In my many years inside, I have seen jails and prisons in North Carolina become de facto rehab and mental health institutions. Here, and across the country, people are too often locked up while still in active addiction, and the effects of narcotic withdrawal can last long after any physical sickness has worn off. 

Inside, I have frequently encountered women who are jumpy, unfocused and erratic, even six months after their last hit. I have seen folks become so desperate for relief that they take near-lethal doses of easier-to-get medications, including anticonvulsant medications like gabapentin and carbamazepine. 

Prisons in North Carolina are a revolving door for people with addiction problems. And people who have recently been released are extremely vulnerable to overdose. A 2018 study found that two weeks after release, there was a “40-fold increase in overdose risk compared with the general population.” 

Between 2001 and 2018, deaths in prison caused by drug and alcohol intoxication increased 611%, according to The Marshall Project. The synthetic opioid fentanyl has been a major culprit — in 2022, over 80,000 people died from opioid overdoses in the United States. 

But there is hope. Prisons are well-suited to provide the structure and supervision conducive to helping people with addictions learn how to function on medication long term. That’s why more facilities should embrace medication-assisted treatment programs, which research shows help treat addiction and stem the drug trade inside, while reducing relapses and recidivism after release. 

Prisons and jails have warmed to the idea of MAT programs in recent years, but greater implementation is necessary. 

Despite promising outcomes, there is still bias against MAT, which some critics say is akin to replacing one substance with another. In some sense, that’s true. The idea is to replace highly addictive opiates — often laced with deadly fentanyl — with one that is regulated, stabilizes addiction. But it has been changing lives including mine for the better.

​​I spent almost half of my so-far 17 years inside self-medicating with Suboxone. No one knew, not even my closest friends. I took a daily low dose for many years. It kept me clean and helped me accomplish so much. But it required an unregulated outside source, and that meant I was always at risk of getting in trouble or losing the medication. 

Eventually, I did. 

Consequences of prohibition

Last year, the U.S. Department of Health and Human Services released a report on buprenorphine, a synthetic opioid which can be used to fight opioid addiction. Suboxone is an opioid fighter that includes both buprenorphine and naloxone. The report argued that the medication is “critical to addressing the nation’s opioid crisis” and stressed its “reduced risk of misuse.” 

But, inside, any substance is subject to abuse. Since its rise in availability in North Carolina prisons over the past 10 years, I have witnessed suboxone become the most desired and used substance inside every facility I’ve been in. Other substances, including K2, heroin and crystal meth, occasionally pop up, but Suboxone is almost always available. 

At my last facility, an honor-grade prison that provides more privileges for residents, I rarely saw drugs; but when I did, it was usually Suboxone. 

In my experience, most people who use it are not looking to get high; they want a stabilizer to soothe anxiety, curb cravings and help them function with more ease.

The real problems arise from the effects of prohibition: exorbitant costs, black market sales, corruption and even violence stemming from transaction conflicts.

In the free world, depending on the state, Medicaid makes Suboxone affordable if not free. Over the years, I have seen prices run over $200 for one strip depending on availability. Since few can afford, or truly need, a full strip of Suboxone, sellers cut it into pieces as tiny as one-sixteenth the original size (about half a milligram) for use and distribution. This amount will only have an effect for those who use sporadically.

I have watched my peers frantically call home, begging for $50, $100, even $300 a week, telling elaborate lies to get what they need. When I ask them how they can possibly spend that much money, they tell me: “I’ll be sick without it” or “I just want to feel normal.” While less severe than opiates, coming off buprenorphine can still induce withdrawal effects.

If more prisons offered medication-assisted treatment programs, these clandestine efforts could be better steered to committing to a supervised treatment plan that helps people learn how to adapt to sobriety. 

Drugs everywhere

At one prison where I lived, in Goldsboro, drugs were everywhere. I frequently walked into a bathroom and witnessed people searching for a vein to shoot dope, often with shared needles. 

Opiates were my weakness too, but on Suboxone, I felt no craving. I only felt sadness looking into the glassy eyes of my peers. Ambulances showed up weekly to carry away people who had suffered overdoses. Many returned, and continued using. 

While most people with an addiction want to make a change, prison drug treatment programs typically promote abstinence only. Public health experts say that disproportionate attention to abstinence can be ineffective and punitive, leading drug users into a maze of treatment regulations and stigmatizing environments that can discourage the use of medication. 

Prisons are rarely, if ever, drug-free environments. That’s why we need programs to teach people how to manage their illness while incarcerated so they can stay healthy once released. Not only would it curb illicit use of Suboxone, it would reduce the use of other narcotics and dramatically diminish black market dealing.

And it would result in fewer fights over money, fewer disturbances from withdrawal behavior, and fewer guards and prisoners becoming smugglers. Most importantly, it would mean fewer ruined lives. 

Losing treatment — and privileges

In 2024, after almost three years at an honor-grade facility and nearly two years working a work-release job, I failed a drug test for Suboxone. 

While people at some prisons are prescribed the medication, I lost everything because my facility didn’t. 

Outside prison, I would be applauded for my sobriety. In the worst-case scenario, I would be supported through my relapse. In here, when my Suboxone use was exposed, I was shamed by guards and peers for breaking the rules.  

In a moment, I went from being a “model inmate” just about to receive my bachelor’s degree to losing phone, visitation and commissary privileges for 60 days. 

I knew the potential consequences of my actions. But I also knew I was an addict who functioned better medicated. Now, I must make the difficult choice to live in complete abstinence in order to regain some of my privileges while I serve the final two years of my sentence. 

It should not be this hard, not when sane and healthy alternatives exist. We need a long-term MAT program inside so we can succeed on the outside.

Correction: Because of an editor’s error, an earlier version of this article misstated two facts. The first is when the author failed a drug test at the honor-grade facility; it was 2024, not 2019. The second is what consequence the writers faced after a second infraction; it was loss of phone, visitation and commissary privileges for 60 days. The earlier vision inaccurately stated that the writer was placed in solitary confinement and lost the latter privileges for 90 days.