Update

Amid a series of drug overdose deaths in jails this year–including in Dauphin County, Lawrence County, and Philadelphia–a new report finds that incarcerated people in Pennsylvania struggle to get appropriate treatment for opioid addiction. 

The report from the Pennsylvania Institutional Law Project (PILP) finds that nearly one in six jails does not offer the medication-assisted treatment (MAT) used as the standard of care in the community. Of those jails that do provide MAT, most offer them only to people who already had a prescription when they entered jail.

“Jails and prisons have an obligation to treat this disease in the same way that they have an obligation to treat diabetes or heart disease,” said Sarah Bleiberg Bellos, the report’s author and a staff attorney at PILP. 

Complementing the report, PILP’s new storytelling project, Let Us Live, features first-hand accounts of people who have suffered from addiction while incarcerated and the powerful difference that medical treatment can make in their recovery.

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Denied life-saving, life-changing treatment

When people addicted to opioids are incarcerated, they may begin to experience painful and dangerous withdrawal symptoms within hours. James D., who told his story for Let Us Live, described what it was like after he was transferred to a prison that denied him access to his prescription for buprenorphine.

“When you go through withdrawal, you can't sleep. You're up all night, awake for days. Your anxieties are through the roof. You don't want to eat. You don't want to do nothing,” he said. “It just takes your life out of you.”

Buprenorphine (known by brand names like Suboxone and Sublocade) and methadone, another medication for opioid use disorder, prevent the suffering of withdrawal. But they also control cravings for drugs and help people function normally without them, aiding their recovery. 

When James started receiving Sublocade injections, “I realized that for the first time in as long as I can remember, I wasn’t thinking about getting high,” he said. “It made me feel like I actually had a shot at doing something with my life.”

The medications are also life-saving. The risk of death from overdose, suicide, and other preventable causes is 87% lower for incarcerated people who receive medication-assisted treatment in jail, and it reduces fatal overdose risk by 75% after release.

Yet not all Pennsylvania jails provide buprenorphine or methadone, the standard of care for opioid addiction. Some only use naltrexone (also known as Vivitrol), which does not prevent withdrawal symptoms or control cravings, and is less effective at keeping people from using drugs and preventing overdose. 

Among the jails that do provide either buprenorphine or methadone, more than two-thirds only make them available to people who already had a prescription when they entered jail. This is also the policy in Pennsylvania state prisons. In addition, one-third of the jails do not offer methadone, which is the only effective option for some people. Bleiberg Bellos stressed the importance of making all three medications available to incarcerated people based on “an individualized assessment of their medical needs.” 

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Stigma and arbitrary restrictions 

Even when jails and prisons offer the medications, the report finds that incarcerated people face barriers limiting access to this life-saving treatment. 

James encountered long delays as he sought to continue his treatment in prison. As a result of the delays, the prison ultimately denied him Sublocade, saying that he was no longer eligible to receive it because he had been off of it for too long. 

Often, jails impose strict restrictions on treatment that serve no medical purpose. Incarcerated people may have their medications taken away if they miss a dose, or as a punishment for misconduct.

“Some jails require extreme, extreme compliance with treatment, and are sort of looking for any excuse to not provide the medication,” said Bleiberg Bellos. She said that the stigma around drug addiction plays a role. 

“The medical staff at the prison say things like, ‘Oh, he just wants to get high,’” said Chase R., another person with opioid addiction incarcerated in a Pennsylvania prison. These attitudes reflect a common misconception that taking buprenorphine or methadone, which are opioids themselves, is no different from taking heroin or fentanyl. In reality, these medications stop people from craving the high of those dangerous illicit drugs.

“People don't really think of opioid use disorder as being a chronic disease–which it is,” said Bleiberg Bellos.

Then there are other on-the-ground realities that delay and limit access to treatment even in jails that have programs. Chronic staffing shortages in Philadelphia jails, for example, mean that there are often not enough corrections officers to escort incarcerated people to medical appointments, leading to a 15-day average wait for treatment this summer.

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Treatment availability growing

While there are significant gaps in treatment availability, the number of jails that offer buprenorphine, methadone, or both has increased from 20 to 52 in the past two years. This is partly driven by pressure from lawsuits brought against jails that do not provide medication-assisted treatment. The U.S. Department of Justice, which has brought several of these cases, holds that a failure to provide medication-assisted treatment for opioid addiction is a violation of the Americans with Disabilities Act. Courts have agreed, and also sided with claims that it violates the Fourteenth Amendment of the U.S. Constitution.

“I think views about opioid use disorder have changed a lot, particularly on the outside, in recent years,” Bleiberg Bellos said. “Jails and prisons are behind the times in really understanding what the science says.”