The Surprising Truth Behind Heroin Addiction in Prison

The percentage of drug addicts in prison is currently more than four times higher than the percentage found in the general population. In 1980, there were approximately 1.8 million adults in prison in the United States, and by 2007, there were approximately 7.3 million, largely due to drug-addicted offenders and drug-related crimes. Thanks to the opioid crisis, a large number of these criminals suffer from heroin addiction and are in need of quality addiction treatment that they will be unable to receive while incarcerated. Less than one percent of heroin-addicted prisoners have access to methadone and those prisoners who are allowed methadone don’t have the accompanying counseling that is needed for a successful recovery.

Despite this, only 11% are receiving any form of addiction treatment, which sets inmates up for continued drug abuse and repeated drug offenses after they are released from prison. Here are some more surprising facts on the current heroin epidemic going on behind bars.

A Lack of Heroin Treatment is Hurting Drug Addicts in Prison

Approximately 15% of prison inmates are addicted to heroin, and without appropriate heroin treatment, a host of problems can arise from this, including the sudden, untreated, and potentially deadly opioid withdrawal faced by drug addicts in prison. Prisoners are driven to take measures to treat their own symptoms, by buying drugs sold by other inmates, or by injuring themselves or lying to receive symptom-relieving medications from prison doctors.

Due to the greater stigma around heroin addiction, some inmates may lie about having alternate conditions that are less stigmatized, telling prison doctors that they are alcoholics to receive alcohol withdrawal medications to ease their extreme anxiety, or claiming to hear voices to get sedating antipsychotic medications. Such medications may help to some degree, but they can’t treat life-threatening symptoms such as severe dehydration from vomiting and diarrhea or heart rhythm abnormalities that could lead to cardiac arrest, and in the case of antipsychotic or other psychiatric medications, prisoners are likely to experience side effects that only increase their suffering.

Prisoners can be at risk of life-threatening withdrawal complications even when prison staff is aware of the heroin addiction. Some prisoners are forced to experience severe symptoms for several days before receiving anti-nausea medications, muscle relaxants, or any other medications to relieve their suffering. Other prisoners are deliberately given no heroin treatment at all. Heroin withdrawal symptoms are often considered a positive punishment within the penal system, with officials believing that if prisoners suffer enough while going off drugs “cold turkey,” they will be motivated to stay off drugs.

Cold turkey withdrawal can be much more severe when an inmate is cut off from methadone. While the worst of heroin withdrawal is usually over after a week or two, methadone withdrawal can last for weeks or months, because the drug leaves the body at a much slower pace. Individuals who suffer this withdrawal, and other inmates who witnessed it, are unfortunately convinced to avoid taking methadone after their prison sentence is over out of a fear of being arrested again and having to suffer the exceedingly lengthy and painful process of cold turkey methadone withdrawal. As a result, these former inmates will not get the treatment they need and may proceed to commit crimes that could have been avoided if they had been able to comfortably withdraw from drugs and receive the treatment necessary to avoid relapse before being released back into the community.

Drug addicts in prison are often compelled to seek out heroin from other inmates at a very high cost—financial, emotional, and psychological. Inmates report that buying drugs inside is more than expensive; it can make you seem weak and put you at greater risk of being manipulated, mistreated, and assaulted. Taking drugs inside a prison also greatly adds to a prisoner’s risk of overdosing, as their tolerance level after forced withdrawal is much lower than before their arrest. Shooting heroin inside prison also greatly amplifies a prisoner’s risk of contracting blood-borne diseases such as HIV due to sharing needles with other inmates.

How the Prison System is Failing Inmates Suffering from Heroin Addiction

Without appropriate care, the lives of drug addicts in prison are at risk.

Currently, federal prisons can only administer methadone treatment to inmates for a maximum of three days while arranging to refer them to a licensed narcotic treatment program. Meanwhile, many heroin-addicted prisoners are never transferred to a treatment program or given any sort of medications for heroin withdrawal. This limited or lacking heroin treatment is partly due to the stigma of addiction, which discourages inmates who were not arrested for heroin use or possession from being honest about their heroin addiction, and partly due to legal or financial limitations within the penal system. Very few lawmakers and people who work within the prison system see any reason to work towards improving the treatment of heroin-addicted inmates due to the negative view of heroin addicts and the mistaken belief that methadone treatment simply replaces one addiction with another, and that it is better to “tough out” withdrawal cold turkey.

As a result, drug addicts in prison not only suffer unnecessarily, they can die from a lack of supportive care during their detox. Anyone who experiences severe vomiting and/or diarrhea is at risk of dangerous dehydration and electrolyte imbalances which can lead to heart irregularities, kidney failure, and other health complications. Other rare, but possible health complications that can result from withdrawal are seizures, tremors, high blood pressure, heart attack, and coma—symptoms that become even more likely when heroin addiction is accompanied by the use of other substances that can easily complicate and worsen the withdrawal experience.

