Among my first memories as a doctor was a disheveled man, barely older than me, handcuffed to a hospital bed, vomiting a thin brown liquid into a pale pink bucket. Between retches, he sobbed and shook violently.
Driving his many medical and legal problems, I later learned, was an addiction to opioid painkillers. Driving his current misery was withdrawal.
I thought of him recently when I visited Rikers Island, where three-quarters of inmates struggle with addiction. Rikers is one of the few correctional facilities in the country that offers inmates all three Food and Drug Administration-approved medications to treat opioid addiction: buprenorphine, methadone and naltrexone.
Nationwide, less than 1 percent of jails and prisons offer medication to treat opioid addiction, and even at Rikers, inmates must be “detoxed” — not off heroin but from their medication — before they can be transferred to state prisons, which generally do not allow medication-assisted treatment for opioid use disorder.