Should Methadone Maintenance Be Utilized In US Prisons?

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The idea of treating opiate addicted criminals with methadone in jails and prisons across the United States has conjured up a heated debate over the past few decades. There are many different opinions held by various government officials regarding this controversial topic. Constitutional rights suggest that each and every person treated for a medical condition that has been diagnosed prior to entrance into jail should have access to continued treatment while imprisoned. Furthermore, the eighth amendment of the constitution prohibits "cruel and unusual punishment" among people entering jail systems of any kind within the country. Any action or lack of action that inflicts unnecessary pain or suffering on any prisoner above and beyond the correctional facility itself, is deemed to be "cruel and unusual". The conflict arises, however, when you account for the fact that different people have different ideas about which situations can be considered "cruel and unusual punishment".

The failure to act appropriately and provide needed medical attention when doing so would prevent physical or mental deterioration to an inmate is called deliberate indifference. Deliberate indifference is cause for legal action against correctional facilities and has been observed in a countless number of circumstances in jails and prisons across the nation. For example, in the McElligot vs. Foley case, an inmate complaining of severe stomach pain and cramping was given inadequate treatment for what turned out to be colon cancer. Instead of medical staff ordering CT scans and blood tests and prescribing proper pain medication, the inmate was initially given nothing more than anti-gas medicine and Tylenol. This is just one of numerous instances where a prisoner was forced to endure unnecessary suffering through what could be described as deliberate indifference and, ultimately, "cruel and unusual punishment".

This brings us to a more controversial topic and poses a more debatable question. Can denying an individual his or her daily dose of methadone that has been prescribed to treat a legitimate medical condition, namely opioid dependence, be considered deliberate indifference and thus "cruel and unusual punishment"? Methadone treats the condition known as "opioid dependence" which, when left untreated, causes the individual to undergo severe flu-like withdrawal symptoms and extreme discomfort unless he or she is able to self-medicate with heroin or other "street" opiates. Complications are almost inevitable given the length of time withdrawal symptoms are experienced in those suddenly cut-off from long term methadone treatment. When you consider this fact, right away it is easy to see that refusing to give an opioid addict his or her medication (in this case methadone) in an institution where other opiates are not accessible, would not only cause unnecessary suffering for the individual, but would pose the threat of physical and mental deterioration brought on by eventual complications.

An institution in Vermont denied two different inmates their methadone on two separate occasions. The officials running the jail claimed that since opioid dependence is "self-inflicted" it did not necessitate continued treatment with a drug that "can produce a high in people who take it". There are two pieces of blatant misinformation in the previous statement.

If opioid dependence can be considered "self-inflicted" due to an individual's choice to repeatedly ingest a certain substance, then so can most cancers and cases of HIV infection. Often times, people who develop cancer do so after years of neglecting their own health such as making unhealthy dietary choices, refusing to exercise or allowing themselves to become habituated to cigarettes. Furthermore, people who acquire HIV often do so because of carelessness and failure to practice simple preventative measures such as wearing condoms during sex, or refusing to share used needles to inject their drugs. Jail and prison officials would never consider denying an inmate with cancer or HIV his or her medication for fear of facing law suits or even criminal charges. Just as people who get cancer are usually genetically predisposed to it, people who become opioid dependent often suffer from an inherent condition known as "endorphin deficiency syndrome". With this disorder, the individual's brain does not manufacture sufficient quantities of endorphins, a chemical mimicked by opioid drugs. Therefore, these people are more susceptible to irregular sleeping pattens, hyperactivity, and general feelings of malaise and discomfort than those who have normal endorphin production.

Methadone used in the treatment of opioid dependence acts as a replacement medication maintaining a balanced level of endorphin-like chemicals in the addict's brain. It does not produce a euphoric effect in those who take it as prescribed for this condition. When ingested once daily, the opioid dependent person quickly becomes tolerant to any euphoria that may be experienced early on in treatment. Furthermore, because of its long half-life (24 to 36 hours) no sort of rush accompanies the consumption of methadone and likewise, there is no sharp "come-down" associated with it. The only truly noticeable effect is the cessation of opioid withdrawal symptoms.

These cases were presented to the court system in Vermont and eventually, the suffering inmates who were forced to abruptly discontinue their methadone treatment were either properly medicated (with methadone) or released from jail.

The facts regarding methadone maintenance treatment have been presented as accurately as possible in this article. Being what it is, the denial of methadone to long-term maintenance patients in prison systems today is not only archaic, but extremely cruel and inhumane as well. More importantly, however, this sort of "punishment" is often harmful to the inmate's health and even potentially fatal. Fortunately, many jails across the United States have either recently implemented methadone programs in their systems, or are planning to do so in the near future. Most, if not all, of these programs have been modeled after KEEP (Key Extended Entry Program) on Rikers Island in New York City, a pioneer methadone treatment program that was launched in 1987 and that was far ahead of its time. We can only hope that jails and prisons that continue to subject their opioid dependent inmates to unnecessary pain and anguish are held accountable for their inexcusable actions.

For more information regarding addiction treatment and the brain, Lester De Vine would like to invite you to take a look at the following web pages:

Opioid replacement therapy
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