Editorials

Editorial

Keeping every option on opioid treatment

In this July 23, 2018, photo, nurse Brian Toia holds tabs of buprenorphine, a drug which controls heroin and opioid cravings, as he prepares to administer the drug, known also by the brand name Suboxone, to selected inmates at the Franklin County Jail in Greenfield, Mass. American correctional institutions are slowly loosening resistance to giving inmates medication for their opioid addiction. (AP Photo/Elise Amendola)
AP Photo/Elise Amendola
A nurse holds tabs of buprenorphine before administering the drug to selected inmates at the Franklin County Jail in Greenfield, Mass.

Tucked into the comprehensive opioid legislation that Governor Charlie Baker signed into law this week was a pilot program for the state to treat inmates suffering from opioid addiction with medications such as methadone or buprenorphine. The program will be limited to five correctional facilities, but it has already drawn criticism from some law enforcement officials.

The Barnstable County sheriff’s office recently released a video of a clinician interviewing inmates who related their concerns around having Suboxone, which is the trade name of buprenorphine in the form of a film that dissolves in the mouth, offered in jails. One inmate called it a “terrible, horrible idea.” Another one said that an “8-milligram Suboxone strip can be cut into 16ths and those 16ths of a Suboxone go for $20 a piece.”

Barnstable County Sheriff James Cummings said the video should not be intended as a sign of opposition to the pilot — he has been using another medication-assisted treatment, Vivitrol — for his inmates on Cape Cod. But the video released by his office does raise the question again of how to best treat opioid abuse in jails. Law enforcement officials favor Vivitrol, manufactured by a local company, Alkermes, over Suboxone or methadone. That’s partly because of the company’s aggressive marketing, but it also reflects skepticism about the other dugs: Vivitrol is not a narcotic, while the other two are opioids that have the potential to be misused or sold to others who will abuse it.

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Yet addiction is a medical problem, and all three drugs have proved effective for opioid abuse treatment. Why, then, not use all the tools available to treat substance disorder?

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The opioid epidemic continues to rage on. Last year, 72,000 people died from an ovedose, a record number, according to new estimates from the Centers for Disease Control and Prevention. On average, that’s roughly 200 Americans per day. The figure represents an increase of about 10 percent. It’s a higher number than the annual death totals from car crashes or guns.

In Massachusetts, opioid-related overdoses have been decreasing, but the threat is so urgent that this is not the time to lower the guard. On the contrary, the state should welcome any evidence-based approach to save lives.

Inmates are at a much higher risk of overdosing following prison release. Rhode Island’s Department of Corrections launched a first-in-the-nation program two years ago offering all three medications — buprenorphine, naltrexone, and methadone — with impressive results: There was a 61 percent decrease in post-incarceration deaths, contributing to an overall 12 percent reduction in overdose deaths in the state. Other prisons in other states have found safe ways to implement such a program.

Massachusetts is following Rhode Island’s lead with its pilot program, which will be implemented in correctional facilities in Hampden, Hampshire, Middlesex, Norfolk, and Franklin counties for three years. Yes, there are risks associated with Suboxone, including the security concerns inside prisons and jails due to its potential for abuse. But the drug also works, and it’s critical to include it in the range of choices to inmates suffering from opioid addiction, along with methadone and Vivitrol.