The National Sheriffs’ Association estimates between one-half to two-thirds of inmates in county jails nationwide have a problem with drug dependence or abuse. In some areas, local law enforcement says, the rates are higher. As a result, many county jails have found themselves transformed into some of the biggest drug treatment centers in their areas.
To address this large and growing problem, local jails are increasingly considering moving towards medication-assisted treatment (MAT) in some form, with the goals of helping addicted prisoners detoxify safely both while they are incarcerated and after their release. Growing in number are jail MAT programs which provide methadone or buprenorphine (also known by the trade name Suboxone) to substitute for the opioids to which they are addicted.
But the most common jail-based MAT programs inject inmates about to be released with naltrexone, which goes under the brand names Vivitrol, Narcan and others, It can bring about withdrawal symptoms in persons physically dependent on opioids, but also blocks brain receptors for those substances and alcohol for about a month.
These efforts aren’t yet widespread (only a little over 10% of jails are thought to have already begun MAT programs), nor have they been free from controversy, both for the potential risk that MAT drugs may be abused within the jails, and for concerns over how effective and expensive such programs can be.
Why don’t more jails offer MAT treatment programs? One major deterrent is a shortage of personnel with the needed credentials. For instance, a jail-based program providing methadone would need to have certification as a methadone clinic or else be partnered with a community clinic. That’s especially problematic in the rural or suburban settings in which many jails and prisons are located, where there is often little access to medications, physicians holding the licenses required to administer them, or post-release follow-up programs ex-inmates.
Another obstacle to jails providing MAT treatment programs lies in potential liability for inmates who relapse into drug abuse after their release. Treatments for opioid addiction can put inmates at greater risk of overdosing if, after they are released, they resume taking drugs to which their treatment has rendered them more vulnerable. One consultant on prison and jail substance abuse treatment programs estimates that states and counties have paid out more than $70 million nationwide over the past decade to compensate families of former inmates who died due to post-release addiction withdrawal.
But a very recent decision from the Boston-based federal appellate court may provide the legal foundation for more localities and states having to provide MAT programs. In the first-ever such from a federal circuit court, the 1st Circuit ruled an inmate in rural Maine has a legal right under the Americans With Disabilities Act and the Eighth Amendment to continue receiving Suboxone, which the inmate had been taking for five years before getting a short-term sentence to the Aroostook County jail.
The jail had resisted, pointing to the risk the drug might be diverted, but the inmate, with the help of the state branch of the American Civil Liberties Union, prevailed. While the decision is now precedent only in New England, it could help persuade more jails and courts to follow suit.