Unleashing treatment and hope for opioid addiction in American prisons

For two decades, the scale of the U.S. opioid crisis has overwhelmed our ability to provide treatment to people who need it. This is particularly true in the corrections system, where opioid use is one of the biggest challenges facing incarcerated people. At least one person in six in prison struggles with oxycodone, fentanyl, heroin or another opioid addiction. And because federal law limits how states can spend Medicaid funds in prisons, far too many of those incarcerated people can’t receive effective medical treatment for opioid abuse.

In 2023, the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs Medicaid, set out to change that. With Congress’s permission, it established a waiver program that allows states for the first time to provide health care to Medicaid eligible individuals in the critical window prior to release from incarceration. These services will include access to medications for opioid use disorder (MOUD) treatment. Getting people started in treatment before they’re released from prison means that when they go home, they’re already on a path to recovery. California, Montana and Washington have already received waivers from CMS that will enable them to offer MOUD treatment to more incarcerated people as they prepare for release, and 19 more states are ready to begin — if they get federal permission.

Patients in MOUD treatment take FDA-approved medications like methadone or buprenorphine to help them break their cravings for more dangerous drugs. MOUD treatment is now the standard of care in treating opioid dependence, because there’s extensive evidence that it works better. By reducing cravings and withdrawal symptoms, it helps people stay off drugs, helps them stay employed and housed during recovery, reduces overdose risk, and improves their general mental and physical health in a range of ways. And for people recently released from prison, studies show, MOUD treatment has particular benefits: It reduces the chance of relapsing into drug use or returning to prison, even under the stress and strain of reentry.

The Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) endorse the MOUD treatment approach for everyone, and the American Society of Addiction Medicine (ASAM) specifically endorses it for people in the corrections system — and has developed resources to help states roll out effective MOUD treatment to incarcerated people preparing for release.

Virtually all people who leave prison find themselves in precarious social and financial straits, and helping them achieve stability is a social imperative. Reducing opioid use among this vulnerable population benefits everyone in society. And, importantly, offering MOUD to incarcerated people preparing for release saves money for state Medicaid programs, too, which pay their health care costs after they go home. It makes sense that treating someone properly for addiction, using the best evidence-based treatment available, would keep them healthier, so they’re less likely to go to the hospital. Research proves it: “medication-assisted therapy,” concludes one study, “is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction.”

Making MOUD treatment more widely available to people who need it in the corrections system and the recovery ecosystem is a powerful way to improve health outcomes and equity among vulnerable Americans. And helping these people during the weeks before and after release are particularly critical: 5 percent of all deaths from illicit opioids across America occur among people released from jail or prison in the last month. That’s why the Medicaid waiver program focuses on the 90-day period before people are released from prison: So they can receive intensive medical support for their addiction that will prepare them for the difficult days ahead.

MOUD treatment for incarcerated people changes lives, keeps people healthy and employed, protects families, and saves our communities money, too. By approving the 19 pending waiver applications, CMS Administrator Chiquita Brooks-LaSure can help ensure that tens of thousands more Americans have access to safe, effective, evidence-based treatment for opioid addiction when they need it. California and Washington have been granted a transformative opportunity to help safeguard the public health. Now Arizona, Illinois, Kentucky, Massachusetts, Montana, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and West Virginia are ready to follow. All they need is a green light from CMS — and they should get it.

Paul Tonko represents New York’s 20th District. He serves on the Energy and Commerce Committee.