According to the Legal Action Center (LAC) an astounding 65% of incarcerated Americans in jail or prison have a substance use disorder, with another 20% of those in prison being “ substance involved.” Those addicted to opiates make up a considerable percentage of prisoners, the LAC claims in its provocative report Legality of Denying Access to Medication Assisted Treatment in the Criminal Justice System, yet many addicts are denied MAT treatment. The report asserts that methadone maintenance treatment (MMT) has been “…confirmed clinically effective for opioid dependence in more than 300 published research studies,” and that a National Institute of Health recommended that “...all opiate-dependent persons under legal supervision have access to (MMT)…” The report also refers to a study that shows that those who were on MAT before incarceration, but were forced to undergo involuntary withdrawal from methadone upon admission,were likely to return to using narcotics, often in prison.
Yet, according to the report, the majority of American jails and prisons fail to offer MAT as a treatment option, ignoring the fact that MAT has been found to reduce drug use, disease rates, criminal activity and recidivism among those addicted to opiates.
LAC announced that there are legal consequences to denying MAT in the criminal justice system. The report states that liability occurs when a person under legal supervision is denied access to MAT:
Pursuant to a flat policy
Due to a decision made on an individual basis but in contravention of the criminal defendant’s or incarcerated person’s doctor, and/or not based on objective medical evidence
Pursuant to a larger policy prohibiting the use of any controlled substances
The LAC report also claims that denial of access to MAT in the criminal justice system violates the Americans with Disability Act (ADA)and Rehabilitation Act of 1973 because individuals requiring MAT meet all the requirements as set forth under the ADA and Rehabilitation Act. The report further states that denying medical treatment for withdrawal from an opiate addiction can violate the Eighth Amendment’s prohibition of cruel and unusual punishment (applicable to prisons) or, when applicable to jails, violation of the Fourteenth Amendment’s Due Process clause.
The report offers some of the reasons MAT may be denied in the criminal justice system:
Cost
Ignorance of the nature of addiction and MAT
Policies prohibiting all controlled substances
Lack of screening, detoxification, or treatment for any form of addiction at some facilities
Unavailability of MAT in some jurisdictions
Most, if not all, of the reasons for denying MAT in the criminal justice system can be countered with intelligent rebuttals.
It is more cost effective in terms of health and public safety to treat addiction.
Policies can be reexamined and change to provide more realistic and effective solutions
Inmates needing MAT can be sent to a facility or jurisdiction that have a screening and treatment program in place, or such a program could be created in the existing facility
In the debate for implementing MAT throughout America’s criminal justice system the pros far outweigh the cons. America is finally getting “smart on crime.” Hopefully that idea will foster a “smart on treatment” protocol in the nation’s jails and prisons.
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