By Sandra Garcia, The New York Times

The American Civil Liberties Union said it had reached a settlement with a federal prison in Kansas that had denied buprenorphine, an opioid addiction medication, to an inmate who the group said would “inevitably suffer and possibly die” without it.
The inmate, Leaman Crews, is set to receive the medication Wednesday night, Lauren Bonds, legal director of the A.C.L.U. of Kansas, said in an email on Wednesday.
Officials at the Leavenworth federal penitentiary had not been providing Mr. Crews, 45, with the buprenorphine he needed to stay sober, Ms. Bonds said on Tuesday. Instead, they had been medicating him with codeine, an opioid, to keep him from going through a painful withdrawal, and Tylenol.
The settlement is not expected to change Federal Bureau of Prisons policy, but instead apply narrowly to Mr. Crews’s case.
Before reporting to the Leavenworth prison last Wednesday to serve a three-year sentence for embezzlement, Mr. Crews, 45, had been in recovery for 14 months with the aid of the medication, according to Ms. Bonds.
“It is a rare feat for that long a period,” she said, referring to using buprenorphine during recovery to treat addiction. “It was kind of a success story.”
The Federal Bureau of Prisons did not respond on Tuesday to questions about why buprenorphine is not available to inmates in recovery, but is permitted for inmates in detox.
The office of the United States attorney for the District of Kansas is reviewing the A.C.L.U. complaint, according to Jim Cross, a spokesman.
The prison bureau, which incarcerates nearly 180,000 people, estimates that close to 40 percent of its inmates enter the federal prison system with a substance abuse problem, according to a letter a bipartisan group of eight senators sent to the Government Accountability Office last year. For federal inmates, methadone and — much less frequently — buprenorphine are usually prescribed for detoxing, as opposed to hedging cravings and maintaining sobriety.
Pregnant women, however, are allowed to take medications that suppress opioid cravings for more than just detoxing, according to the prison bureau. By prescribing codeine to inmates, Ms. Bonds said, the federal prison system is supporting the cycle of addiction and increasing the chance inmates have of overdosing once they are released from custody.
“We do know that in Leavenworth they offer buprenorphine for inmates in certain situations, usually to help people detox, as opposed to maintaining sobriety,” Ms. Bonds said.
Nadine Johnson, the executive director of A.C.L.U. of Kansas, said that while the organization was “thrilled” that Mr. Crews would receive additional medical attention, the “narrow agreement” with the prison was not sufficient.
“We don’t want others to endure the same or similar situations,” Ms. Johnson said. “We look forward to seeing a Bureau of Prisons policy that respects what doctors are recommending in these cases.”
By providing Mr. Crews with codeine, the prison was “making his opioid addiction worse,” Michael V. Pantalon, a senior research scientist in the Yale School of Medicine’s department of emergency medicine, said.
“He will have codeine to reinforce his opioid addiction rather than the medications that would treat it,” Dr. Pantalon said. “I can understand why there is a lawsuit,” he added.
According to the complaint, filed on Friday in the Federal District Court, federal prisons do not provide buprenorphine to inmates even when, as with Mr. Crews, the inmate had been prescribed the medication before being in custody.
Studies show that the success rate for staying sober is much greater when buprenorphine is made available to the person struggling with addiction for at least a year, according to Dr. Pantalon.
“People who stay on it for one consecutive year or longer do far, far better and stay abstinent for longer,” he said.
“It is a chronic disease, so it needs chronic treatment just like people with asthma or hypertension,” he added. “We don’t ask people with hypertension, ‘When are you coming off the hypertension medication?’”
Most professionals who treat addiction recommend a combination of therapy and medication.
“This is a brain disorder; it is not just an addiction of the body,” Dr. Karan Baucom, director of the Baucom Institute, a treatment facility in Overland Park, Kan., said on Tuesday. “The brain has been reconfigured by the drug itself; it structurally changes the brain’s response.”
The cycle of opioid addiction is fueled by the body’s natural response to avoiding pain, Dr. Baucom explained. If someone in recovery does not have buprenorphine or methadone available, she said, they can get “so sick that they have to use the narcotic to recover from the symptom.” Most people addicted to opioids get to a point where they are only using opioids to keep from getting sick, she added.
Opioid abusers have less than a 30 percent chance to stay sober without the proper medication, Dr. Baucom said.
The chances that an inmate will survive a relapse after being released from custody plummets, while the chances that he or she will overdose skyrockets.
“It is not life or death, like you take him off and he dies,” Dr. Pantalon said. “It is life or death mainly when he comes out,” he added.
Of course, some inmates can find opioids in prison in the codeine they are prescribed. And illegal drugs can make their way into prison as well, Ms. Bonds noted.
“I think there is a risk of relapse, and not just when he is released,” she said.