As the opioid epidemic continues to ravage the United States for a third decade, communities look for new solutions. For the 200,000 heroin-addicted individuals who pass through correctional facilities each year, prison may be the opportunity for change.
Incarceration pauses access to illicit drugs and presents a chance for intervention. For individuals with Opioid Use Disorder (“OUD”), the most effective treatment option involves opioid agonist medication, such as methadone or buprenorphine. Allowing inmates with OUD to receive these medications while incarcerated improves outcomes for the individual inmate and yields public health benefits by reducing costs associated with poor health, disease transmission, criminality, and recidivism. Despite these significant benefits to individuals and society, most prisons do not treat inmates’ OUD with methadone or buprenorphine.
This Note examines why most of the United States’ prisons—including those in Minnesota—resist providing the most effective treatment for OUD. First, this Note will consider the public policy arguments for and against this treatment. To begin, OUD will be defined, and its prevalence among incarcerated individuals in the U.S. will be examined. Next, the best practices for treating OUD will be detailed, focusing on methadone. The discussion will then turn to the lack of availability of opioid agonist therapy within prisons. The rationale for limiting opioid agonist therapy in prisons will be considered, including fear of diversion within prison, the cost of providing care, philosophical opposition to utilizing medication when treating substance use disorders, and regulatory difficulties. Each justification will be challenged.
Next, this Note will explore the legal reasoning that supports allowing methadone treatment for OUD in prison, including the Eighth Amendment, the American Disabilities Act (“ADA”), and recent case law. Finally, this discussion will narrow its scope to Minnesota’s state prisons and consider the current practices of the Department of Corrections. After evaluation of current policy, this Note will offer recommendations for change.