New Insights on What Makes People Stop Using Drugs: Bringing Methadone and Buprenorphine Into Correctional Settings

    • July 23, 2009

Mark Parrino, MPA
Founder and President
American Association for the Treatment of Opioid Dependence
New York, N.Y.

The problem: More than 1.5 million Americans were arrested on drug charges in 1998. Many of these were intravenous users of heroin or other opiates (opioids). Methadone maintenance treatment is not available to most inmates and the lack of medical therapy helps perpetuate a drug subculture in American correctional settings, as well as a cycle of violent crime and recidivism.

Programee background: Mark Parrino, MPA, is founder and President of the American Association for the Treatment of Opioid Dependence (AATOD). The association works to enhance the quality of patient care in treatment programs by promoting the growth and development of comprehensive methadone treatment services throughout the United States. For 15 years before founding AATOD in 1984, Parrino administered a methadone maintenance program in New York City.

The award: In 2003, Parrino received an Innovators Combating Substance Abuse award and got a chance to advance change. The Robert Wood Johnson Foundation (RWJF) created the Innovators program to nurture and promote innovation in combating substance abuse. Between 2000 and 2003, some 20 senior researchers, practitioners and policy-makers received Innovators awards. See Program Results Report for more information on the program.

Parrino used his Innovators award to replicate a model program at Riker's Island (New York City's jail). Heroin-addicted inmates in the program receive methadone and other FDA-approved pharmacotherapies while incarcerated and referrals to continued treatment upon release from jail.

"Programs like the one at Riker's significantly reduce recidivism," Parrino said. "In addition, in some correctional systems, up to 55 percent of the population are IV drug users and more than half are positive for HIV or hepatitis C. Denying treatment is not just inhumane, but poor public policy."

A tough sell. Parrino's goal of persuading correctional systems to offer methadone and other treatments (buprenorphine) to recovering addicts was much tougher to achieve than he expected.

Parrino and his colleagues met with federal and state corrections officials, encouraging them to start methadone and other therapy programs for heroin-addicted inmates and to establish systems to refer those inmates to treatment upon release.

Parrino urged U.S. Department of Justice officials to write and publish statements supporting the use of medications (methadone and buprenorphine) to treat inmates addicted to opiates, but the officials declined to take any action. Parrino met similar resistance at the state and local level.