other that tapered off the treatment.

Among the 114 prisoners who continued their MMT behind bars, 111, or 96 percent, returned to a local methadone clinic within a month of being set free. That compared to just 77 out of the 109 prisoners who phased off their MMT treatment, or 71 percent.

The study, which was funded by the National Institute of Drug Abuse at the National Institute of Health and the Lifespan/Tufts/Brown Center for AIDS Research (CFAR), only looked at inmates with sentences ranging from one week to six months, which Rich acknowledges is a limitation, though he says it’s most often the newly arrested and jailed inmates who haven’t yet been convicted who are going through MMT withdrawal.

When an opioid-addicted prisoner is cut off from methadone treatment and is released from jail, “this is the absolute worst time to have people not on methadone, when there are lots of triggers and stresses, and they are likely to overdose and die,” Rich said. “We are setting them up for not only relapse to drug use and behaviors and all the other problems, but we are setting them up for fatal overdose.”

By allowing inmates to continue MMT, the researchers say, the criminal justice system may lower the rate of such overdoses.

“If you have that methadone to hold on to, it’s a little bit of an anchor,” Rich said. "You’ll still be in the middle of a storm, but you might be able to ride it out.”