By Todd Duncan, Law Enforcement and Safety Specialist

According to a recent CDC report, opioid overdose has become one of the leading causes of death in the U.S. This grim trend has resulted in a disproportionate number of people in jails who have substance use disorders (SUDs). The Department of Justice’s (DOJ) 2020 bulletin on SUDs in jails reports that over 60% of people in jail meet the criteria for drug dependence or abuse, while that rate is only 5% in the community.

However, according to the Bureau of Justice Assistance’s 2023 report on opioid use disorder (OUD) in Local Jails, less than 25% of jails support allowing inmates to continue their medication assisted treatment (MAT) for OUD upon admission or initiate MAT once in custody. This disparity between the disproportionate number of inmates with substance use disorders and limited availability of MAT creates significant risks for jails.

Inmates with SUDs may start to withdraw from alcohol and drugs within a few hours of arrest. Like withdrawal from alcohol and benzodiazepines (Xanax, Valium, etc.), opioid withdrawal can be life-threatening if not medically managed. Furthermore, jails that do not offer withdrawal-related medical care face increased risk of legal liability and adverse health outcomes for those in custody. Counties have been sued civilly for failure to provide withdrawal management services to inmates with SUDs.

For example, in 2017, 27-year-old Kelly Coltrain was booked into the Mineral County Jail in Nevada for unpaid traffic violations. During intake, she told jail staff that she was dependent on drugs and requested to go to the hospital for help with withdrawal symptoms. Jail staff denied Coltrain’s request and instead, placed her in a cell that required 30-minute checks.

Unfortunately, the 30-minute checks were not performed as required. For the next three days, Coltrain was observed on video vomiting, sleeping often, and eating very little. On her third night in jail, she started convulsing then went motionless. Four hours passed before jail staff checked on Coltrain. Video later showed the deputy who eventually checked on Coltrain did not call paramedics when he found her unresponsive in her cell. Instead, he nudged her with the toe of his boot, then left the cell to call his supervisor. The medical examiner labeled Coltrain’s death accidental, caused by “complications of drug use.” Toxicology results showed she had heroin in her system. Coltrain’s family filed a wrongful death suit, which was settled in 2019 for $2 million plus 4 years of federal district court monitoring of the jail during implementation of new policies and procedures to ensure proper care of inmates at risk of withdrawal. This case is a good reminder that if we don’t police ourselves, someone else will.

Jail staff have a constitutional duty to provide adequate care for the serious medical needs of inmates and prevent deaths whenever possible, and this includes serious medical needs that arise from drug and alcohol withdrawal. It is essential that jail staff effectively manage detoxification and treatment of inmates with substance use disorders to avoid running afoul of the law. In its 2022 publication, The Americans with Disabilities Act and the Opioid Crisis: Combating Discrimination Against People in Treatment or Recovery, the Department of Justice clarifies that blanket policies within jails prohibiting the use of medications for opioid use disorder would violate the ADA.

The evidence is clear that jail-based medication-assisted treatment using FDA-approved medications methadone, buprenorphine, or naltrexone offer several benefits including:

  • Decreased risk of serious illness or death associated with drug and alcohol withdrawal.
  • Lower risk of overdose mortality.
  • Reduced risk of HIV and HCV transmission.
  • Increased likelihood a person will remain in treatment.
  • Enhanced safety and security for staff and inmates by minimizing disruptive inmate behavior often associated with drug and alcohol withdrawal.
  • Reduced recidivism by interrupting the cycle of arrest, incarceration, and release of individuals with SUDs.
  • Reduced costs. According the 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) TIP 63: Medications for Opioid Use Disorders, “Data indicate that medications for OUD are cost effective and cost beneficial.”
  • Increased likelihood of employment once released.

Medication-assisted treatment is an evidence-based approach to reducing risks associated with inmates with OUD and is supported by NIRMA as well as numerous professional organizations including the National Sheriff’s Association, National Commission on Correctional Health Care, and the Substance Abuse and Mental Health Services Administration (SAMHSA). Considering the relationship between criminal behavior and substance abuse, jail-based MAT programs offer a unique opportunity for corrections professionals to positively impact risk, safety, and quality of life both inside the jail and in the community.

To ensure compliance with the law, agencies are strongly encouraged to contact their local medical and/or mental health provider for further guidance on implementing a jail-based MAT program. For additional information, please see the following resources: