Two years ago, Chuck Schooley woke up in a hospital bed. He had overdosed in Maine State Prison and was rushed out of the maximum-security complex. He went into a coma. When he came to, his kidneys had failed, and a prison guard was sitting next to him.
He returned from the hospital wanting to shake his decade-long addiction, with the help of a prison drug treatment program that offers medication for people diagnosed with opioid use disorder, Politico reports.
Schooley, serving a four-year sentence for assault, got an open-ended prescription for Suboxone, a combination of the synthetic opioid buprenorphine and naloxone that’s used to prevent withdrawal and curb cravings for more dangerous drugs.
Something new is happening in Maine’s prisons, and officials in Washington. D.C., are watching closely. In recent years, the nation's 4,400 state prisons and local jails have emerged as a frontline in the unrelenting opioid crisis, which killed more than 80,000 people in 2021 alone and has helped drag U.S. life expectancy to its lowest levels in a quarter century.
About 2.3 million people are incarcerated in prisons each year, and eight to ten million move through local jails. About two-thirds of them have a substance use disorder.
he vast majority go untreated, putting people with opioid use disorder at high risk when they go back home with reduced drug tolerance to face an increasingly dangerous supply.
With a disproportionate number of Black, Indigenous and people of color in the criminal justice system, that puts those groups in particular peril. Individuals leaving prison are as much as 40 times more likely to die from an opioid overdose in the first two weeks after their release than the general population.
While medications such as buprenorphine and methadone have existed for decades as a treatment for opioid use disorder, they have largely been ignored or shunned in jails and prisons. That is beginning to change, with an increasing number of county jails, and, to a lesser extent state prisons, offering medication-assisted treatment.
Now, almost every state offers some form of medication for opioid use disorder in at least one jail or prison, according to Georgetown Law’s O’Neill Institute, which researches addiction and public policy.
The results are promising. In Maine, for instance, about 40 percent of inmates across the prison system are now administered drugs to treat opioid use disorder. In a state with one of the highest rates of drug overdose deaths in the nation, fatal overdoses among people leaving prison have dropped 60 percent since the program started in 2019, according to the state Department of Corrections, and drug smuggling, violence and suicide attempts inside state prisons have all plummeted.
But the growing number of programs still only cover a small fraction of the incarcerated population. The Jail and Prison Opioid Project, a non-profit research group, estimated in 2021 that just 12 percent of jails and prisons in the country offered medication for opioid use disorder.
The Biden administration, which wants to increase the number of jails and prisons offering medication for opioid use disorder by 50 percent in the next two years, says Maine’s program is a model for the rest of the country.
In July, Rahul Gupta, Biden’s director of National Drug Control Policy, visited the Maine State Prison in Warren to learn more about its opioid treatment program. Gupta said he was struck by the state’s ability to run a program that successfully is reducing overdose deaths at a minimal cost, while also promoting a culture of respect within the facility between staff and residents.
The Office of National Drug Control Policy released the first-ever federal guidance to help correctional facilities evaluate their medication-assisted treatment programs, a move aimed at expanding access across the country. The report, written by the Legislative Analysis and Public Policy Association and Rulo Strategies, a consulting firm that works on health issues in corrections, offers guidance for prisons and jails to assess their programs, to monitor individuals’ access to treatment once they are released, and — critically — to evaluate whether or not their programs are preventing overdose deaths.