Treating addiction in jails
At a time when the U.S. government is trying to deal with a nationwide opioid epidemic, many jails across the country are only now rolling out medicines to help inmates overcome addiction. And most of those jails dispense only one of the drugs currently available.
Nearly 1 in 5 jail and prison inmates regularly used heroin or opioids before being incarcerated, making jails a logical entry point for intervention, according to the U.S. Department of Justice.
Medication, when paired with counseling and social support, is considered the standard treatment for opioid addiction. Three medications treat addiction to opioids. Methadone and buprenorphine diminish opioid withdrawal symptoms and can reduce cravings. Naltrexone blocks the effect of opioids and also treats alcoholism.
About 220 of more than 3,000 jails nationwide offer naltrexone for inmates — mostly to those about to be released, said Andrew Klein, project director of a Department of Justice grant program that supports agencies providing drug treatment for inmates. Only about 20 jails offer methadone or buprenorphine, he said. The numbers don’t include facilities that offer methadone for pregnant inmates.
But cost and a long-standing belief that the best way to overcome addiction is abstinence are barriers to using any type of medication to help treat opioid addiction, experts said. In addition, methadone and buprenorphine require a special license to distribute and, to be an effective long-term solution, should be continued after many inmate patients are released.
Those two medications also can induce mild opioid effects, which creates the potential for misuse and illicit sales. “They are very valuable commodities in jail,” Klein said.
The jails in San Mateo County, located just south of San Francisco, recently began offering naltrexone, about 20 months ago. Jail officials say they believe the medication will improve patients’ chances of recovery and reduce the likelihood they will return.
“We want to use every tool in the toolbox,” said Akhil Mehra, a psychiatrist at the jails. “It’s not a panacea. … But when used appropriately, it can help people stay sober.”
But Mehra said about half of the inmates evaluated for naltrexone decide not to take it because they are worried about side effects — which can include headaches, joint pain or upset stomach — or they believe they can kick their habits without it.
Though few jails dispense medications to treat addiction, experts say they expect that to change over time. The American Society of Addiction Medicine and the American Correctional Association issued a joint statement in February supporting the use of medications behind bars.
Experts said treating opioid addiction behind bars could help address the broader opioid epidemic. Some research has shown providing medication is effective at reducing the likelihood of relapsing and returning to jail.
Several programs that provide medication-assisted treatment have demonstrated success, including ones in New York and Rhode Island, which offer the full suite or medications — methadone, buprenorphine and naltrexone. A small study on the Rhode Island program found a 60% reduction in opioid overdose deaths among recently freed inmates.