Treating Opioid Addiction in the Criminal Justice System | Center on Addiction

Treating Opioid Addiction in the Criminal Justice System

Treating Opioid Addiction in the Criminal Justice System


Overdose death rates from opioid drugs have increased significantly over the past 14 years, largely due to tremendous increases in the prescribing and consequent availability of addictive painkillers. Certain populations, especially individuals involved in the criminal justice system, are particularly vulnerable to overdose. In fact, one study found that drug overdose was the leading cause of death for those who left prison and rejoined their community.

While this paints a bleak picture, recent medical and scientific developments point to a reason for hope in reversing this overdose trend. 

Medication-assisted treatment works

When used in combination with therapy and support services, opioid addiction can be treated effectively with medication. Individuals who receive medication as part of their treatment plan are more likely to achieve sustained recovery and lead healthier lives. In addition to improving treatment outcomes, medication-assisted treatment also can reduce the risk of other health problems, such as the spread of HIV and hepatitis B and C, which can be transmitted through injection drug use.  

Saving and rebuilding lives in the criminal justice system

While in prison, individuals with addiction typically have limited access to drugs, which reduces their physical tolerance for them. Once released, if the individual returns to previous levels of drug use, the risk of overdose is especially high. Opioid addiction medications dramatically reduce the risk of death from overdose upon release from prison.

In addition to protection from accidental overdose and ensuring effective treatment for addiction, medication-assisted treatment for those in the justice system reduces recidivism which is when a person continues to engage in criminal behavior after returning to the community.

Despite the considerable evidence supporting the use of medication to treat opioid addiction, medication-assisted treatment remains vastly underutilized in most jails, prisons and drug courts, to the detriment of many vulnerable citizens.

One state’s approach to addiction treatment flies in the face of evidence

Kentucky’s drug court system’s stance on treatment is one that supports only abstinence-based treatment, in spite of the fact that this approach does not work for most people with opioid addiction and can prove fatal for those at risk of relapse. A 2013 Huffington Post article reported that the Kentucky drug courts’ promotion of abstinence-based treatment was associated with many overdose deaths in Northern Kentucky that took place shortly after those with opioid addiction left jail or participated in the state’s abstinence-based treatment plan.

Fortunately, two law firms have collaboratively taken emergency action against the state of Kentucky on behalf of Stephanie Watson, a woman involved in the justice system, who is forbidden from taking any medication prescribed by her doctor to treat her opioid addiction at the risk of having her bond revoked and being sent to jail. The lawsuit questions the court’s ability to impede on doctor-patient relationships and prohibit medical care. It also argues that the ban on medication to treat opioid addiction for those involved in the criminal justice system is unconstitutional and violates the Americans with Disabilities Act, as well as the Rehabilitation Act of 1973. 

The lawsuit is not seeking any financial compensation, aside from court and attorney costs. Instead, it seeks to require Kentucky to allow people like Watson and others in the criminal justice system to receive medical treatment for a disease, in this case opioid addiction.

Promising steps for Kentucky and the nation

Federal mandates have recently prohibited drug courts that receive federal assistance from refusing medication-assisted treatment for justice-involved individuals with addiction. States that continue this practice may be at risk of being denied federal funding. This push has caused Kentucky, whose drug courts receive a substantial amount of federal grants, to rethink their position on medication-assisted drug treatment for justice-involved individuals, although a definitive reversal of policy has yet to be made.

Another promising step is the introduction of the Comprehensive Addiction Recovery Act of 2015. This is an initiative that attempts to address the addiction treatment gap in criminal justice settings. It does so by allowing the federal government to provide grants to state and local governments to encourage them to provide medication-assisted treatment for opioid addiction.

Overall, Watson’s case is part of a national conversation around recent federal action toward addressing the gap in addiction treatment services, especially among those involved in the criminal justice system. Federal mandates prohibiting drug courts from refusing medication-assisted treatment, the Comprehensive Addiction Recovery Act of 2015, and Watson’s case are encouraging steps toward reversing the opioid addiction and overdose trends in America. These steps will help to improve access to effective addiction treatment for all citizens, and remedy the historical bias against, and inadequate treatment of, those with the disease of addiction.


 Brandie Pugh, MA

 Brandie Pugh is a Research Associate at CASAColumbia





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