Opioid use disorder affects millions of Americans and their families in the United States.
Within the criminal justice system, opioid use disorder is even more common compared to the general population.
Unfortunately, most community or county jails in the U.S. offer limited, if any, addiction treatment services for people with substance use disorder and opioid addiction.
What harm can this pose? Research shows that undertreated drug and alcohol dependence is a high risk for relapse, recidivism, and fatal drug overdose post-release.
What Is The Scope Of Opioid Use Disorder In Jails?
According to a 2021 report from the American Civil Liberties Union (ACLU), about a quarter of incarcerated individuals in the United States are addicted to opioid drugs.
Opioids (opiates) like fentanyl, heroin, and morphine are a class of drugs that can relieve pain, as well as have sedative and euphoric effects.
Used chronically, opioids can also cause drug dependence and become addictive.
Understanding U.S. Jails And Jail Populations
The United States contains about 3,000 local jails. Unlike prisons, which are state- or federally-controlled, jails are run by local governments, such as a county system.
Jails are where the majority of those who are locked up in the United States either await trial or serve their sentence. An estimated 10 million jail admissions in the U.S. occur each year.
What Opioid Treatments Are Available In Carceral Settings?
Research shows that the majority of jails and prisons in the U.S. do not offer the most effective treatment for opioid addiction: medication-assisted treatment (MAT).
Here’s a snapshot of what we know:
- About half of people with OUD in the United States have reported having contact with the criminal justice system.
- From 2000 to 2018, the number of people who died of drug intoxication in jail increased by nearly 400 percent, according to the Prison Policy Initiative.
- Lacking access to opioid addiction medication in jail or prison can increase the risk of death due to overdose in the weeks following release.
- Providing medications for opioid use disorder (MOUD) can reduce the risk of overdose death by 75 percent in the weeks following release.
Yet, less than one percent of U.S. jails and prisons allow access to FDA-approved medications for opioid use disorder, according to Pew Research.
Medication-assisted treatment, according to the American Civil Liberties Union (ACLU), is “basic healthcare” for opioid addiction.
Federal health agencies, like the Substance Abuse and Mental Health Services Administration (SAMHSA) describe it as a “gold standard” treatment for OUD.
What Is Medication-Assisted Treatment?
Medication-assisted treatment (MAT) combines the use of medication with counseling and behavioral therapy.
The U.S. National Institute on Drug Abuse (NIDA) describes this as a “whole-patient” or “whole-person” approach to opioid addiction treatment.
What medication-assisted treatment can do:
- reduce drug cravings
- treat opioid withdrawal symptoms
- reduce risk of severe withdrawal
- reduce risk of opioid-related deaths
- improve substance use disorder treatment retention
- decrease criminal activity (including illicit opioid use)
As of May 2022, there are currently three FDA-approved medications for treating opioid dependence and OUD: methadone, buprenorphine, and naltrexone.
Methadone Treatment For Opioid Use Disorder In Jails
Methadone is a medication first used to treat heroin addiction in the 20th century.
What to know about methadone:
- Methadone, like other opioids, is classified as a full opioid agonist, meaning it affects opioid receptors in the body similar to other opiates.
- Unlike opioids like heroin, methadone is fully synthetic, it’s long-lasting, and when dosed correctly, it can effectively treat opioid dependency long-term.
- It can reduce withdrawal, reduce opioid cravings, and blunt the effects of other opioids.
- It is a first-line treatment for opioid use disorder in people who are pregnant.
Unfortunately, accessing methadone can be complicated. Many federal, state, and local regulations severely restrict access to methadone for opioid dependence.
Outside of carceral institutions, methadone must often be accessed through a methadone clinic or other opioid treatment program (OTP).
Buprenorphine Treatment For Opioid Use Disorder In Jails
Buprenorphine is a newer drug than methadone, but is believed to be similarly effective both alone and when combined with naloxone (e.g. Suboxone).
What to know about buprenorphine:
- Buprenorphine is an opioid partial agonist, meaning it partially (but not fully) acts on opioid receptors in the brain and body.
- It is a first-line addiction treatment that can reduce drug cravings, alleviate withdrawal symptoms, and increase safety in cases of opioid overdose.
- It is available in generic form, or under the brand names Subutex, Probuphine, and Sublocade for opioid dependence.
- It is also the ingredient in buprenorphine/naloxone combination medications such as Suboxone, Zubsolv, and Bunavail for opioid dependence.
- The added naloxone ingredient can help reduce the risk for misuse, diversion, and can precipitate acute opioid withdrawal.
Like methadone, prescribing and dispensing guidelines for buprenorphine are often subject to state regulations, which can limit access to this medication in jails.
Naltrexone Treatment For Opioid Use Disorder In Jails
Naltrexone (Vivitrol) does not have as much evidence to support its use for treating opioid addiction as buprenorphine and methadone, but it can still be effective.
What to know about naltrexone:
- Naltrexone, like the opioid overdose reversal drug naloxone (Narcan), is classified as an opioid antagonist.
- It can prevent, or block, the euphoric and sedative effects of opioids.
- It can prevent euphoria if an opioid drug is taken.
- Naltrexone does not reduce cravings, nor is it a treatment for withdrawal.
Naltrexone is a newer drug that is typically costlier than both methadone and buprenorphine, which can serve as a barrier to its access in the U.S. jail and prison system.
Why Do Few Jails Offer Opioid Addiction Treatment?
Various barriers exist when it comes to the implementation of opioid addiction treatment programs in U.S. jails. Some are more easily surmountable than others.
Common barriers to MAT in jails include:
- federal, state, or local governmental regulations
- abstinence requirements imposed by drug courts
- stigma surrounding medications for opioid use disorder
- belief that medication treatment is “trading one addiction for another”
- concerns about the financial cost of a MAT program
- lack of available community-based MAT treatment providers
Which States Offer Opioid Treatment In Jail In 2022?
Rhode Island was the first state in the U.S. to provide access to all three FDA-approved medications for opioid addiction within all its jails and prisons.
According to Pew Research, more correctional facilities in states like Massachusetts, New York, and Colorado in recent years are distributing medication for opioid dependency.
As of February 2020, at least 120 jails offer methadone, buprenorphine, and/or naltrexone to those who are incarcerated.
Additionally, at least 10 states offer some form of MAT in their state-run prisons:
- California
- Rhode Island
- Hawaii
- Connecticut
- New Jersey
- Delaware
- Vermont
- West Virginia
- Washington state
- Pennsylvania
Opioid Treatment Outcomes In Jails
There’s evidence to suggest MAT programs in corrections settings can offer a number of benefits, including public health benefits and reduced overdose deaths.
According to a JAMA study, opioid overdose deaths among those recently incarcerated in Rhode Island dropped two-thirds within the first year of its statewide program.
Additional research has indicated that MAT in criminal justice settings:
- can reduce illicit opioid drug use
- can reduce the risk of relapse post-release
- can offer cost-savings over the long-term
- can reduce criminal activity
- can reinforce positive behavior change
Learn More About Finding Opioid Treatment Today
At OpioidTreatment.net, we aim to provide families with the resources they need to better understand and access treatment options for opioid abuse and addiction.
For more information about how to find opioid treatment for yourself or a loved one, call our helpline to speak with a behavioral health treatment specialist today.
