In what’s being called a landmark decision, a federal judge in Essex County, Massachusetts ruled that a man facing jail time must be permitted to continue his treatment for opioid addiction. This was the first time a federal judge mandated prisons to continue an inmate’s opioid use disorder treatment. While the ruling was specific to 32-year-old Geoffrey Pesce’s situation, it has set a precedent that could have far-reaching consequences for addicts who are forced to discontinue treatment during incarceration.

The Prison System’s Lack of Opioid Addiction Treatment Options

Experts estimate that nearly a quarter of inmates suffer from opioid use disorder. Yet out of 5,100 facilities in the US, only 30 jails offer methadone or buprenorphine, which are proven to effectively treat opioid addiction.


In most US prisons, inmates who are addicted to opioids must go through the painful withdrawal process unassisted. Opioid withdrawal includes flu-like symptoms such as nausea, diarrhea, dehydration, fever, pain and vomiting, and while withdrawal itself do

esn’t usually result in death, symptoms like dehydration have killed several inmates in recent years.

The real danger, however, waits outside prison walls. Once an opioid addict gets back on the streets, the risk of overdose is high. After going through involuntary withdrawal, opioid users lose their tolerance for the drug; when they take their usual dose, the results can be fatal. The involuntary withdrawal process is traumatic, and many inmates continue to experience intense cravings throughout incarceration. An estimated 95 percent of untreated opioid addicts who go through the prison system return to drug use within three years of leaving jail, and one North Carolina study found that former inmates were 39 times likelier to overdose on opioids than the general population.

The Massachusetts federal judge found that the prison that attempted to deny Geoffrey Pesce treatment was in violation of the Americans with Disabilities Act, and that its actions were comparable to denying a diabetic insulin. Experts are hopeful that the ruling will help change the attitude, still prevalent among prison administrators, that providing medically-assisted treatment (MAT) to opioid addicts is replacing one drug with another.

Despite the Evidence, Stigma Around Drug Rehab Persists

This attitude is baffling in light of the overwhelming evidence that medically assisted treatment (MAT) for opioid addicts works, and works especially well in a prison setting. Providing methadone or Suboxone to incarcerated opioid addicts has been shown to reduce post-incarceration deaths by 61 percent in the case of Rhode Island, which is the only state to offer all addiction treatment options to inmates. MAT has also been shown to reduce the risk of former inmates reoffending once released. And anecdotally, prison officials have noted that introducing addiction treatment options has made for a better environment in prisons.

Needless to say, stigma around drug addiction persists in our society, but nowhere is it more evident than in the prison system. One official stated that “The best way to not get addicted to opioids is to never use them,” and other officials have expressed reluctance to replace one drug with another, which shows a fundamental misunderstanding of the treatment method itself.

Concerns Over Logistics Are Costing Lives Amidst the Opioid Crisis

The main objections to MAT that prison officials voice are logistical: inmates would have to be closely watched to ensure they actually take the medication, additional training would be needed for staff administering MAT, inmates would have to be escorted somewhere to take their prescription and precautions would have to be in place ensure the drugs are not sold on the black market. To be sure, these are valid concerns and logistical hurdles that prisons will need to overcome.

However, prisons have a duty of care to inmates that is not currently being met. Support staff have training to administer insulin and inmates with cancer receive treatment (though the quality of prison health care in some states has been disputed). The logistical concerns are not insurmountable, and are a small price to pay for helping to abate the opioid crisis and save lives. When treatment was made available for opioid-addicted inmates in Rhode Island, statewide overdose deaths dropped by 12 percent. This is no surprise given that opioid users are 13 times more likely to come into contact with the criminal justice system. The prison system must not underestimate its vital role in addressing America’s opioid crisis.

The Prison System’s Role in the Cycle of Addiction

In the current state of affairs, the prison system plays a central role in the cycle of addiction that ensnares many opioid users. As money runs out and desperation sets in, opioid addicts often resort to crime to pay for their addiction. They land in prison, stay for an involuntarily detox, and then they’re released and often relapse due to lack of support and proper treatment. Once an addict is caught in the prison system, minor infractions can carry a jail sentence, and the cycle repeats itself until an overdose occurs.


But instead of perpetuating the cycle of addiction, the prison system could be instrumental in breaking it. When incoming inmates are identified as opiate addicts, MAT and even therapy could be administered. And once they’ve served their time, providing addicts with MAT and inpatient or outpatient treatment program options would drastically lower the odds of relapse and recidivism. The recent ruling in Massachusetts is cause for optimism, but it’s only the start of the changes that need to be made to ensure incarcerated addicts get the treatment they need.

Broadway Offers Orange County Families a Way Forward

If you’re struggling with opioid use or substance-related legal issues, you deserve a chance to recover. Broadway Treatment Center offers a Jail Diversion Program as an alternative to incarceration for drug-related offenses. We are located in Southern California, but able to accept jail diversion clients from all over the nation. At Broadway, you’ll have the chance to recover in a safe environment with a personalized combination of one-on-one counseling, group therapy, family counseling, and continuing care.

Contact us today to find out how we can help you get – and stay – sober.