The Albuquerque Metropolitan detention center and the nearby Sandoval County detention center recently enacted new bans on crayon drawings, greeting cards and stamps in an effort to stem the tide of Suboxone, the brand name for the opiate substitute buprenorphine, being smuggled to inmates. The Albuquerque area jails may be the latest to enact such a ban, but it's doubtful they'll be the last to deal with a surge of Suboxone smuggling. The negative effects of Suboxone are certainly a trend that Indian country must monitor closely.
Correctional facilities across the country have seen a massive increase in Suboxone smuggling over the past couple of years. The orange pills are crushed into a paste then painted on colorful drawings, so inmates can lick or chew the paper. Stamps and envelope flaps are common hiding places for sublingual strips of buprenorphine. Pills are sewn into hems, cords, and book spines. Although Suboxone is an FDA-approved drug that is beneficial in moderate doses, it can produce a desired euphoria in higher doses, as well as other unpredictable effects.
How did Suboxone become such coveted contraband from Maine to California? The narcotic drug was approved in 2002 as a prescription alternative to methadone (which can only be dispensed in special clinics), and immediately gained street value for its effectiveness in managing withdrawal symptoms. But since 2002, heroin and prescription opiate addiction have skyrocketed across the nation, and the demand for— and availability of—Suboxone has risen accordingly.
Part of the demand for Suboxone among prisoners comes from individuals who were on a Suboxone treatment program before becoming incarcerated. Depending on the correctional institution, opiate-addicted inmates typically make up between 12 and 20 percent of the general population. Yet, only a handful of prisons nationwide offer buprenorphine therapy; more offer methadone therapy, but the total number of prisoners under medical treatment for opiate withdrawal in 2011 was probably only about two thousand people nationwide. Most prisons administered opioid replacement therapy only to pregnant women and individuals with chronic health problems. One reason for the low rate is that federal methadone licensure is a barrier for many correctional institutions.
The National Institute on Drug Abuse (NIDA) recommends opioid replacement therapy for inmates to reduce rates of heroin abuse, HIV transmission and re-incarceration. A recent NIDA study on attitudes toward Suboxone by prison personnel shows that the majority perceives it to be a drug of abuse rather than an effective medication. Attitudes and approaches may shift as the benefits of Suboxone treatment are more widely understood, but for now, the black market Suboxone economy is booming.
One estimate from the National Association of Drug Diversion Investigators (NADDI) is that half the buprenorphine prescribed ends up on the street. An 8 mg Suboxone pill may cost $10-$25 on the street, but will sell for $50-$75 in jail. Postage-stamp sized scraps of sublingual buprenorphine are worth $20 each.
The mentality that leads a person to smuggle drugs using a child's photograph is a problem in itself, but prisoners have other problems to worry about aside from dragging children into the mix. Drug diversion experts point out that using Suboxone without concurrent therapy only maintains an addiction; the drug is approved for recovery only under the supervision of an addiction counselor.
The heroin problem among tribal communities is sadly nothing new. Some tribes have experienced soaring rates of both prescription pill addiction and heroin addiction. Reacting to drug smuggling in tribal jails can be like a game of Whack-a-Mole; desperate people can become very creative in meeting their needs.
Tribes can take several approaches to solving this problem rather than reacting to it. Tribal Healing to Wellness Courts offer offenders options for recovery and restitution in lieu of jail time. Tribal jails can work with behavioral health providers to administer opioid replacement therapy, or to refer inmates to facilities after release. These collaborative approaches may require more effort than simply enacting a ban, but may have better long-term impact on opiate addiction and recidivism in our tribal communities.