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| Addiction and controversy |
| By Sarah Etter, News Reporter |
| Published: 02/05/2007 |
After Pennsylvania's Lehigh County Jail last week announced plans for a new methadone maintenance treatment, or MMT, program for incarcerated heroin addicts, it became front page news yet again.
In Lehigh County, corrections officials noticed that many inmates who had been enrolled in MMT programs for their heroin addictions could not continue their treatment plans once they were incarcerated. “We had an issue where people would be arrested while they were undergoing methadone treatment and that treatment would stop when they entered our facilities,” says Lehigh County Director of Corrections Ed Sweeney. “The corrections community is starting to embrace the use of methadone as an ongoing treatment and we wanted to give it a try.” When Lehigh's health care provider, Prime Medical Care, offered to continue its services for those already enrolled in their clinic and for no additional cost to the jail, Sweeney decided the program was a go. “I'm rather conservative by nature,” he adds. “But this isn't something we've leapt into blindly. We reviewed the studies, the legal issues and the benefits of this program. For a small percentage of our inmate population, this is a worthwhile endeavor.” Sweeney estimates that about twenty percent of his seven thousand inmates will take advantage of the program annually. Although Prime Medical, Inc. did not return calls for comment, Sweeney says Prime Medical is funding the MMT program with the help of a grant. Lehigh County isn't the first correctional facility to tackle the problem of heroin withdrawal. For the last 15 years, New York's Rikers Island has been offering methadone maintenance treatment to recovering inmates. “We maintain this program because we find that offenders are more likely to go right back to using illegal opiates upon release without the help of methadone,” says Steve Morello, spokesman for the City of New York Department of Corrections. “When we maintain MMT programs, we find that seventy percent of our inmate population enroll in community support programs upon release and do not recidivate.” Rikers' MMT is paid for by the New York Department of Health, so it is maintained at no extra cost to the corrections, just like Lehigh County. The treatment is relatively cheap, costing about $13 per inmate per day. But paying for the program isn't where the controversy lies. Methadone misconceptions Since the discovery of methadone in the 1960s, studies and pilot programs in prisons and jails have proven that MMT reduces the chance of drug relapse, as well as recidivism. But medical and corrections communities are still torn over the treatment. Critics believe the drug coddles addicts and is only a legal replacement for heroin. Dr. Kevin Fiscella, co-author of the report, Opiate Detoxification in Jails, 2004, says this is a misconception. “Methadone simply relieves the cravings associated with heroin withdrawal,” he says. “There is no high or euphoria when used in the appropriate dose. Those suffering from heroin withdrawal just experience normality. Methadone reduces, and in many cases completely eliminates, the overwhelming craving for these drugs.” It does so by blocking the brain receptors responsible for regulating dependence on opiods. However, Fiscella's research showed that only one percent of corrections facilities offered methadone treatment, leaving many inmates to suffer as they experience detoxification. Many of them then end up using heroin again after their release, which can quickly lead to committing crimes like petty theft and larceny to pay for their addiction. “Without the help of treatment, these offenders return to areas and neighborhoods with the same triggers for abuse. The drugs are available, they are surrounded by people using, and that creates psychological and physical cravings to heighten,” Fiscella says. “Even knowing that they are at risk of dying or are likely to be drug tested by their parole officers, they still use. This is baffling behavior, but it is only baffling if you don't recognize the profound impact of opioid addiction on the human brain.” Many doctors and researchers say heroin addiction is a disease, but according to Mark Parrino, President of the American Association for the Treatment of Opioid Dependence, society does not seem willing to accept that theory. “There is an ideology in society to deal with,” Parrino says. “There are people who think that we should not treat people for addictions in jails in prisons because they broke the law. As decades go on, that group is starting to diminish in numbers, but it still exists.” He believes treatment for heroin addicts will follow much the same trajectory as treatment for alcoholism, which was not recognized as a disease for quite sometime. “Even alcoholics will say Hey, at least I'm not a heroin addict.' There is still such a stigma and shame around acknowledging this problem, let alone supplying treatment for it. We are just starting to see this shift towards recognizing and dealing with this issue,” Parrino adds. “But it will take some time because the stigma that this is not a legitimate illness is enormous. To say this stigma is just a problem in corrections would be inaccurate.” Corrections conundrum In corrections, methadone treatment is making headway, in part because of lawsuits. While it is not common for offenders to die during heroin withdrawal, some states have faced litigation after medical reviews found that unsupervised detoxification in facility cells have led to death. “There is an adage physicians learn that says people don't die of heroin detox, only alcohol detox,” says Fiscella. “That is actually not completely correct. If a person is fully healthy, their odds of dying during detox are low. But most opioid addicts aren't completely healthy. They haven't maintained regular health care; they suffer from heart problems and liver complications as well as unhealthy diets. That's when it gets complicated.” Typically, corrections medical staff will make routine checks on an offender going through detox, and will supply additional fluids and the occasional light painkiller to relieve the pain. But sometimes it just isn't enough. “We're seeing states realize that it is cheaper to provide the methadone than suffer costly litigation after someone dies during detox,” adds Parrino. In Florida, Orange County officials instituted the program after one detox-related overdose lead to a costly court settlement. But MMT isn't exactly easy. Many facility administrators are concerned that inmates will not swallow the methadone pills, but instead “cheek” them and then sell them to other offenders. Fiscella says there is a solution for that, too. “We're seeing great success with liquid methadone. Inmates can't divert the drugs to other offenders, so they almost definitely ingest the treatment,” he explains. “Also, I don't know of any corrections agency that has 100 percent eliminated illicit drug use, so methadone does not pose that big of a risk.” The controversy over methadone is still being dealt with across the country as states and facilities conduct their own research and come to their own conclusions. But back in Pennsylvania, Director Sweeney says the MMT program at his facility is a sign of things to come. “I think the natural evolution of health care will lead to methadone treatment programs being listed as a recommendation for a best practice,” Sweeney says. “I think that will be in the next National Commission on Correctional Health Care revision. We're going to start seeing this move very quickly across the country.” |
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