Responding to evidence that offering Medication Assisted Treatment (MAT) to prison inmates with substance use disorder significantly reduces the risk of overdose death—either while in prison or after release—California began a program in 2020 using buprenorphine, methadone, and naltrexone to treat inmates addicted to opioids, as an alternative to forced abstinence. Yesterday, the Associated Press reported that the rate of overdose deaths among inmates dropped 58 percent and hospitalizations for overdose dropped 48 percent during the 2 years since the program’s inception, according to state corrections officials.

California had an alarming overdose death rate of 51 per 100,000 inmates in 2019 and had been climbing since 2012. That rate dropped to a preliminary estimate of 20 per 100,000 in 2021 and is estimated at 21 per 100,000 in 2022. (California corrections officials estimate 65 percent of inmates have substance use disorder.) Such results were not seen in other state prison systems that did not offer MAT.

Researchers at Harvard published a study in the Journal of the American Medical Association in early 2020 comparing the effectiveness of MAT using methadone or buprenorphine, MAT with naltrexone, inpatient detoxification, non-intensive behavioral health services, intensive behavioral health services, and no treatment. They found MAT using methadone or buprenorphine was the only approach “associated with reductions in overdose and serious opioid-related acute care use compared with other treatments.”

Many opponents of MAT believe it amounts to replacing one addiction with another. Former Trump Administration Secretary of Health and Human Services Tom Price famously said, “If we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much.” Yet a substantial body of research refutes that claim.

While California’s experience with MAT in its prison system adds to the evidence supporting this treatment approach for opioid addiction, it is important that we not overlook an even greater point: prison inmates are overdosing from illicit opioids that they obtain while in prison. Drug war proponents argue that we need to toughen up border security to prevent illicit fentanyl from entering our country. If we can’t keep it out of prisons, why should anyone expect doubling down on border surveillance and interdiction efforts will somehow work?