Tapering off drugs or using addiction treatment medications such as methadone is much safer than quitting cold turkey. In addition, a recent study showed that participants who continued methadone treatment during incarceration were twice as likely to turn to a community methadone clinic after their release than participants who were forced to withdraw from methadone prematurely.

Improper Addiction Treatment in Prison is Detrimental to our Society

People who have spent time in prison are already very vulnerable to reoffending and returning to prison in the years after being released back into society, with nearly 68% being rearrested within three years after their release, and nearly 77% were arrested within five years after their release. Over half of these prisoners (56.7%), were arrested during their very first year of freedom from incarceration. These rates are especially concerning when you consider that two-thirds of all inmates suffer from addiction, and nearly half were arrested for drug-related crimes. Failing to treat heroin addiction in prison makes it astronomically more likely that a former inmate will return to drug use and crime after incarceration.

Prisoners who have asthma are allowed inhalers to treat asthma attacks, and prisoners with diabetes are allowed insulin injections, so why should prisoners with heroin addiction go without addiction medications and other treatment interventions? Drug addiction creates profound changes in the brain that take years to heal and leave people vulnerable to relapse. In addition, approximately 50% of prisoners suffer co-occurring substance use and mental health disorders, which means that they will not be able to overcome addiction unless the underlying mental health issues are also addressed through integrated treatment. This is one of the many reasons why having an inmate quit drugs in jail without any sort of recovery treatment makes them incredibly vulnerable to using again upon release, no matter how long it has been since they last used.

Most inmates begin using again immediately after being released from prison, putting them at greater risk of fatal overdose in the first two weeks after release than at any other time in life. The months or years of forced abstinence from drugs causes a very low physical tolerance, while the psychological craving for heroin could be just as strong as it was before the arrest. If the inmate is lucky enough to avoid a fatal overdose, they will most likely get re-arrested for more drug-related crimes within the first few years after release.

Research shows that heroin treatment works, even when addicts enter that treatment involuntarily. Forced abstinence without treatment, however, tends to lead to drug use relapse and re-arrest within one year after release. Providing heroin treatment avoids this and is extremely cost effective. The reductions in criminal activity and re-incarceration save between two and six dollars for every one dollar spent on drug addiction treatment. Very few governmental programs can show such dramatic returns on money spent.

How to Improve Heroin Treatment in Prison

Approximately two-thirds of the 2.3 million inmates in U.S. prisons have substance use disorders in comparison to just 9% in the general population, and yet only 11% of these addicted inmates receive any treatment for their disease. Many addiction specialists see the lack of treatment in prisons as a missed opportunity to help drug addicts in prison. Not only is prison a controlled environment where treatment services could be extremely well-structured and regulated, providing heroin treatment to inmates would be a preventative measure to avoid additional crime and suffering after the inmate is released back into society.

So, what needs to be done to ensure proper heroin addiction treatment in prison? First off, inmates need to be thoroughly evaluated to identify the addiction and mental health issues that may have led them to commit crimes in the first place. Then, once the inmates in need of addiction and/or mental health treatment are identified, they should be given consistent treatment provided by trained personnel, including addiction specialists. And last, long-term treatment programs that include Medication Assisted Treatment should be made available to prisoners, with referrals to community resources to continue addiction treatment after release if needed.

At first glance, the cost of such programs may seem like too much to pay just to help drug addicts in prison, but in fact, it is an investment that will pay off for all citizens in the long run. Currently, only 1.9% of every dollar spent by our government on substance use goes to prevent and treat addiction, while 95.6% goes toward paying for the consequences of addiction. Essentially, we are paying billions of dollars on cleaning up the destructive aftermath of addiction, and far, far less money on helping people overcome addiction so they can avoid creating that kind of destruction in the first place.

A 2010 CASA study found that if quality addiction treatment were provided to every inmate who needed it, it would only take a year to break even on the investment, even if only a little more than 10% successfully stayed out of trouble, employed, and drug-free. The economic benefit for the country would equal over $90,000 a year for each former inmate. And considering the fact that research shows forced treatment produces equal or even better results than treatment individuals receive voluntarily, the percentage of inmates to succeed from such interventions is likely to be much higher than 10% in practice.

One new program in Barnstable, Massachusetts managed to greatly improve the rates of re-offending among heroin addicts through use of the addiction medication Vivitrol. Vivitrol reduces cravings and blocks the euphoric effects of opioid drugs, so that addicts are less likely to want to use heroin, and would be unable to experience a high from the drug even if they did use. Since Barnstable began offering the medication to departing inmates, the rate of re-arrest and re-incarceration has dropped to just 9%—an amazing improvement over the 77% re-arrest rate found among drug offenders at the national level.

Investing in quality heroin treatment for drug addicts in prison would be an investment in our nation’s economy, safety, and overall well-being, while also greatly reducing the individual suffering of heroin-addicted inmates and their loved ones.