Recommendation 4a: Addiction-related health services, including all approved medications, should be available to all incarcerated individuals who have opioid use disorder, including during the high-risk period surrounding discharge.
Rehabilitation is one of the core missions of correctional systems. This includes a responsibility to treat health conditions such as addiction. Indeed, in the Plata decision in 2010, the U.S. Supreme Court held that providing inadequate health care in prison violated the 8th Amendment’s injunction against cruel and unusual punishment. Even were it not a legal requirement and an ethical imperative, there are additional practical reasons to treat OUD and other substance use disorders in prison: the marginal costs of providing addiction care to people who are incarcerated is small relative to the potential public health and safety benefits of such care.
Because prison-based addiction treatment without continuing services after release has less impact (indeed some studies find it has none) and because post-release is such a high-risk period, the Commission also recommends that community re-entry services after release should also be universally provided and adequately resourced. In addition to addiction treatment, incarceration should also be seen as an opportunity to attend to other health needs of the addicted population, including offering pre-natal care, providing hepatitis B vaccines, treating sexually transmitted infections, caring for psychiatric disorders, and offering overdose education and naloxone distribution (which could have radiating benefits to non-prisoners upon release.
In the USA, the Commission recommends making addiction-related services available in correctional facilities by passing the Medicaid Re-Entry Act being considered in the current Congress. Currently, Medicaid does not generally cover services provided in correctional facilities. This hampers both in-facility service provision as well as re-entry services because once Medicaid is shut off upon incarceration, there can be paperwork hassles and delays before benefits are reactivated in the vulnerable post-release period. The Medicaid Re-Entry Act reactivates Medicaid coverage to cover addiction treatment provided in the final month of an individual’s incarceration. This could allow prison staff to provide the care themselves, but in most cases the likely division of responsibility will be Medicaid-funded contracts to community health care providers to care for incarcerated people both prior to and after release.