Public Health Law Watch
An initiative of the George Consortium

Public Health Law Watch blog


A Heartbreaking Tale Underscores Why Massachusetts Corrections Facilities Need to Offer Medication Assisted Treatment for Opioid Use Disorder

By Elisabeth J. Ryan

Last month, I wrote about Massachusetts criminal justice reform and lamented that a clause allowing medication assisted therapy in correctional settings had been removed from the final bill:

One of the earlier versions of this reform bill contained a provision that would have allowed people with opioid use disorders to have access to medication assisted treatments(MAT) while in prison. That would have been a major public health triumph, as illustrated by its success in Rhode Island prisons. MAT remains the gold standard of care for opioid use disorders; studies show that people on MAT are more than twice as likely to remain opioid-free. Incarcerated individuals have much higher than usual rates of substance use disorders and are 129 times more likely to die of an overdose within two weeks of release from prison, compared to the general population.  The Rhode Island program that gave its incarcerated population access to MAT not only resulted in much higher rates of adherence to treatment after release, but also corresponded with a 12% reduction in overdose deaths statewide. Unfortunately for Massachusetts, which has one of the highest overdose death rates in the country, the provision that would have provided MAT is prisons did not make it to the final criminal justice bill.

According to the Boston Globe, however, a change in the policy is "gaining momentum - but slowly." Twenty-six groups continue to advocate for medication assisted treatment to be required in Massachusetts jails and prisons, emphasizing that, "The science and research on this is clear. To wait any longer to do this is just going to result in needles loss of life," according to the chief executive of the Association for Behavioral Health Care. The Globe story features the heartbreaking tale of a mother who had struggled with her own substance use disorder and then lost her 27-year-old son to an overdose the same day that he was released from pretrial custody. Stephen Gonzalez had been on prescribed methadone for five years prior to being arrested. The Suffolk County jail, per policy, did not provide him with the methadone while holding him in custody. His brutal withdrawal sent him into "unbearable pain." With a diminished tolerance, he sought heroin almost as soon as he got out to attend his stepfather's funeral. The overdose killed him, leaving his mother "to bury her husband and her son in the same week."

The barrier to providing medication assisted therapy in Massachusetts correctional settings is not just the lack of a law enabling it, however. The Department of Corrections and most of the sheriff's departments actively object to having methadone and buprenorphine available to inmates "because the drugs are opioids that can be diverted for illicit use." Only the two houses of correction in Franklin and Hampden counties in Western Massachusetts offer medication-assisted treatment.

The US Department of Justice is also investigating whether denying inmates access to legitimately prescribed medication assisted therapy while incarcerated violates the Americans with Disabilities Act.


Elisabeth Ryan