\n
![](\"https:\/\/progressive.org\/downloads\/21734\/download\/CruzSuboxoneIllo2.jpeg?cb=b5715e76ca206eeed9023fc10358c395\")
<\/p>\n
\n<\/p>\n
Suboxone is best known for its use treating opioid dependence. Designed to reduce cravings and prevent overdose deaths, Suboxone\u2019s tiny, orange strips ease the very difficult process of quitting opioids. But the substance has gained popularity for another use: It has become the drug of choice in Ohio prisons.<\/p>\n
Composed of buprenorphine and naloxone\u2014a synthetic opioid and an opioid blocker, respectively\u2014Suboxone has been, like many everyday objects, transformed in prison. Outside prison, it is administered as dissolvable strips or films and sublingual pills or tablets. When the strip is dissolved in a water-filled spoon and snorted, the solution produces a stronger psychoactive effect than the strips do. Suboxone\u2019s compact, tiny strips make it easy to conceal and therefore smuggle into prison, and its usage in prisons has become<\/a> a very lucrative business for incarcerated drug dealers and correctional staff.\u00a0<\/p>\n With the help of a razor, a single strip can be sliced into thirty-two individual pieces\u2014even more if the strip is \u201cstretched\u201d by dealers rolling a double-A battery across them. Each sells for $8, a significant amount when most of Ohio\u2019s incarcerated population makes $22 a month<\/a>.\u00a0\u00a0<\/p>\n I have observed the proliferation of Suboxone in prison over the past decade. It has looked like<\/p>\n staff members smuggling Suboxone to prisoners, gangs battling for control of the trade, and incarcerated users falling into debt and resorting to stealing or sexual favors to stave off physical assaults by dealers. In the midst of my own addiction ten years ago, I leveraged my youth, long hair, and slender frame to borrow money from older gay men. I spent my days connecting with dealers and other unscrupulous characters before returning to my shared dorm, where a friend watched for guards while my strip dissolved in a spoon I kept in my locker.\u00a0<\/p>\n To curb the issue, many prison administrators have turned to increased security and harsher supervision. Here in Ohio, prison officials\u2019 concern that Suboxone was arriving through the mail has meant that, since 2021, we\u2019ve no longer<\/a> received original copies of our mail.<\/p>\n As of February, we don\u2019t even get a physical photocopy of our mail\u2014just a scan on a tablet. We\u2019re thoroughly strip-searched at the end of heavily monitored family visits. Correctional officers perform several \u201cyard sweeps\u201d each day, combing through the grass to make sure nobody from outside of the prison throws drugs over the razor wire fence.\u00a0<\/p>\n Yet, these and similar tactics have failed to significantly reduce the quantity of illicit drugs that continue to flood our prisons. From Washington to Pennsylvania and New Mexico to Virginia, the Prison Policy Initiative offers several examples of the failure<\/a> of mail scanning and visitation restrictions to meaningfully reduce drug use or overdoses in prisons, instead increasing punishment.<\/p>\n So what is the solution? At first it may sound counterintuitive, but considering that it\u2019s the illicit use and trade of Suboxone that\u2019s dangerous, and not the substance itself, prisons should directly administer medications to people experiencing opioid dependency like Suboxone in the form of medication assisted treatment (MAT).<\/p>\n While some of the people in my prison addicted to Suboxone were addicted to opioids before they were locked up, many of them were not. Thanks to a combination of depressing conditions, peer pressure, and easy access to Suboxone, people are becoming drug addicts in prison. When they\u2019re released, the dependencies they\u2019ve developed lead them to more dangerous street drugs like heroin and fentanyl.<\/p>\n If Suboxone was directly available to prisoners, drug dealers and gang members would lose a good portion of their trade and the income, prestige, and influence over the prison\u2019s culture that comes with it. Instead of running around the prison yard forming criminal connections, violating institutional rules, and becoming further ingrained into drug-seeking habits, incarcerated people could report directly to their institution\u2019s medical facility for treatment. Rather than snort strips, patients would either place them directly under their tongue or drink the medication in its liquid form under strict supervision by medical professionals and security staff.<\/p>\n The National Institute of Health holds that the medication assisted treatment approach is the \u201cgold standard<\/a>\u201d of treatment for opioid use disorder: It reduces cravings, overdose deaths, and drug-related crimes while increasing the success rate of counseling and other therapeutic interventions with which it\u2019s paired. A 2018 Yale study found<\/a> that people who received methadone, another medication used to treat opioid addiction, while incarcerated were three times less likely to be cited for violating institutional rules while incarcerated. They were also more than thirty times more likely to voluntarily visit a MAT program after their release from prison, continuing their treatment. Similar findings have been endorsed by the Substance Abuse and Mental Health Administration<\/a>, the National Academy of Sciences, Engineering, and Medicine<\/a>, and other research institutions<\/a>.