A plan to give Massachusetts prisoners access to all medications that treat addiction was removed from the final version of the landmark criminal justice bill, but advocates intend to seek the Legislature’s approval via another route.
The proposal would have made Massachusetts only the second state, after Rhode Island, to provide opioid-addicted inmates the full array of treatments, including methadone and buprenorphine (often known by the trade name Suboxone).
“This is something that will save lives,” said Vic DiGravio, president and CEO of the Association for Behavioral Healthcare, a trade group of treatment providers. “We’re committed to getting this passed.”
The legislators who sponsored the provision — Senator John F. Keenan, a Quincy Democrat, and Representative James J. O’Day, a West Boylston Democrat — said Monday that they would try to get it incorporated into Governor Charlie Baker’s proposed legislation to address the opioid crisis.
As many as two-thirds of prisoners have a substance-use problem. And state data show that people who have been incarcerated are 120 times more likely to overdose than the general population. Buprenorphine and methadone have both been shown to prevent overdoses and help people sustain sobriety.
But corrections officials oppose the two medications because they are opioids that can be used illicitly. Buprenorphine, in particular, is frequently smuggled into prisons and jails, where inmates use it to ease withdrawal pains and, if they haven’t used opioids in a long time, to get a mild high. Corrections officials have said that expensive contraband like buprenorphine leads to fights and assaults.
But Keenan said that officials in Rhode Island report that providing the medications to inmates did not increase contraband. “If they have access to it through structured programs,” he said, “they’re less likely to smuggle it in.”
There is one addiction medication that Massachusetts prison officials do accept: Vivitrol, a shot that prevents a person from getting high on opioids for up to a month. Vivitrol is not an opioid and has no street value. The state’s prisons and some of the county houses of correction offer Vivitrol injections shortly before discharge.
Additionally, addicted pregnant women serving sentences receive methadone, because opioid withdrawal is dangerous to both mother and fetus.
Otherwise even those who arrive at a Massachusetts prison or jail with a prescription for buprenorphine or methadone are forced to stop, and inmates undergoing withdrawal do not receive the standard treatment for their symptoms — tapered doses of methadone.
Legislators added the addiction-treatment provision as amendments to the House and Senate versions of the criminal justice bill. The amendments passed with little opposition, but the conference committee that reconciled the House and Senate versions removed them from the final version unveiled Friday.
The conference committee felt the issue of addiction treatment for inmates arose too late for legislators to weigh its complexities, according to O’Day and Keenan.
“Conceptually, I think people understand there is real need to make a change,” O’Day said. “But how do we implement it, how do we pay for it, and who’s going to be responsible for it?”
Keenan said the proposal offers a rare combination: an evidence-based solution for a well-documented problem. “If you view it objectively, in terms of what that data has shown us, it’s something that should pass,” he said.
Proponents expect their case will be bolstered by a recent study in Rhode Island, which since July 2016 has been offering buprenorphine, methadone, and Vivitrol to all addicted inmates in the state’s prisons and jails. During the first six months of 2016, the study found, 26 of the 179 people who died of an overdose, or 14.5 percent, had been recently incarcerated.
In contrast, during the same period in 2017, only nine of the 157 people who had fatal overdoses, or 5.7 percent, were recently incarcerated.
Meanwhile, Prisoners’ Legal Services of Massachusetts is looking into suing to ensure appropriate addiction treatment for inmates, according to litigation director James Pingeon.
“We are obviously very concerned about the policies of the Department of Correction not providing substance use treatment that meets the standard of care in the community,” Pingeon said. “This is a disorder like any other disorder. People who need medical treatment should get it.”Felice J. Freyer can be reached at firstname.lastname@example.org.