By Pranay Nadella and Aakash Shah
“Sometimes I just wish I had diabetes,” Jon said. “At least then I’d get the medication I need.” Jon was sitting in an emergency room, handcuffed to his stretcher, retching from opioid withdrawal. His struggle with opioid use disorder began when he came across a leftover bottle of oxycontin in the medicine cabinet, escalated to injection heroin use, and recently landed him in prison.
Just prior to incarceration, he had started medication-assisted treatment (MAT) — the use of medications such as buprenorphine, methadone, or naltrexone in conjunction with counseling and related therapies — to stave off cravings and prevent relapse. He was convinced that it was the biggest step toward recovery that he had taken in months. And with good reason. Multiple studies show that MAT cuts the risk of overdose in half and doubles the chance of recovery. There are few drugs in modern medicine, and certainly no other therapies for opioid addiction, that come close to that type of efficacy.
And yet, patients like Jon typically have this life-saving therapy stopped at the prison or jail gate — only 31 out of the over 5,100 correctional facilities in the country offer MAT, according to one recent investigation.
The result is as predictable as it is heartbreaking. Without treatment, one’s tolerance to opioids wanes, cravings increase, and relapse followed by overdose death becomes increasingly likely. In fact, in the weeks following release, the risk of opioid overdose death among former inmates is 129 times that of the risk within the general population, making this period the most dangerous in the life of a patient with opioid use disorder. Thus, the tragic reality is that we unwittingly permit those with opioid use disorder who have “done their time” to then suffer a de facto death sentence upon release. As Jon noted that day in the emergency room, between bouts of retching, we would never restrict diabetics’ access to the life-saving medications that they need. Too often, however, we do exactly that to patients like Jon.