The Case against Forced Methadone Detox in the US Prisons

Abstract

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies (Rich, J. D., McKenzie, M., Larney, S., Wong, J. B., Tran, L., Clarke, J. et al. (2015). Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification for current policies of forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries.

Public health nursing workforce and learning needs: A national sample survey analysis

“…Pragmatically, this means PHN training materials should include information on screening, stabilizing interventions, and community referral activities in the context of low resource settings. Long term substance use disorder prevention and treatment, as well as acute safe detoxification protocols, provide essential lifesaving interventions in any public health or clinical care setting (Bryson et al., 2019; D'Hotman et al., 2019; Johnson et al., 2020). Establishing trauma informed care settings and patient‐centered care of the person with psychiatric comorbidity provides unique challenges and continuing education needs for PHNs (Ellis & Alexander, 2017; Melnikov et al., 2017; Mollard & Brage Hudson, 2016).…”

Public Health and Prisons: Priorities in the Age of Mass Incarceration

“…In prison, people suspected of, accused of, or found to be using drugs may be subjected to strip searches and forced (and sometimes unmonitored) detoxification, rather than receiving treatment and harm reduction strategies ( 44 ). In some cases, these individuals face new criminal charges that extend incarceration and/or disciplinary sanctions such as the loss of visitors or solitary confinement ( 132 ).…”

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

“…The use of the opioid agonists methadone or buprenorphine is often not seen as a treatment but rather considered substituting one opioid for another (LaBelle & Weizman, 2019). Philosophical opposition to MOUD by correctional administrators often motivates decisions to exclude budget allocations to implement MOUD in corrections as a prioritized use of limited fiscal resources (D'Hotman et al, 2019). Yet research indicates that continued methadone treatment in corrections has an overall societal cost savings benefit over forced withdrawal of reduced medical care costs after release and savings from avoiding HIV and hepatitis C transmissions (Rich et al, 2015).…”