Illegal prescription drugs have reached epidemic numbers globally. Women make up one-third of all drug users, one-fifth of intravenous drug users, and are arrested for drug-related offenses more than other crimes (United Nations, 2018). Let us ask this question, “Why do women use drugs”? Research shows some women start using drugs to cope with the physical and emotional pain caused by abuse or trauma. Other studies suggest women traffic drugs to sustain their drug use, are sexually exploited for payment, or “forced out of fear” to be used as “mules” (United Nations, 2018).
In contrast, another study argued women are empowered key actors in the drug supply chain. The reasons are determined by the socioeconomic vulnerability, violence, intimate relationships, and economic considerations (United Nations, 2018). Most jails are not mandated to provide methadone maintenance treatment or suboxone treatment due to the short jail terms. Still, research from 2015 showed over 24% of inmates had either undiagnosed or undertreated mental illness (Chandler, et al., 2016).
Healthy People 2020 specifies the United States’ mission to help its citizens achieve long healthy lives with a mission to public awareness, measurable goals, strengthen policies according to evidence-based practice, and identify critical research. Healthy People 2020 aims to help citizens live free of preventable diseases, premature death, eliminate health disparities, improve health of all citizens, and create environments that promote health, quality of life, and healthy behaviors (Centers for Disease Control and Prevention, 2020). As I read Healthy People 2020, it includes all citizens regardless of race, culture, and socioeconomic status. A person is innocent until proven guilty, so if a person can receive treatment outside of jail, the same premise should be true inside a jail.
Inmates with withdrawal symptoms could receive medications such as methadone, buprenorphine, and Vivitrol injections. Methadone is an opioid with strict regulations, so jails are least likely to use it in liquid form, but it is available in pill form costing approximately $0.15 per 10mg tablet (UptoDate, 2019). Buprenorphine is an opioid with less risk of overdose and available in both oral and sublingual (under the tongue) forms. The 2mg sublingual costs approximately $4.14 (UptoDate, 2020). Naltrexone and an opioid antagonist that works against opioids and is available as a pill or injectable. The injectable is administered every four weeks and reduces the risk of diversion, also known as “cheeking” or hiding pills in the mouth, but costs around $1665 per injection (UpToDate, 2020). The lack of medication-assisted treatment in jails is parallel to withholding insulin from a diabetic or beta-blockers from a person with high blood pressure.
Addiction is a chronic disease that requires treatment. Social stigma, lack of community knowledge, and improperly trained correctional officers place this vulnerable population at a disadvantage both inside and outside of jail. Imagine a woman withdrawing from heroin arrested for a domestic dispute, stealing food because she was hungry, or prostituting to buy crack or heroin. That newly arrested woman can experience opioid withdrawal which includes severe physical discomfort (runny nose, yawning, fever, hot/cold flashes, nausea, vomiting, abdominal cramps, body aches, diarrhea, hallucinations), and psychological distress, and risk of suicide. She is also at risk of losing opioid tolerance, which increases her risk of fatal and non-fatal overdose post-release (Brinkley-Rubenstein, et al., 2018). Generally, society looks down on these women without understanding the why or how they ended up addicted to drugs. The lack of addiction treatment exposes women to health disparities, does not promote quality of life, and neglects the needed education on healthy behaviors upon release from jail. This behavior contradicts the mission and goals of Healthy People 2020.
In 2015 heroin use cost the United States more than 51 billion dollars, which includes heroin-related crime, imprisonment, treatment of newborns with heroin-related medical conditions, lost productivity on the job, treatment for addiction, chronic infectious diseases, and overdose deaths (Preidt, 2017). To support an approximate $50,000 a year heroin addiction, some women have resorted to theft, pawning of possessions, and prostitution to support their habit, which increases their risk of arrests and incarceration.
According to the Office of Drug Control and National Policy, every dollar spent on substance abuse treatment saves $4 in healthcare costs and $7 in criminal justice costs (Pat Moore Foundation, n.d.).
Buprenorphine is an effective medication used in the outpatient treatment of opioid use disorder (OUD) associated with higher retention and survival with fewer side effects than methadone (UptoDate, 2020). Governments, health care providers, and society need to understand and form policies that address the economic burden of non-medical, medical, and illicit drug use on society through health care costs, public safety, crime, lost productivity, and family impact (Chandler, et al., 2016).
I urge you to contact your congressperson for legislation to advocate for this vulnerable population. I believe treatment is the only option, rather than withholding treatment for chronic disease.
Brinkley-Rubenstein, L., McKenzie, M., Macmadu, A., Larney, S., Zaller, N. D., & Rich, J. (2018). A randomized, open-label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug and Alcohol Dependence(184), 57-63. doi:10.1016/j.drugalcdep.2017.11.023
Centers for Disease Control and Prevention. (2020, December 14). Healthy People 2020. Retrieved from National Center for Health Statistics: https://www.cdc.gov/nchs/healthy_people/hp2020.htm
Chandler, R., Finger, M., Farabee, D., Schwartz, R., Condon, T., Dunlap, L., . . . O’Grady, K. (2016). The SOMATICS collaborative: Introduction to the national institute on drug abuse cooperative study of pharmacotherapy for opioid treatment in criminal justice settings. Contemporary Clinical Trials(48), 166-172. doi:10.1016/j.cct.2016.05.003
Pat Moore Foundation. (n.d.). The financial cost of drug addiction and alcohol abuse. Retrieved October 15, 2019, from Pat Moore Foundation: https://www.patmoorefoundation.com/blog/financial-cost-drug-addiction-and-alcohol-abuse
Preidt, R. (2017, June 14). The increasing cost of the heroin epidemic. Retrieved from WebMD: https://www.webmd.com/mental-health/addiction/news/20170614/as-us-heroin-use-reaches-20-year-high-cost-to-society-soars
United Nations. (2018). World Drug Report. Vienna, Austria: United Nations Office on Drugs and Crime.
UptoDate. (2019, April). Methadone. Retrieved from UptoDate.com: https://www.uptodate.com/contents/methadone-drug-information?search=methadone&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1
UptoDate. (2020, March 28). Buprenorphine: Drug information. Retrieved from UptoDate.com: https://www.uptodate.com/contents/buprenorphine-drug-information?search=buprenorphine&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1
UpToDate. (2020, March 28). Naltrexone: Drug information. Retrieved from UpToDate.com: https://www.uptodate.com/contents/naltrexone-drug-information?search=naltrexone&source=panel_search_result&selectedTitle=1~84&usage_type=panel&kp_tab=drug_general&display_rank=1