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Hogan's right to focus on addiction in prison, but he can do more

The centerpiece of Gov. Larry Hogan’s new plan to combat opioid addiction and Maryland’s epidemic of overdoses is a recognition that treatment for those who are incarcerated is one of the crucial missing links in the state’s efforts. That’s vitally important. Addiction and the steps people take to cope with it are responsible for much, if not most, of the state’s prison population: About 60 percent of inmates state-wide are estimated to have substance abuse problems. And opioid addiction is particularly dangerous for those who cycle in and out of the correctional system, including the Baltimore jail, which is run by the state. Opioid addicts who go through a period of detox while behind bars are at substantially heightened risk of overdose when they get out because their bodies can’t handle the same doses they used to. If you want to save lives and break the cycle of addiction, the correctional system is a crucial place to start.

But the specific step the administration is taking, commissioning a study of the feasibility of creating a new treatment facility on the site of the now shuttered Baltimore City Detention Center, is drawing some questions from treatment advocates. They ask whether the money to build a new facility could better be spent on programs to keep addicts out of jail in the first place, and whether the corrections system could take other, more immediate steps to provide treatment not just for those awaiting trial or serving short sentences in the city jail but throughout the prison system more broadly.

We understand the thinking behind the Hogan administration’s plan and consider it worth pursuing. The population that moves through the city jail is particularly unstable medically and socially, and the idea is to create a modern facility that is designed to handle a wide variety of inmate health needs — medical, psychiatric and addiction-related. About half of the 19,000 inmates in the state corrections system come from Baltimore, and officials see the center as a key opportunity to address issues like addiction that contribute to the cycle of crime and punishment. Given the profound social costs it presents to Baltimore, that’s a welcome priority. But the advocates are absolutely right; there’s more the Department of Public Safety and Correctional Services can do right now to help combat addiction.

Like in the vast majority of prison systems in America, what drug addiction treatment is available behind bars in Maryland is mainly focused on abstinence-based programs. That works for some people, but many more are helped by medication-assisted treatment — the use of methadone, buprenorphine or naltrexone to curb addiction cravings, in conjunction with other therapy. The state offers a limited methadone program in the city jail for those who can demonstrate they were already on medical maintenance before their arrest, but it helps only a small number of detainees, and those who were taking buprenorphine to manage their disease are forced to switch medications. Those who are convicted and sent to prison — except in rare circumstances — are forced to go through detox, a painful and difficult process, even if they may have been managing their addiction medically for years.

With the exception of prisons in Rhode Island and a few isolated cases elsewhere, that’s typical of America’s prisons. There are reasons for that, but none of them are good. Even as a bipartisan consensus has grown about the need to treat addiction as a medical issue, not a criminal one, it remains stigmatized. We would never conceive of denying diabetics access to insulin in prison or heart disease patients access to their medications, and we don’t blame them for their conditions even if they are related to diet or smoking or other factors that were theoretically within their control. But we do that for addiction. In fact, in some prisons where methadone is available, it is treated as a privilege that can be taken away if an inmate violates the rules. And in prisons, officials are typically concerned with the potential for diversion of methadone and especially buprenorphine — which is often taken in the form of a film and is hence easy to conceal. But addictions specialists say the common combination of buprenorphine and naloxone (known by the brand name Suboxone) has extremely low potential to be misused by people trying to get high and that when it is diverted from its intended user, it is almost always to someone who is also trying to reduce drug cravings.

Maryland DPSCS Secretary Stephen T. Moyer says he recognizes that the way the state prison system has handled addiction in the past doesn’t work, and as the department enters new contracts for medical and mental health services, officials are evaluating what approaches to treatment make the most sense for its population. But the research is clear that medication-assisted therapies are the gold standard for helping people overcome their addiction and reduce their risk for overdose. DPSCS already has some experience with administering methadone and is doing pilot studies of naltrexone. It needs to commit to making those medications and forms of buprenorphine its standard of care for treating addiction just as it would a medication vital to treating any other disease.

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