NEW YORK – For Dr. Ross Macdonald, every person who enters New York City's main jail with an opioid addiction represents an opportunity for treatment, and the possibility of saving a life.
As the medical director of the city's correctional health program, he ensures that offenders who come in on methadone continue to receive it. And he and his staff try to persuade as many addicted inmates as possible to get started on methadone before they leave the jail.
Rikers Island Correctional Facility has run a model opioid treatment program since 1987, and has assisted tens of thousands of inmates in maintaining treatment after they return to their communities. Medical researchers have repeatedly found that the jail's program has resulted in overall health care savings, reduced crime and recidivism, reduced HIV and hepatitis C transmission, and better than average rates of recovery from drug use.
But few U.S. jails and prisons have emulated the program. The vast majority of correctional facilities reject the use of methadone, as well as a newer anti-addiction drug called buprenorphine. That's despite a history of research showing that both medicines are highly effective.
Two-thirds of the nation's 2.3 million inmates are addicted to drugs or alcohol, compared with 9 percent in the general population.
From Macdonald's perspective, prisons and jails are the perfect place to start addiction treatment. Few corrections officials see things the same way. The problem, many say, is that both medications are themselves narcotics.
But now that the opioid overdose epidemic, which killed more than 28,000 people in 2014, has become a priority, a few correctional authorities are rethinking long-held biases against the oldest anti-addiction medication.
Connecticut tested methadone treatment programs at two jails, and is looking to expand statewide. Rhode Island offers methadone and buprenorphine at its prisons. Vermont plans to expand a limited correctional methadone program.
Methadone is offered in correctional institutions in only a few other urban centers, such as Baltimore, Chicago, Philadelphia, San Francisco and Washington, D.C., that have battled heroin addiction for decades, as well as in a handful of smaller jurisdictions.
In all, fewer than 40 correctional facilities are offering methadone to inmates. Even fewer facilities are administering buprenorphine, which like methadone blocks the brain's cravings for drugs and relieves withdrawal symptoms.
