The effects of the ongoing opioid epidemic are evident across Pennsylvania. Prisons are no exception. According to Pennsylvania Department of Corrections (DOC) estimates, the number of individuals entering state prison with an opioid addiction has more than doubled since 2010. By 2017, a quarter of new inmates reported that opiates were their drug of choice, a dramatic increase.
The DOC has responded in a number of ways. There are now therapeutic communities — housing units completely dedicated to substance abuse — in six DOC institutions. Other programs, including Narcotics Anonymous, operate at every facility. New initiatives, including medication-assisted treatment (MAT), have been launched and expanded. Vivitrol, a form of injectable extended-release naltrexone used to treat addiction, is offered in every state prison as part of the reentry process. Although these programs combine evidence-based treatment with the realities of the correctional environment, there are opportunities to do better.
Despite these efforts, opioids and the immediate and long-term effects of opioid abuse continue to pose challenges within the correctional system. A reasonable solution is not, however, to promote greater access to Suboxone.
Suboxone can be both a medication and an illegally diverted opioid drug. It is effective at reducing symptoms of withdrawal and can reduce the chance of relapse. Suboxone can be a valuable tool to help with recovery within the community.
However, there is also substantial evidence Suboxone can be abused. While most users self-medicate during withdrawal outside the supervision of health-care professionals, some use it as an alternative to heroin or other drugs due to the powerful influence of their addiction. It can trigger the same receptors in users' brains as other opioids. Like all abuse, this can be life-threatening, especially when Suboxone is taken with legal medications and other illicit drugs.
This complex situation is acceptable when individuals are receiving managed MAT in the community. Prison presents different challenges; the solutions from MAT often may not work. Delivering MAT in prisons requires the introduction of a controlled substance into a secure environment, as well as ensuring adherence to security protocols. Failing to acknowledge this as it relates to Suboxone jeopardizes the well-being of many who live or work inside a state prison. This is one reason almost no prisons or jails nationally use Suboxone in their treatment programs, even where other MATs are offered.
Suboxone is uniquely susceptible to smuggling and abuse. When access to alternatives is limited, as in prison, it becomes a highly desirable drug. As a dissolvable, but solid, strip, it can be concealed inside mail. Dissolved in a liquid, it can be smuggled and consumed many ways. This makes tracking its use challenging for either medical or security purposes. Unsurprisingly, Suboxone is found in more than 40 percent of all illegal drug seizures in Pennsylvania's prisons.
Suboxone plays a prominent role in prison's "underground economy." This is not unique to Pennsylvania. The large quantities of Suboxone strips found inside many prisons suggest that these drugs are meant for distribution. Recently, stashes of Suboxone have been discovered with more than 500 strips – far beyond the amount safely permitted by a licensed addictions specialist. Contraband-driven markets undermine the security and medical systems, as well as possibly contributing to violence.
Most Suboxone currently inside of DOC facilities is illicitly obtained. Legal prescriptions are diverted from their intended recipients, smuggled, and resold. In this case, when alleged Suboxone is received, individuals may not know what they are taking nor the appropriate dose, even for self-medication. This has consequences. Although the exact drug is often impossible to determine, approximately 20 inmates a month are currently sent to the emergency room for overdoses; Suboxone is often identified.
Substance abuse within DOC facilities remains a persistent and significant challenge. The DOC, as a member of the Governor's Taskforce on Opioid Addiction, and other state agencies have been working to provide more treatment options, but in a manner that reflects the distinct and challenging prison environment as well as evolving best practices. This includes increased access to Vivitrol; the development of a program for injectable buprenorphine, one of the first in the nation; and and a potential pilot program for strictly supervised Suboxone maintenance. These programs could potentially address aspects of ongoing withdrawal or opioid cravings among the DOC's population, ensure medically appropriate treatment, and ensure compliance with the restrictions of the prison environment, all without many of Suboxone's current and unique limitations.
There are illicit drugs inside of DOC prisons and other impediments to recovery. The psychological and medical effects of opioid abuse persist. It is clear that more treatment options should be made available in prisons to address these distinct challenges. Accepting self-medication with illicit Suboxone is not a solution — it is part of the cause — and its presence undermines genuine efforts to break the cycle of addiction.
Jordan M. Hyatt is an assistant professor in the Department of Criminology and Justice Studies at Drexel University. He has conducted several research projects with the DOC, including the Vivitrol Pilot Evaluation.