Pubdate: Mon, 25 Jul 2016
Source: Baltimore Sun (MD)
Copyright: 2016 The Baltimore Sun Company
Author: Kenneth B. Stoller


Maryland has recently enacted or proposed two work-arounds for the 
problem of Suboxone being smuggled into prisons. The first action, 
taking Suboxone off the Medicaid preferred drug list ("State action 
limits opioid addiction treatments," June 23), destabilized patients 
in recovery without reducing demand in prisons. Last week, Maryland 
correctional officials proposed a ban on prisoners receiving personal 
letters by mail. This proposal was later withdrawn, presumably as a 
response to criticism by the ACLU ("Maryland corrections officials 
withdraw proposal to limit inmate mail to postcards," July 21).

Such approaches are ineffective and potentially harmful work-arounds 
for a problem that calls for a direct solution that would improve 
safety within prison walls as well as for Maryland citizens outside 
the walls. The effective and proven medications, methadone, 
buprenorphine and naltrexone, should be made available in all of 
Maryland's correctional facilities. Currently, access only exists in 
a small fraction of facilities and is limited to just methadone. It 
is no wonder that there is a high demand for Suboxone. If prisons 
prohibited diabetes medication, black-market insulin would flood the 
prison blocks.

With few exceptions, Maryland arrestees stable in addiction treatment 
are withdrawn from their medication, receive very limited treatment 
while incarcerated, are expected to avoid illicit drug use and, when 
released, find themselves in a state of irresistible drug craving. 
This leads to relapses, overdoses, HIV or hepatitis infections, and 
rearrests. It also exposes Marylanders to higher rates of crime, 
unemployment, community/family instability, and increased health care 
and criminal justice costs.

It is time for Maryland to follow the guidance of the U.S. Department 
of Health and Human Services, and other enlightened states, by 
mandating that these medications be made available to all arrestees 
and prisoners based on medical necessity. Untreated addiction only 
increases drug diversion and associated crime and violence in its 
correctional facilities. Releasing prisoners with untreated addiction 
keeps the jails' revolving door spinning. It puts us all at risk and 
worsens the burden that addiction imposes on our economy and our communities.

Dr. Kenneth B. Stoller, Baltimore The writer is an assistant 
professor at the Johns Hopkins University School of Medicine.
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