Post-incarceration overdose risk is a consequence of how the body responds to the use and non-use of opioids. Long-term, regular use of opioids (e.g., OxyContin, heroin) results in physical tolerance, meaning that larger and larger doses are needed to get the same effect. Because obtaining a steady supply of drugs in prison is very difficult, opioid-addicted offenders generally lose tolerance while behind bars. The result: If they take their “usual dose” after leaving prison, the effects can be fatal.
In a perfect world, opioid-addicted prisoners would leave incarceration already linked to a substance-use disorder treatment provider that would give them care from their first day back in the community. But bureaucratic hurdles often prevent this from happening.
Medicaid coverage, which would normally cover such addiction treatment, typically shuts off when someone is incarcerated, on the assumption that the correctional facility will cover inmates’ health care. Getting that coverage reestablished after release can be a weeks- or months-long struggle, during which many drug-addicted individuals relapse or overdose.
The Medicaid Reentry Act, sponsored by Rep. Paul Tonko (D-N.Y.), is intended to cut this red tape and get addicted prisoners the care they need. The bill’s key provision is to encourage states to experiment with reestablishing Medicaid coverage a month before an inmate’s release, eliminating any gaps in addiction-related care.
The experience of Rhode Island suggests that this approach could save lives. A recent study of the state’s new policy of providing medication-assisted treatment (e.g., methadone, buprenorphine, naltrexone) to opioid-addicted offenders during and after incarceration decreased fatal overdoses among former prisoners by 60.5 percent.
Tonko’s bill has moved to the Senate. If lawmakers there are wise enough to pass it and President Trump signs it, it will be an important step in turning back the epidemic of opioid overdose.