WASHINGTON, D.C. — Tens of thousands of people with opioid use disorder pass through the corrections system each year and, right now, the vast majority don’t have access to treatment while in jail.
Instead, they’re forced to go through detoxification without medication, which lowers tolerance levels without curbing opioid cravings. Unmanaged withdrawal is in itself painful. But for those who leave jail and return to their previous levels of drug use, their risk of fatal overdose is 129 times over the general population.
There is clear consensus on the most effective treatment for opioid use disorder: FDA-approved medicines such as buprenorphine, methadone, and naltrexone, often provided alongside counseling and social supports. The absence of evidence-based treatment within correctional facilities represents a critical point for intervention for reducing deaths and improving public health and safety.
That’s why Arnold Ventures has committed $720,000 to assist 16 counties across the country in providing opioid treatment in jail. Through a facilitated nine-month planning process, each jurisdiction will build comprehensive jail-to-community treatment programs.
“It’s not just a planning initiative. It’s a make-a-plan-and-start-doing-it initiative,” said Julie Wiegandt, who helps oversee opioid policy initiatives at Arnold Ventures.
A few weeks ago, representatives from each of these counties came together at a hotel in Arlington, Va., for the opportunity to engage in peer-to-peer learning and to troubleshoot barriers with project partners, including staff at Arnold Ventures and experts at the Bureau of Justice Assistance, the Institute for Intergovernmental Research, and Health Management Associates.
They told stories of their shared challenges: chief among them pervasive misconceptions about opioid treatment. Opioid use disorder is often treated as a moral failing, and objections to medications for addiction treatment are still common.
“There is a great deal of stigma associated with methadone,” said Scott Haga, a physician assistant and opioid use disorder expert at Health Management Associates, which is providing technical assistance and intensive coaching to the participating communities. “But the problems associated with it have to do with its delivery and not the substance itself.”
Logistical hurdles pose another issue. Jails face staff, space, and time constraints on their ability to deliver treatment. For example, Camden County, N.J. is looking to provide individual counseling as part of its treatment program to alleviate privacy concerns and foster openness that may be difficult in group counseling settings. But this requires more rooms and more people.
That can cause a problem when you consider that facilities are required to store medication in secure areas and put safeguards into place to prevent diversion.
There’s also the question of how to pay for the medication. In states that have expanded Medicaid, substance use disorder treatment is covered for people after they’re released into the community, but not while they are incarcerated. This means that jails are responsible for paying for treatment out of their own limited budgets.
And the work doesn’t end when a person walks out the door. If jail officials truly want to see a decline in overdose rates in their communities, it is just as important to ensure that people are connected to treatment in the community once they leave custody. Using medication for an abbreviated period leads to high relapse rates, according to Wiegandt.
We need to remember that jails are not treatment facilities. The goal should always be to start people on medication and to connect them to programs outside the corrections system.Julie Wiegandt Arnold Ventures Public Health Manager
Jails can be a key partner in managing the linkage to treatment and transition back into the community. People often lose jobs and housing while incarcerated, making it much more difficult to stay engaged with treatment after release. Seemingly small details, like not having personal identification, either because it’s expired, lost, or confiscated, create additional barriers that require multi-agency planning to knock down.
“We need to remember that jails are not treatment facilities. The goal should always be to start people on medication and to connect them to programs outside the corrections system,” Wiegandt said.
Despite the challenges, Wiegandt sees a growing willingness among corrections administrators nationwide to open their doors to medication-assisted treatment programs. By working together to overcome these implementation hurdles, with the assistance and evaluation provided by Arnold Ventures, participants in this initiative will help develop best practices and an evidence base that can be implemented more broadly in other communities.
“Lowering the risk of overdose to people leaving jails is critical to broader efforts to save lives and promote recovery,” Wiegandt said. “What’s exciting about this initiative is that these officials can share what they’re learning with more communities around the country grappling with the same problem.”