Smuggling Suboxone

I was intrigued by an article I saw on my internet homepage. It was titled: “When Children’s Scribbles Hide a Prison Drug”

http://www.nytimes.com/2011/05/27/us/27smuggle.html?_r=1&hpw

 This article describes unique ways Suboxone is being smuggled into jails. Law enforcement officials associated with both state and county jails from Maine and Massachusetts were interviewed. They say prisoners and their accomplices make Suboxone into a paste and smear it over the surfaces of papers sent to prisoners from their families. The article mentions the paste being spread over children’s coloring book pages, and under stamps. Suboxone films have been placed behind stamps or in envelope seams. Correctional officers now have to inspect material coming in the mail to prisoners much more closely.

 I had several thoughts. First, yet again, I’m struck by the creativity and cleverness of addicts. If only they could channel this energy in the right direction, amazingly good things could come to them, instead of the continued hardships brought by addiction.

 Then I felt sad that such actions described in the article would taint the reputation of a medication that has the potential to save lives, when used appropriately. Such illicit use of Suboxone gives ammunition to those who would prefer that office-based treatment with Suboxone didn’t exist.

 Then I wondered, how many of these prisoners have a legitimate prescription for Suboxone, but are denied their medication by prison officials? How many are legitimate patients of methadone clinics, also denied their medication while imprisoned, who know that Suboxone will alleviate some of the opioid withdrawal they are feeling? How many of these people are addicted to opioids, not in any kind of treatment, but who know Suboxone will treat their withdrawals?

At least one study supports the idea that many people use Suboxone illicitly not to get high, but to prevent withdrawal. Dr. Schuman-Olivier studied 78 opioid addicts entering treatment. Nearly half said they had used Suboxone illicitly prior to entering treatment. Of these people, 90% said they used to prevent withdrawal symptoms. These addicts also said they used Suboxone illicitly to treat pain and to ease depression.

Many law enforcement personnel and members of the legal community have strong biases against medication-assisted treatments. They don’t understand that addiction is a disease, and that methadone and buprenorphine are legitimate, evidence-based treatments. They have difficulty letting go of their idea that addiction is a choice that deserves blame, and have a punitive stance towards addicts. They have low opinions of addicts who are using drugs, but often have no better opinion of a recovering addict who has sought treatment and is doing well on replacement medications, like methadone or buprenorphine.

 But no matter what law enforcement personnel think they know, when they deny prescribed, life-saving medications, I believe they’re practicing medicine without a license.

The article mentions one woman who, with the aid of the Maine Civil Liberties Union, sued because her Suboxone treatment had not been continued while she was in jailed for a traffic violation. She settled out of court, but her lawyer made the excellent point that if inmates are denied their medications, they will try unlawful means to get it.

Other patients and their families have brought successful lawsuits against the jail facilities. In at least two cases, in the same Orange County, Florida jail, patient/prisoners were allowed to go through withdrawal for so long that they died. The estate of one person won a three million dollar judgment against the county. (1, 2)

I’m glad to see these lawsuits. I’ve heard appalling stories from many methadone patients, who were denied their medication while incarcerated. I’ve heard tales of jailers taunting these prisoners, when they became sick. There is no defense for such cruelty.

Orange County now works with local methadone clinics. If a prisoner is a current patient of a clinic, his clinic will send a week’s worth of medication in a locked box via courier. Nurses at the jail have the key to the box, and administer each day’s dose. The jail doctor consults with the medical director at the methadone clinic. Prisoners still have to pay out of pocket to get the medication, so the only cost to the jail is the time required for personnel to administer the medication. It’s certainly much cheaper than paying three million to the estate of a dead prisoner, not to mention much more humane.

I wish the county jails around the methadone clinic where I work would approach the problem of opioid addiction and treatment in a collaborative way. Sadly, only seven state prison systems offer medication-assisted treatment with methadone or buprenorphine.

Rikers Island, in New York City, gives us another example of how such a system could work. There, opioid-addicted prisoners charged with misdemeanors or low grade felonies can be enrolled in a program known as KEEP (Key Extended Entry Program). This program treats opioid addicts with methadone and counseling. Upon release from Rikers Island, these patients are referred to methadone treatment centers in the community. Seventy-six percent have followed through with their treatment, post-release. The results of this program show significant reduction in reincarceration and significant reduction in criminal activity. (3)

Drug courts trying to save money would be well-advised to look at the Rikers Island program. Studies have shown a cost savings of at least four dollars for every one dollar spent on methadone treatment. This money is saved because methadone patients require fewer days of hospitalization and other healthcare costs, and also because of reduction in criminal activity and incarceration costs. (3, 4)

I know from comments written to this blog that there are many more people abusing Suboxone than I previously imagined. For sure, some of the prisoners getting smuggled Suboxone are misusing it. But I don’t think the majority are using for anything other than prevention of withdrawal, since they are usually not offered any other effective treatment for this medical condition.

