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One State’s Opioid Success Story

In just one year, Rhode Island reduced the overdose death rate among former prisoners by 61 percent.

opioid medicated-assisted treatment
Medication-assisted treatment, such as methadone, is not common in prisons and jails. Some think it should be.
In recent years, most states have devoted increased resources to easing the transition of prisoners back into society through job training programs and, in some cases, therapy and counseling. But few provide effective drug treatment programs, such as methadone maintenance. Given the rising number of opioid deaths, they might want to consider doing so.

The period immediately after release from prison is a dangerous time for addicts. They’ve experienced a stretch of enforced, if not total, sobriety. Suddenly they have access to drugs, but their tolerance level has diminished. The stress of re-entry and the difficulty finding jobs and housing don’t help. One study of released prisoners in Washington state found that they were 13 times more likely to die from drug overdoses than the population as a whole.

In Rhode Island, the Corrections Department now provides medical addiction treatments to criminals while they are still incarcerated. The results have been striking. Between 2016 and 2017, the number of deaths among recent ex-prisoners dropped by 61 percent. That was enough to bring down the total number of overdose deaths in the state as a whole by 12 percent, even at a time when opioids are driving up the death rate in most places.  

Weaning people off drugs through the use of medication is standard operating procedure in health clinics. Some states run “step-down” clinics to help prisoners or the mentally ill get off drugs, but medication-assisted treatment in prisons and jails is not common. “Providing those same treatments to people who are severely involved in opioids in the prison system seems like an appropriate response, since they are at risk,” says Ingrid Binswanger, an addiction expert at the University of Colorado.

Rhode Island brought licensed medication providers into prisons to run its program. They not only lent expertise, but gave prisoners admission in advance to one of a dozen community treatment centers around the state. “That gets rid of delays when somebody is waiting for a spot in a clinic,” says Jennifer Clarke, the medical programs director at the Department of Corrections.

Rhode Island’s success may not be easily replicated elsewhere. It’s a small state. What’s more, it has a combined prison-and-jail system, meaning that prisoners can be tracked more easily throughout their period of incarceration. Still, Rhode Island’s immediate success in cutting down deaths among ex-prisoners is something other jurisdictions should consider. “The take-home message,” Binswanger says, “is that treatment in facilities can have a significant impact on the reduction of overdose in those populations.” 

Alan Greenblatt is the editor of Governing. He can be found on Twitter at @AlanGreenblatt.
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