<\/p>\n The Food and Drug Administration has approved three medications<\/a> to treat opioid use disorder: methadone, buprenorphine, and naltrexone. In 2016, Rhode Island became the first state<\/a> to offer all three FDA-approved medications, along with counseling, to all incarcerated people with opioid addictions across its correctional system. The first year of the program saw<\/a> a 12 percent drop in overdose deaths in prisons across the state and a 61 percent drop in overdose deaths after incarceration. Kentucky estimated that in 2017, for every $1 spent on its corrections-based MAT approach, the state saw a more than $4 return on investment<\/a>.<\/p>\n Yet, a 2023 review of MAT in U.S. jails and prisons found<\/a> that just 1 percent of the Federal Bureau of Prisons population received MAT in 2021. Because there\u2019s no national tracking system of MAT programs, it\u2019s difficult to decipher the extent to which these programs are offered in U.S. jails and prisons. The same review did, however, find that five states appear to offer MAT in correctional institutions while fifteen states offer it at either intake or release \u201cin a considerable number of its jails and prisons.\u201d Others offer restricted versions of MAT, but only under extenuating circumstances like pregnancy.<\/p>\n Ohio\u2019s Department of Rehabilitation and Corrections has been slowly piloting and rolling out<\/a> its own MAT program. London Correctional Institution, where I\u2019m incarcerated, began offering oral naltrexone<\/a> a few years ago and recently began offering buprenorphine.\u00a0<\/p>\n The current treatment still isn\u2019t enough. My friend Ryan (whose real name I am withholding for his safety and privacy) is on naltrexone and, as a result, has stopped using the illicit drugs available in the yard. He\u2019s been gaining weight back and attends twelve-step meetings and cognitive behavioral therapy sessions. He is, however, unfortunately unique. I asked him why others in prison haven\u2019t taken advantage of naltrexone like he has. \u201cSome people have,\u201d he replied. \u201cBut most of them can\u2019t do it because you have to detox from opioids first, and it\u2019s hard to do that in here\u2014you can\u2019t go to a private place away from the supply.\u201d<\/p>\n I asked him what happens if you don\u2019t detox first. Because naltrexone is an opioid blocker, it works differently<\/a> than synthetic opioids like buprenorphine and methadone, which activate opioid receptors to suppress cravings. Instead, naltrexone blocks those receptors. If naltrexone users don\u2019t detox for the recommended seven to ten days beforehand, Ryan says, \u201cthe naltrexone causes you to have very intense withdrawals. Most people give up halfway through.\u201d<\/p>\n This is the problem: Painful withdrawals are what keep people from quitting opioids in the first place. I suspect that the system prefers naltrexone because it\u2019s an opioid antagonist and thus more palatable to people with the kind of ideological biases that keep MAT from being implemented in most of our nation\u2019s prisons despite the evidence of its effectiveness.<\/p>\n Many people, including some substance abuse professionals, incorrectly believe that MAT patients are \u201cstill getting high<\/a>.\u201d But according to the federal government\u2019s Substance Abuse and Mental Health Administration, MAT does not produce the euphoric effects<\/a> typically associated with opioids. I can personally attest to this with Suboxone. When I used the strips as they were designed to be used by placing them under my tongue, I didn\u2019t experience even a mild high. Even when I snorted Suboxone, I never got that full-on opioid euphoria.<\/p>\n Others claim that MAT is a crutch for people who don’t want to do the hard work to overcome their substance use disorder. This claim is a value judgment, not an objective fact. That\u2019s akin to saying that diabetics use insulin as a crutch to reduce the amount of effort needed to maintain a good diet and exercise regimen. This claim also contains a logical fallacy. Just as insulin and exercise are not mutually exclusive, neither are MAT and drug counseling. In fact, the two are more effective together<\/a> than either are alone.<\/p>\n Skepticism about MAT is simply untenable in light of the massive amount of supporting evidence available. Yet, it persists.\u00a0<\/p>\n I once worked as an assistant for a licensed chemical dependency counselor here at London who lampooned COVID-19 vaccine skeptics while hypocritically denying the efficacy of MAT. I pointed out that almost all of the same state and federal agencies, medical associations, and research institutions that endorsed the COVID-19 vaccine also endorsed MAT; that most of the opposition stems from ideological bias and stigma rather than any real counterevidence. She replied, \u201cWell, this is a piece of ideological bias that I\u2019m going to keep.\u201d<\/p>\n