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A Case for Methadone in Our Jails

Methadone could have saved David Stojcevski, who died on the floor of his jail cell last year.
(Photo: WDIV)

(Photo: WDIV)

Earlier this week, footage surfaced of David Stojcevski, a 32-year-old man from Michigan, slowly wasting away in a Macomb County jail cell. Last summer, Stojcevski was incarcerated when he failed to pay a $772 fine for careless driving; 17 days into a 30-day sentence, he had lost 50 pounds. Too weak to stand up, he spent at least 48 hours on the floor of his cell before dying. His official cause of death: drug withdrawal. WDIV, a local television station in Detroit, reports that Stojcevski had been on methadone—a standard treatment for drug addiction—before he was jailed. Unfortunately, Stojcevski's case is not unique. Despite the fact that opioid addiction is considered to be a medical condition, jail officials too often withhold methadone from addicts in recovery, and the consequences can be tragic.

For decades, methadone has been widely used to treat opioid dependence. It is safe and effective, slashing the rates of disease, death, and criminal behavior among addicts more than any other treatment. But methadone is itself a narcotic, and a persistent misunderstanding of how it works by those outside the medical community ensures that it remains a controversial treatment option.

"The scientific community's conclusion that opioid dependence is a medical disorder best treated with [methadone maintenance treatment] should quell the moral argument about methadone," Rebecca Boucher wrote in a 2003 Vermont Law Review paper. "Opioid dependence and its drastic impact on communities are safely and effectively addressed with methadone maintenance treatment."

Only about a quarter of jail administrators report that their institutions treat withdrawal.

And yet, as Maia Szalavitz pointed out in May, in most jurisdictions across the United States, jails don't allow inmates to continue their methadone intake. Reliable statistics on drug addictions in prison are hard to come by, but as many as four percent of arrestees enter jails and prisons addicted to opiates, according to a 2004 study in the American Journal of Public Health; still, only about a quarter of jail administrators report that their institutions treat withdrawal. Stojcevski's death is the perfect example of why that's a mistake.

The sheer physical discomfort associated with methadone withdrawal should be enough to convince jail officials to allow maintenance treatments. In a 2001 investigation for the Portland Phoenix about the lack of methadone treatment in jails, a 34-year-old addict described her experience as such: "I was dying. When you're on methadone for three years it stays in your bones. Being in jail without it just about kills you. I mean, the chills, the sweats, the cramps, the leg cramps, the muscle aches ... I'd rather come off heroin than methadone any day."

Similarly, a 2009 article in the Journal of Psychoactive Drugs surveyed 53 opioid dependent adults about their withdrawal experiences while incarcerated. "The discomfort of heroin withdrawal was often contrasted with methadone withdrawal, which was consistently considered to be far worse," the authors found.

"The first time I went in [to prison] and kicked cold turkey I had a heart attack," one participant shared with the study authors.

Many of the 2009 survey participants communicated that they felt that the trying physical symptoms of withdrawal—extreme cramps, diarrhea, nausea, vomiting—were considered by many jail officials to be just another form of punishment. But the institutional assumptions that painfully withdrawing from drugs in prison might deter individuals from using drugs is simply false; the study found that "rather than avoiding heroin and other drugs while out in the community, many addicts simply resolve to try to avoid or minimize withdrawal during future incarceration episodes," the authors wrote.

But it's not just the inmates actually experiencing withdrawal who have to deal with the consequences. The authors of the paper note:

The vomiting and diarrhea of withdrawal heightens the likelihood of spreading viruses among other inmates as well as correctional staff. The milieu is negatively affected by the sickness and misery, as well as by the subversive drug-seeking behaviors of the inmates, and the institution experiences a drain on its human and financial resources while attempting to deal with the situation.

Beyond that, when individuals on methadone are forced to suddenly stop treatment, relapse is likely. A 1991 study (referenced by Boucher in her paper) found that over 80 percent of people with opioid addictions who stop methadone maintenance treatment return to using intravenous drugs again within a year. The likelihood of relapse is particularly troubling given that patients who go through a forced detoxification lose their built up opioid tolerance; what was once a typical dose of their drug of choice becomes fatal.

The National Institute on Drug Abuse estimates that roughly 200,000 heroin addicts pass through the criminal justice system each year, and few of them receive treatment while there. Resistance to allowing methadone in jails and prisons is at least partly due to the skewed perceptions officials have of the treatments's effectiveness, according to some researchers.

"People working in the criminal justice system sometimes encounter individuals on methadone or buprenorphine who have been reincarcerated, and some may see this as a failure of the medication rather than viewing relapse as a symptom of a chronic disease," Josiah Rich, a professor of medicine and epidemiology at Brown University, told NIDA researchers. "They may not see the many individuals who are stable on these medications and leading productive lives outside of prison."

Stojcevski's family has filed a wrongful death suit against Macomb County. CBS Detroit reports that the suit claims: "All of the named defendants herein were so deliberately indifferent to David's mental health and medical needs that the defendants, named and unnamed in this litigation, monitored, watched and observed David spend the final 10 days of his life suffering excruciating benzodiazepine withdrawal symptoms." According to the family's attorney, Robert Ihrie, jail officials have access to a central registry that tracks the medications inmates are prescribed, but thus far there has been little explanation as to why Stojcevski was denied treatment. It remains to be seen if this case will result in the change necessary to get incarcerated addicts the treatment they need.