The state of Maryland has recently enacted or proposed two work-arounds for the problem of Suboxone being smuggled into prisons. The first action, taking Suboxone off the Medicaid preferred drug list ("State action limits opioid addiction treatments," June 23), destabilized patients in recovery without reducing demand in prisons. This week, Maryland correctional officials proposed a ban on prisoners receiving personal letters by mail. This proposal was later withdrawn, presumably as a response to criticism by the ACLU ("Maryland corrections officials withdraw proposal to limit inmate mail to postcards," July 21).
Such approaches are ineffective and potentially harmful work-arounds for a problem that calls for a direct solution that would improve safety within prison walls as well as for Maryland citizens outside the walls. The effective and proven medications methadone, buprenorphine and naltrexone should be made available in all of Maryland's correctional facilities. Currently, access only exists in a small fraction of facilities and is limited to just methadone. It is no wonder that there is a high demand for Suboxone. If prisons prohibited diabetes medication, black market insulin would flood the prison blocks.
With few exceptions, Maryland arrestees stable in addiction treatment are withdrawn from their medication, receive very limited treatment while incarcerated, are expected to avoid illicit drug use, and when released, find themselves in a state of irresistible drug craving. This leads to relapse, overdoses, HIV or hepatitis infection, and re-arrest. It also exposes Marylanders to higher rates of crime, unemployment, community/family instability, and increased health care and criminal justice costs.
It is time for Maryland to follow the guidance of the U.S. Department of Health and Human Services, and other enlightened states, by mandating that these medications be made available to all arrestees and prisoners based on medical necessity. The HHS Einstein Expert Panel recommended this. That expert panel pointed out that individuals with addiction are protected under federal laws and that prisons and jails that deny access to medications could be violating the U.S. Constitution's 8th and 14th amendments.
Irrespective of questions involving the legality, ethics, and civility of withholding medically necessary medications, Maryland policy should be driven by the knowledge that untreated addiction only increases drug diversion and associated crime and violence in its correctional facilities. Why else should Maryland's citizens care? Because releasing prisoners with untreated addiction keeps the jails' revolving door spinning. It puts us all at risk and worsens the burden that addiction imposes on our economy and our communities.
Dr. Kenneth B. Stoller, Baltimore
The writer is an assistant professor at the Johns Hopkins University School of Medicine.