RI is a small state known for its circuitous politics, but there is proof that when push comes to shove, we can come together and make aggressive changes for all the right reasons. RI is the first state in the nation to put adult prisoners who abuse opiates (ie, have an Opiate Use Disorder (OUD)) on medically assisted treatment (MAT), which includes the addiction treatment medications buprenorphine, methadone and naltrexone, while they are incarcerated and to ensure they are on MAT when they are released.
MAT is controversial because society and some in the medical profession consider it to be treating a drug addiction with a drug. Yet MAT has proven to be the most effective therapy for OUD. This, along with a carefully placed legal safeguard to keep any conversation around substance-abusing clients — even within and between the medical and behavioral health communities — difficult if not impossible, contributes to the stigma. If we understand and prescribe to the idea of addiction as a disease, why continue to shroud it in this secrecy? We must be able to discuss it for medical care and not protect it as though people with an addiction are different than people with diabetes or asthma.
Back to the facts. Amid a drug crisis like none that we have seen in decades, teams of people from all RI state offices got together and thought outside of the proverbial box. In 2017 the RIDOC partnered with CODAC behavioral healthcare to bring all three approved addiction medications (buprenorphine, methadone and naltrexone) to incarcerated people affected by OUD. It is well known that incarceration and addiction go hand in hand, yet incarcerated populations are often not the first considered for treatment. Recognizing that incarcerated Rhode Islanders are part of our community helped to get this initiative off the ground.
The pilot, though small, was very promising. The first year RI saw a 60% decrease in overdose deaths among pilot program members released from prison. This was a remarkable finding and enough to get the attention of policy makers and determine how to keep the program running. Policy makers have sought funding to expand the program and reach as many incarcerated Rhode Islanders as needed to not only get them signed up for treatment in the community, but coordinate that treatment while they are still incarcerated. Today all inmates are assessed for an OUD upon entrance to the adult correctional institution, which allows for immediate withdrawal and treatment assistance. The program has not only saved lives, but has reduced RI’s recidivism rates.
RI is unique in that there is a main facility that houses the entire adult corrections population; this makes it easier to monitor care and makes RI an ideal place to pilot these kinds of initiatives. Other states and the federal government are looking closely at this innovative work and hoping to replicate it, but it will not be easy. In larger states, the operational piece is more complicated. But with RI paving the way, showing that the controversy was not insurmountable and modeling what can be done by shifting from what we think we know to being open to modify while collaborating with other state agencies, there is plenty of room for other states and the federal government to get on board.
