Pills Behind Bars: Access to Medications in the U.S. Prison System

PABLO ASHI –

The United States is praised at the forefront of medical innovation, with billion-dollar pharmaceutical industries and new discoveries daily. However, for the nearly two million people behind bars across the country, access to care and life-saving medication is oftentimes not readily available. 

The 1976 Supreme Court case Estelle v. Gamble granted constitutional access to healthcare for people incarcerated in U.S. prisons and jails. Specifically, it outlawed any “deliberate indifference” to the health needs of patients in carceral systems, including: delayed access to physicians, failure to administer prescribed treatment, and denial of professional medical judgement. These acts would violate the Eighth Amendment against cruel or unusual punishment, and this case marked a judicial milestone to protect those behind bars. 

Although this law was passed nearly 50 years ago, its legal precedent falls short. A 2023 JAMA Health Forum report points to “sparse external oversight” of healthcare and “inconsistent data,” making it hard to guarantee reliable healthcare behind bars. In this article, I want to highlight some more reasons and statistics that describe the magnitude of this problem:

High Need, Low Standards

Unlike public hospitals and clinics that must adhere to strict protocol and regulations, prisons and jails often operate with minimal infrastructure and standards. According to the New England Journal of Medicine, the carceral system lacks “quality standards, robust monitoring, and funding from public medical insurance programs.” This results in a lack of support for correctional administrators, who must then provide uninformed care with limited resources. Shockingly, a 2019 New Yorker article reported that 1500 lawsuits had been filed between 2013 and 2018 against two of the largest U.S. providers of jail health care (Corizon Health and Wellpath) for neglect, malpractice, or wrongful injury or death. 

Compounding this issue, the medical need is high. The incarcerated population generally comes from lower-income households and often exhibits higher rates of disease, including tuberculosis, HIV, hepatitis, and diabetes. Incarceration can be a brutal cycle, and more than half of the incarcerated have a mental illness and/or substance abuse disorder. This disparity of high need and low standards only hinders one’s ability to make it out of the carceral system.

Unmet Needs in Opioid Use Disorder

One of the largest disparities in the prison system is the treatment of opioid use disorder, experienced by about two-thirds of individuals, according to the Bureau of Justice Statistics. Despite the need for medications like methadone, buprenorphine, and naltrexone, many jails do not offer these options. 

A 2024 NIH Report stated that only 43.8% of 1,028 jails surveyed across the nation offered any form of medication for opioid use disorder, and only 12.8% made these available to anyone with the disorder. They also found that 70.1% of jails surveyed lacked any type of substance use disorder or recovery support. Overdose is the leading cause of death for those returning to their communities after incarceration, and the absence of treatment while serving time is devastating.

A Need for Change

The denial of sufficient medication and treatment to the incarcerated is not only a constitutional violation, but also a public health failure. There is a need for support of these populations both behind bars and after they return to their communities, which will help break the cycle many fall into and prevent death from causes like overdose. 

If you wish to read about this issue in the context of Athens, read this 2020 article about an Athens-Clarke Jail Program to help inmates with addiction through Medication-Assisted Treatment! 

Copy Editor: Pablo Ashi

Photography Source: https://www.istockphoto.com/photos/pills