The opioid crisis in the United States began in the mid-90s. Many things contributed to its growth, including Purdue Pharma’s release of the first FDA approved controlled-release opioid, OxyContin. Until that point, opioid pain medications were generally reserved for patients suffering from extreme pain, such as that caused by cancer. OxyContin’s release changed this. Purdue Pharma, controlled by the Sackler family, marketed OxyContin as a nonaddictive opioid, claiming that the slow-release mechanism in the drug removed its addictive qualities (Keefe, 2021). These marketing efforts led to dramatic increases in prescribing rates of what were, in reality, highly addictive opioids. In 2017, the U.S. Department of Health and Human Services declared, for the first time, that the opioid crisis was public health emergency, a declaration which was renewed in June 2024 (HHS). Over the more than two decades that this crisis has gone on, understanding of opioid use disorder (OUD) and addiction, and how to treat it has evolved. Specifically, there has been a slow but steady shift towards the understanding that medication can play an important, and often necessary, role in OUD treatment.
The purpose of these website pages is to show how the opioid crisis and treatment of OUD is evolving in the context of the United States prison industrial complex, with a focus on the provision of medications for opioid use disorder (MOUDs). I seek to explore what the current state of the crisis looks like for incarcerated populations, why it is this way, and to propose a path forward that is rooted in an abolitionist approach to OUD treatment.
I root my analysis in the abolitionist framework proposed in Abolition. Feminism. Now. This theory argues for the eventual rejection of prisons as an acceptable place to house and treat those with substance use disorders. It defines abolition as a complete dismantling of the prison industrial complex. While I accept and agree with this definition, for the purpose of my argument I have chosen to redefine abolitionism in the in the context of OUD treatment in U.S. prisons.
I believe that to make an argument for the necessary short-term solutions to the crisis of addiction treatment in carceral spaces is to make an abolitionist argument because it is an argument that demands a transformation of the operating principles and attitudes present in prison. Prisons are, first and foremost, spaces of punishment. If someone is sent to prison it is because they have done something worth punishing. The implication, then, of sending people with substance abuse disorders to prison is that they are engaging in a behavior worth punishing. Their SUD is a moral failing rather than a disease needing treatment. This means that a carceral approach to substance use disorders is to punish, not to treat. I argue that this punishment often takes two forms: to deny or restrict available and necessary avenues for treatment within prison, and to do little, or nothing at all, in the release process for incarcerated individuals to ensure long-term recovery. Thus, in the short-term, an abolitionist approach to OUD treatment in carceral spaces means devoting any resources necessary to ensure complete access to MOUDs for those that need them, and implementing post-release policies that allow for continued use of MOUDs at the discretion of the formally incarcerated individual.
In seeking to understand the current state of MOUD availability for incarcerated populations, I rely on three forms of relevant qualitative information. The first is legislation that I believe is relevant to the prescribing and legality of MOUDs. The second is court cases relevant to the intersection of the carceral state and the availability of MOUDs. Finally, I rely on a set of seven interview questions emailed to each state’s State Opioid Treatment Authority. The legislation and court cases serve the similar purpose of showing where, in this country’s handling of the opioid crisis and OUD treatment, we see consistency and generally positive practices. It is difficult to separate legal and carceral systems, but for the sake of my analysis I treat the legal apparatuses responsible for settling the court cases as separate from the prison industrial complex. In these instances, it is serving to inhibit the problematic practices of carceral institutions. The inclusion of the interview responses shows where the consistency seen in federal and legal apparatuses breaks down: within the carceral system and across state lines. This disjuncture between states, and between federal and legal policies and the practices of carceral institutions are, I believe, revealing of many of the fundamental problems with OUD treatment for incarcerated individuals.
What I hope the information on the following pages reveals is that inadequate OUD treatment can take different forms. Some of these forms include: not having access to all three FDA-approved medications, being forced to take a specific medication, provision of medication without first undergoing an assessment of individual need and developing a personalized treatment plan, complete denial of medication access, lack of staffing, lack of financial resources to facilitate treatment that may otherwise be allowed, and generally inadequate post-release continuation of care and follow up protocols. Ensuring adequate treatment will require eliminating the deficiencies listed above through proactive state and federal action. It will also require efforts to combat stigma both inside and outside prison walls. Combating stigma in the community is an especially important step in creating non-carceral approaches to supporting recovery from an OUD. I believe that community-based approaches to addressing OUD will only replace carceral approaches when this stigma is addressed.