For the first time, Massachusetts prisons are providing a medication to treat opioid addiction to newly arriving inmates, as the state launches a groundbreaking program established by legislation passed last year.
For now, the Department of Correction is providing just one of the two medications required under the law, which took effect Monday.
Still, the change puts Massachusetts ahead of most prisons and jails in the country, where the medications are usually denied.
“It’s long overdue,” said Dr. Christin Price, director of an addiction treatment clinic at Brigham and Women’s Hospital, who recently visited a prison to discuss treatment of inmates as they are discharged. “It will address a lot of the racial inequalities in addiction treatment and prevent the high mortality after release.”
The issue of treatment for addicted inmates has gained attention as states grapple with the opioid crisis. Two-thirds of inmates suffer from some kind of addiction, and they face an extremely high risk of fatal overdose upon release.
Three medications that ease withdrawal pains, block cravings for opioids, and prevent overdoses are considered standard treatments for opioid addiction. Two of the three are controlled substances that prisons and jails have resisted providing. That has led to several lawsuits, and federal judges in Massachusetts and Maine have recently ordered jails to provide medication to specific inmates who sued. New Jersey, Vermont, Connecticut, and Rhode Island are already offering the medications in state facilities.
The Massachusetts law, part of a multifaceted bill addressing the opioid crisis, requires the Department of Correction to offer buprenorphine and methadone at the two women’s prisons, MCI Framingham and the South Middlesex Correctional Center; at MCI Cedar Junction, where male prisoners typically stay for 90 days before being assigned a permanent spot; and at the Massachusetts Alcohol and Substance Abuse Center, a Plymouth treatment program for civilly committed men. The law does not address the 12 other state prisons.
The Department of Correction has hired a new company, Wellpath, to manage prisoner health and to launch the medication program. The Legislature allocated $2.2 million for the program in the current fiscal year, but the department had no estimate on future costs.
The first phase, which started Monday, involves only one drug — buprenorphine, best known by the trade name Suboxone, said Dr. Steven Descoteaux, Wellpath’s Massachusetts medical director. Inmates who arrive already taking prescribed buprenorphine will be allowed to continue taking the medication behind bars.
Buprenorphine will also be used to treat the painful symptoms of withdrawal from illicit opioids or methadone, which Descoteaux described as “kinder and gentler” than the less-powerful medications previously used for withdrawal.
On Monday evening, the first day of the program, one inmate at Framingham and two patients at the Plymouth treatment program started buprenorphine detox, Descoteaux said. They will receive decreasing doses of the medication over five days as they withdraw from opioids.
WellPath also intends to evaluate inmates for opioid use disorder and start offering buprenorphine long-term to treat their addiction. The prison will also offer naltrexone, a drug that blocks the effects of opioids and alcohol, in the form of a daily pill, with the monthly naltrexone injection (known as Vivitrol) offered shortly before discharge, Descoteaux said.
The department is still working on plans to administer methadone. When used to treat addiction, methadone can only be provided by a federally certified clinic. Wellpath is seeking to partner with a community clinic to offer the medications to prisoners, but had no estimate on when that might start.
As inmates start taking medications long-term, it’s not clear what will happen to male inmates at Cedar Junction, the only men’s prison offering medications, when they are assigned a permanent location. “People may stay longer than 90 days [at Cedar Junction] if it’s clinically appropriate,” Descoteaux said. “I can’t speak for the department, but they may start to open this up to other locations so that people can move on.”
Descoteaux said launching the program has required months of planning and consultation, complicated by the inability to predict exactly how many people will qualify for medication.
Wellpath has added clinical staff to ensure that addicted inmates also receive counseling and medical care. “It’s not just about giving medication,” Descoteaux said. “We want this to be a whole program, not just giving medication that makes people feel better.”
Then there are daunting logistics. Buprenorphine isn’t simply swallowed like most medication; it has to dissolve under the tongue, which takes seven to 10 minutes. Inmates taking buprenorphine will need a place to sit and absorb the medication for several minutes, while under watch by security personnel — to make sure they take it all and don’t bring any of it inside to give or sell to someone else. The medical staff will dispense buprenorphine in pill form and crush the pills before giving them to the patient.
“It’s a huge culture change,” said Dr. Joji Suzuki, director of addiction psychiatry at Brigham and Women’s Hospital, who visited the prison with Price.
“On our site visit, we were absolutely inspired by how passionate they were. These folks really care,” Suzuki said of the Wellpath staff.
In a separate pilot program created by the same law, seven county jails — where inmates await trial or serve short sentences — will start offering buprenorphine and methadone in September.