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The heroin emergency behind bars

Gov. Hogan needs to make sure his heroin emergency looks at treatment behind bars.

On March 1, Gov. Larry Hogan declared a state of emergency and called for an "all-hands on deck" approach to the "rapid escalation of the heroin and opioid crisis in our state." ("Hogan declares emergency, announces new funding to fight drug overdoses," March 1). His commitment of $10 million of funding is laudable and well-founded. The scope of this work, however, most not overlook a vulnerable population, most at-risk of succumbing to the opiate epidemic: incarcerated individuals. These patients need access to evidence-based medication-assisted therapy while they are incarcerated.

Roughly half of incarcerated individuals suffer from addiction. Without appropriate treatment, individuals addicted to opioids are more likely to suffer from relapsed opioid use, drug-related health complications, overdose, criminal activity, and recidivism. When prisoners are released, the likelihood of death from overdose in the two weeks following release is 129 times increased over the general population. This is not the case with appropriate treatment.

Treatments for opioid addiction exist. Methadone, buprenorphine/naloxone (Suboxone), and injectable naltrexone are all medications that have robust evidence for their efficacy in bringing about biological and social benefits to patients. In Maryland, only a handful of county jails offer these medications. Yet the majority of incarcerated persons in Maryland have no access to available medication for their disease and only a subset has access to buprenorphine.

As a primary care physician, I have cared for recently-released prisoners and witnessed how buprenorphine can change lives. As a physician caring for patients struggling with opioid dependence, I have seen how buprenorphine restores families and their livelihoods. These patients can be treated. They deserve treatment.

To be sure, some will argue that methadone is a "substitute drug" while others will echo old concerns about buprenorphine diversion. These arguments demonstrate a lack of evidence-based knowledge (if not a lack of empathy) in providing standard of care to suffering patients that happen to be on the other side of the prison doors. Methadone is a treatment for a disease. Buprenorphine is a treatment for a disease.

The benefits of these therapies are not only to individuals alone, but to our communities. If we want to save lives on the streets, we cannot send out untreated individuals from prisons when they are most vulnerable to overdose and death. If we want to freeze the revolving door of recidivism, we must stop the addiction that leads to crime.

We must continue the momentum that has been built by government leaders in Baltimore and Maryland. We must have all hands on deck. Opioid addiction in our jails and prisons carries over to our families and community. This new state of emergency must serve as a call to provide a standardized approach to offer medication-assisted therapy in correctional facilities across the state. Let us not forget a population that is most at risk.

Dr. Justin Berk, Baltimore

The writer is a combined medicine and pediatrics resident at Johns Hopkins Hospital.

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