This article argues that correctional institutions violate the Eighth Amendment when they refuse to establish MAT programs and prevent doctors from exercising medical judgment to properly treat incarcerated people with OUD.

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C (...) transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

The chief sources of groundwater contamination on farms come from point sources and diffuse sources. Possible point sources are feedlots, poorly-sited manure piles, septic sewage-treatment systems—all of which can release nitrate, phosphates and bacteria— and sites of chemical spills. Diffuse sources are typified by excess fertilizer leaching from a number of arable fields. The basis of quality standards for drinking-water is discussed in relation to common contaminants present on farms. Samples of drinking-water were collected in 1991–1992 from wells on about (...) 1,200 farms in order to study the quality of rural groundwater in Ontario. Analysis showed that approximately one third of wells were contaminated with bacteria, 14% were contaminated with nitrate, two wells were contaminated with pesticide, but 40% were considered unsafe because of the presence of at least one contaminant. These values were similar to those reported for similar regions in the U.S. There was no significant effect of agricultural practice on the proportion of contaminated samples. One response of Ontario's farmers to information on water quality has been to initiate their own program, the Environmental Farm Plan, which has 23 modules by which the risk of environmental contamination can be assessed. Government policies for agriculture can be expected to influence farming practices. However, the literature suggests that the consequences of policies aimed at reducing environmental contamination are poorly understood, not least because the instruments used for implementation can have widely differing impacts. The need for discussions on the ethics surrounding the relationship between food producers and consumers with regard to environmental contamination is identified. (shrink)