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Old 07-23-2005, 04:39 AM
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Default Article: Trying to break the cycle of heroin addiction, prison

Trying to break the cycle of heroin addiction, prison

Inmates: As part of a study, 60 will receive methadone leading up to release.

By Alec MacGillis
Sun Staff

July 23, 2005

Over and over again, Dennis Wise re-enacted the destructive routine that Baltimore knows all too well. He sold drugs and shoplifted to support his 10-year heroin habit; he went to jail or prison after getting caught; he went without drugs while inside - and then went right back on them as soon as he got out.

But then, while he was serving a 12-month prison term two years ago, something different happened. He was offered the chance to go on methadone, the syruplike heroin replacement medication, five months before his release. When he got out of prison last year, he stayed on methadone. He's now proud to be holding down a job and caring for his family in Northeast Baltimore.

"I had a start this time. I had a clear mind," said Wise, 41, during a recent visit to the Man Alive clinic on Maryland Avenue, where he goes three times a week for methadone and counseling. "It got me on a different track."

Wise benefited from an approach being tried in Baltimore to break the cycle of arrest, release and relapse that has stymied the city's and state's best efforts to reduce crime and fight drugs. As part of a five-year federally funded study, a total of about 60 inmates at the Metropolitan Transition Center, the state prison on Forrest Street, will be given methadone in the months leading up to release.

Researchers from the Friends Research Institute, a Baltimore organization that administers health-related studies, are trying to determine whether these inmates will be more likely to seek methadone and counseling after their release, and to get jobs and stay out of trouble, than other inmates with heroin problems.

The researchers are following up with the inmates up to a year after their release, and they expect to have results by 2008. At that point, the state may decide to expand methadone distribution to all its prisons, depending on the study's findings.

Unique approach

The $500,000 study represents a sharp departure from the way most prisons have handled drug treatment for the many inmates who come into prison with histories of drug use and drug-related crime. While methadone has long been a fixture of heroin treatment, it is rarely used behind bars. Some jails use it to help detoxify incoming inmates, and the Rikers Island jail in New York offers it on a longer-term basis to addicts at the jail.

But there are no reports of methadone's use at prisons, where inmates serve longer sentences than they do at jails, and where treatment is typically limited to group counseling sessions. Most corrections officials have reasoned that prison inmates, who are typically in for at least a year, will by necessity break their addiction while inside because even the drugs that do manage to get inside prison are often not adequate to sustain a serious habit.

The state corrections department, which supports the study, acknowledged that the approach could strike some as odd: Why give inmates who have spent months or years without heroin a daily opiate dose, even in the well-regulated form of methadone maintenance?

"These are theoretically people incarcerated long enough that it's not just a question of [using methadone for] going through detoxification or withdrawal," said Richard B. Rosenblatt, assistant secretary for treatment. "Theoretically, we're starting them up again."

The researchers in charge of the study point out, however, that some inmates manage to get drugs while in prison. More important, even those who go without inside tend to go back on drugs when they get out, increasing their chances of infection with HIV or hepatitis C through shared needles.

Relapse after release is so common because abstinence brought on by a lack of supply often isn't enough to break an addiction, said Dr. Robert Schwartz, a Baltimore psychiatrist specializing in substance abuse and one of the lead investigators on the study.

"When they're sitting in jail, they may be going cold turkey, but all they're thinking about is getting out and using," he said. Offering methadone before release "potentially is an opportunity to make a huge difference."

Wise, the recovering addict, puts it another way: "When you're locked away, you didn't stop because you wanted to. You stopped because you have to; it's taken away from you," he said. "Very few stay clean when they get back out. They may stay clean for a minute, but that's it. Their mind is still the same. It's a disease. It's a big disease."

The numbers back up claims that the current approach hasn't been working. A survey by the Center for Substance Abuse Research at the University of Maryland found that more than a third of men arrested in Baltimore, and nearly half of women arrested, have used heroin in the month before their arrest, among the highest rates in the country. Other studies have found that a majority of addicted inmates relapse onto heroin within a month of their release.

The magnitude of Baltimore's drug problem helped the researchers make the case to the state for trying methadone in the prison. The researchers and Man Alive administrators overseeing the study say corrections officials have been highly supportive of the project - an attitude the researchers trace to Gov. Robert L. Ehrlich Jr. and Public Safety Secretary Mary Ann Saar, both of whom have spoken in favor of drug treatment in prison.

Use at jail

Rosenblatt, the corrections administrator, said the state would consider using methadone for pre-release inmates at its other prisons if the study shows the approach to be effective. He said the state is moving to expand the use of methadone at the Baltimore jail, where the medication had until recently been given only to heroin-addicted pregnant women.

Under the correction system's contract with a new medical provider, inmates will be examined by doctors within their first day in jail and prescribed methadone if they are on the medication or if they need it for detoxification. Before, checkups didn't happen until inmates' fifth day inside, by which time they'd either been released or been through withdrawal.

The state will also consider keeping addicted inmates on methadone for the duration of their stay in jail, as is offered at Rikers Island, Rosenblatt said. Also an option, he said, is offering jail inmates buprenorphine. It's an opiate substitute that is more expensive than methadone but tends to be less habit-forming.

Lack of clinic slots

The biggest limitation on all the possible initiatives, Rosenblatt said, is the shortage of treatment slots at the state's 40 methadone clinics. If the state wants to expand methadone treatment behind bars, he said, there will have to be an equivalent expansion of capacity outside, so that recovering addicts can continue the regimens they started inside.

Those leading the study at the Friends Institute and Man Alive argue that a strong case could be made for such an expansion, inside and outside prison. The cost of a year of methadone treatment, about $3,000, is far less than the $23,000 it costs to imprison someone who has relapsed into drug use and crime, they say. And it makes sense, they argue, to attack the city's drug problem in prison because that is where the addicted population is most concentrated.

"If you have a lot of people with a disease who all go to the same market, it sure as heck makes sense to set up a table at that market with information," said Man Alive medical director Dr. Terry Fitzgerald. "It's a no-brainer. It's fundamental public health thinking: You go where the people are."

A similar case has been made for the only other known experiment in opiate replacement in prison, in New Mexico. That state is about to start giving buprenorphine on a pre-release basis to addicted women in prison, a population with a 75 percent recidivism rate.

"The public may say, 'Well, let 'em rot,'" said Dr. Barbara J. McGuire, an Albuquerque physician helping to start the program. "But this is what happens: These folks go back into the community ... and it's just terribly expensive."

The Baltimore study's directors won't say what kind of results they're seeing for the inmates who have been released and completed their year of follow-up interviews. In addition to the roughly 60 who will receive methadone in prison, there is a group of 60 inmates who will receive counseling in prison and will be given a slot at Man Alive upon release, and a third group of 60 who will receive only counseling.

But Man Alive staff say Wise, for one, has been a success story. He has worked at a Wendy's for 10 months, the longest he has held a job in years, and is being promoted to a crew chief, he said. He is on schedule to taper off methadone by early next year, and he says he hopes to save enough money to move his wife and four children to Columbia, where he grew up.

"I got four kids, and they're watching me," he said. "I can't let them down."

Copyright (c) 2005, The Baltimore Sun | Get Sun home delivery

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