  1. “Outrageous: the death of Susan Bennett raises serious questions about the competence and quality of the jail’s nursing staff” Orlando Sentinel, editorial, March 27, 1998.
  2. Doris Bloodsworth, “Inmate begged for methadone” Orlando Sentinel July 12, 2001.
  3. Par`rino, Mark, “Methadone Treatment in Jail,” American Jails, Vol: 14, 2000, issue 2, pp 9-12.
  4. California Department of Drug and Alcohol Programs, 2004, California drug and alcohol treatment assessment (CALDATA) California Department of Alcohol and Drug Programs. California Drug and Alcohol Treatment Assessment (CALDATA), 1991-1993 [Computer File]. ICPSR02295-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-10-07. doi:10.3886/ICPSR02295

 

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6 responses to this post.

  1. Posted by John Q on March 11, 2012 at 4:51 am

    I definitely agree with your assumption that the vast majority of people who use suboxone illicitly only do so to prevent withdraws. It is the least preferred among opiate addicts I know that snort of IV their drugs. I know lots of addicts who will keep suboxone films on hand for months at a time until their drug of choice supply ruins out . Only when their are sick do they use suboxone. The ability for an addict to keep a drug around for that period of time tells you of its abuse potential! Obviously people who are not opiate tolerant can get extreme effects by taking suboxone but the naloxone in suboxone definitely keeps the majority of opiate addicts I have come across from injecting or snorting it.

    Reply

  2. Posted by Jezmund on July 6, 2013 at 5:36 am

    Perhaps there are indeed a few isolated cases of inmates taking the smuggled suboxone to get high… But it would defy all logic… The potential high caused by suboxone is practically nonexistent in those who are already addicted to opiates, and even in the opiate naive, the high is extremely mild as bupernorphine is only a partial agonist… So if you were a non-addicted inmate, and someone on the outside was willing to smuggle you in a narcotic so you could get high… why on earth ask for suboxone?? Why not oxycodone? hydrocodone? morphine? heroin??? or ANY other full agonist that actually does you get high… The drugs mentioned are typically more widely available than suboxone and in some areas, cheaper as well. Why take the risk for suboxone when you can take the same risk for some oxy’s- they’ll probably have a much higher resale value in jail than the suboxone… I’m not saying it doesn’t happen, but it’s highly unlikely to be smuggled in for recreational use.

    So this would stand to reason that the vast, vast, vast majority of suboxone being smuggled into jail is for opiate addicts who are trying to avoid the horrific, degrading, excruciating hell known as opiate withdrawal… And I can tell you from firsthand knowledge that the jails in my county (Maricopa County, AZ- ran by the notorious Sheriff Joe Arpaio) do not provide medical aid to addicts in withdrawal in any way, shape or form… Many of these addicts entering jail have not even been convicted of a crime yet… And there have been a few cases where people never make it out alive to see that conviction (or acquittal though we’ll never know because they’re DEAD)… But I suppose in the minds of punitive minded individuals, these people got what they deserved, regardless of the severity of the crime or whether they were actually innocent or not.

    Reply

  3. Posted by bob on May 10, 2014 at 1:43 am

    Hello, i was recently convicted of an addiction related crime that happened over a year ago, since the indecent I’ve cleaned up my act, have been taking suboxone for over 12 months, 8mg, 3 times a day and now have to go to jail were I’m going to be denied my medication by jail officials/laws, I’ve been in jail before and i kno they do next to nothing for withdrawing opioid patients? From what i hear, it could take months for that type of dosage to get out of my system? Now being a former i/v heroin user of about 7 years, I’ve done a#on my body and feel my health isn’t exactly top notch, i am legitimately concerned about this withdrawal! Should there be sum kind of law protecting us patients? Aren’t these dangerous withdrawal symptoms? Thanks in advance for your response in this matter!

    Reply

    • Ask your lawyer and your doctor to get involved. Sadly, in my area, patients are denied their medication while incarcerated. It does not seem to be right or legal to me, so you need a lawyer to help you.

      Reply

  4. Posted by Danny on August 2, 2015 at 10:35 am

    Like I told a person on the other side of the fence that if I were God I would inflict the HELLISH withdrawals on these subhuman people for just one minute and then they might look at us addicts in a different way.ie the law makers, the jailers and the doctors and nurses that say(opiate withdrawals will not kill you) If you are an alcoholic they have a medication protocoll,Go figure? The only time I contemplated suicide I was in jail coming off methadone and did not eat or sleep for 21 long days and even longer nights, We all know of people who have done a swan dive off the balcony and mirad of other wild tactics just to stop the PAIN! I don’t go to jail anymore and am doing well on Suboxone treatment.

    Reply

  5. My son just went to jail an they r refusing him his neurottin witch he’s been on fo some time if he dont have it it could cause him some sever side affects i called an told them that I’ve had to rush him to the hospital wen he dident hav it they said it was up to the jail doc to make the decision to give it to him. Well needless ta say they haven’t helped him pluse he is addicted to herione he seem to b ok with the withdraw from that but he really needs his nurottin please can anyone help me with som suggestion???

    Reply

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