For Inmates on Methadone, Forced Detox Can Be a Dangerous Cycle

Apr 12, 2016

Credit <a href="">Mike Cophlan</a>

  Health practitioners across the state say the drug methadone should be available behind bars – especially to patients already on the medication. But jails and prisons in New Hampshire do not offer the drug to recovering addicts, many of whom rely on it to stay sober.    

It wasn’t long ago that Michael Burghardt managed a restaurant. He was on the up and up: getting methadone at a clinic every morning, going to work, staying sober. But, he says, a recent stint in jail has landed him back at the bottom of the restaurant ladder as a line cook.

We met at a Dunkin Donuts just blocks from the Valley Street Jail, in Manchester, where he was locked up a few months earlier. Every time he goes to jail, Burghardt says, he has to detox from methadone.  When he gets out, he relapses.

“It causes you to get back in the circle of addiction, that you were just about, maybe at the end of,” he says.

Burghardt is 32. He’s been working on staying sober for a decade with the help of methadone, a slow-acting opiate doctors use to help people steer clear of heroin. Still, he’s been in and out of jail 11 times in the last 12 years: arguments where the police are called; drug possession; driving without a license.

And every time Burghardt lands in Valley Street Jail, he has to go off methadone, cold turkey.  

“You have muscle aches, bone aches, you feel like you’re almost basically dying,” he says. There’s the diarrhea, the constant throwing up, and the insomnia can last more than a month.  

If Burghardt lived in at least 33 other countries -- from Canada to Iran to Kyrgyzstan -- he could continue his methadone treatment behind bars. But very few jails and prisons in the United States allow the drug, even though the World Health Organization calls it an “essential medicine” and recommends that it be available to inmates.

The United States is one of a handful of developed nations to not offer methadone or buprenorphine treatment to imprisoned addicts. | Data: World Health Organization
Credit Sara Plourde, NHPR

Jody Rich is a physician and researcher at Brown University.  He and many other addiction specialists say refusing to give methadone to a drug user is as bad as taking insulin away from a diabetes patient. “This notion that correctional facilities can just simply stop a proven treatment for no good reason - that’s absurd, and we should not tolerate that,” Rich says.

Yet corrections officials say methadone is not medically necessary. Some worry patients would keep the liquid in their mouth, then sell it as contraband. And while the drug is inexpensive, acquiring a license to administer it or transporting inmates to a local clinic poses logistical hurdles.

“We’ve become a de facto detox center," says Denise Ryan, the health services administrator at Valley Street Jail.

Each day, her team keeps watch on about about 40 inmates who are detoxing - a number that's quadrupled in the last five years. As many as half are on medically assisted treatments like methadone and Suboxone. Nurses at the jail hand out Tylenol and make sure the inmates don’t get dehydrated.

The only people with access to methadone are pregnant women, Ryans says, "because they’re getting methadone for the safety and the health of the child."

Withdrawal from opiates can cause miscarriage, but it’s usually not fatal for adults. Still, it can be indirectly fatal. When opiate users detox , their tolerance drops, their cravings increase and they become as much as eight times more likely to die, most likely of an overdose.

Methadone clinics in New Hampshire have waiting lists. At some clinics, the wait is a few days long. At others, it can be a few weeks. Burghardt says three of his friends died recently after detoxing from methadone in jail.

“When they came out they started using again, waiting to get in the methadone clinic," he says. "And they just used an amount they were used to thinking it would be okay still, and their body, they had a less of a tolerance so that caused them to overdose.”

Detoxing from methadone takes far longer than detoxing from heroin, and it’s excruciating.  Jody Rich says users know they are likely to do time in jail. They tell him they would rather undergo the short detox from heroin in jail than the long detox from methadone. His research shows correctional policies even deter drug users who are not incarcerated from seeking treatment.

Still, Rich says, he has hope about a medication called naltrexone.  Unlike methadone and Suboxone, it is not an opiate.

Jails in New Hampshire, which are short-term and house most of the state’s detoxing inmates, are not looking at offering naltrexone to inmates.

But the state prison is beginning to help parolees get a single injection – which lasts one month – before release. The hope is that it could stem a tide of post-release overdoses and give people time to find treatment in the community.