Methadone proves its worth for incarcerated populations

As substance use disorders have an increasingly large impact on incarcerated populations, more addiction prevention and treatment strategies are needed in correctional facilities to address the crisis, Lipi Roy, MD, MPH, clinical assistant professor at the New York University Department of Population Health, told attendees of the Summit for Clinical Excellence event on Tuesday in Pittsburgh.

Roy, the former chief of addiction medicine for New York City Jails, noted that more than two-thirds of individuals entering New York correctional facilities report a history of illicit drug use and that about 20% of those arrested in New York City test positive for opioids.

Nationally, the vast majority of men and women experiencing withdrawal while in custody do not receive treatment, and mortality rates for incarcerated populations are particularly high in the first two weeks post-release, Roy said.

Two substance use disorder treatment initiatives at Rikers Island, New York’s primary jail facility, however, have shown promising results for recovery, Roy said. Launched in 1987, the Key Extended Entry Process (KEEP) program, is the nation’s first jail-based opioid treatment program, and it remains the largest. Funded by the New York City Department of Health and Mental Hygiene, KEEP has delivered care for about 11,000 detoxes per year, with about 4,000 individuals on methadone maintenance.

“People who are on this medication, when it is prescribed and used appropriately, and people are monitored, they not only live, they can thrive,” Roy said.

Roy also noted the effectiveness of mindfulness therapy. At Rikers, yoga and meditation sessions were offered to female inmates by volunteer instructors twice a week for a four-week period. Despite the relatively short duration of the program, 64% felt it decreased their urge to use tobacco, alcohol and illicit drugs, Roy said.

“Some of the testimonials—‘I like how my mind and body have changed,’ ‘It helps me to be calm,’ ‘Yoga has given me a coping mechanism in jail’… For anyone who has not had the privilege of at least visiting a jail-based setting, it is incredibly chaotic,” Roy said. “It’s really hard to have some quiet time. You have no freedoms. So, to hear these statements after only four weeks, it’s pretty impressive.”