This month in the prestigious New England Journal of Medicine, Dr. Justin Berk wrote about his experiences treating patients in the Projects Connections at Reentry (PCARE) van, which is parked (illegally, Dr. Berk notes) outside of the Baltimore City Jail every day. OSI provides support for the Behavioral Health Leadership Institute to run the project, which offers treatment for people with substance use disorders as they leave the jail.
“This team was prepared to — quite literally — meet patients with addiction where they were,” Dr. Berk writes. “One third of people with opioid use disorder (OUD) have been involved with the criminal justice system in the previous year. But despite robust evidence showing the effectiveness of addiction treatment in correctional facilities, people with OUD who are incarcerated rarely receive medication. Reentry into the community can be a dangerous time: people recently released from prison are 129 times more likely than the general population to die of an overdose.1 To help save lives, our van goes to them.”
Dr. Berk says his role was primarily to prescribe buprenorphine to people with opioid use disorder, which, as he notes, “significantly reduces the risk of overdose.2” OSI led efforts to increase the use of buprenorphine to treat addiction in Baltimore, as described in our 2016 report, “Using Buprenorphine to Treat Opioid Addiction.”
While Dr. Berk applauds the work of the van he notes that there are much more efficient models to treat this population.
“Although this model has been successful, the need to prescribe buprenorphine from a van is a tragedy,” he writes. “Our society criminalizes the disease of addiction and stigmatizes patients. We often force people, many of whom are stable on maintenance medication, to experience painful and dangerous opiate withdrawal by failing to offer such medication when they’re incarcerated. Pharmacologic treatment costs money, but untreated addiction accounts for a substantial amount of recidivism, mortality, and societal cost. Denying treatment is not only ethically questionable but also financially shortsighted.
“Despite court rulings supporting a constitutional right to medication for OUD in jails and prisons, few facilities offer these lifesaving treatments. In 2016, Rhode Island became the first state to offer comprehensive medication for addiction treatment in jails and prisons: anyone with OUD can be started on medication and will have a follow-up appointment on release. The program has demonstrated a reduction of more than 60% in overdose mortality after incarceration.5 For every 11 people whose treatment was initiated during incarceration, one life was saved.”