Perspectives of Jail Facilities & Staff, People with Opioid Use Disorder, and the Community

Opioid use disorder (OUD) is a treatable medical condition that too often results in chaos, high costs, and unnecessary deaths for jails, communities, and individuals.

Increasingly, jails are treating opioid use disorder with FDA-approved medications.

Here we provide information on how implementing these programs is beneficial from multiple perspectives.

Download our brochure.

Relevant Laws, Lawsuits, and Policy Guidance

Washington State law
  • “To the extent that funding is provided, city and county jails must . . . Provide medication for the treatment of opioid use disorder to incarcerated individuals not less than thirty days before release”, WA SB 5380 section 34
  • “…all jail inmates receive appropriate and cost-effective emergency and necessary medical care”, City and County Jails Act: 70.48.130 RCW – Emergency or Necessary Medical Care
  • “Jails may provide for the delivery and administration of medications and medication assistance for inmates in their custody by nonpractitioner jail personnel…”, City and County Jails Act: 70.48.490 RCW – Delivery and Administration of Medications
Federal legal decision
  • A federal appeals court upheld the district court ruling which ordered the Aroostook County Jail to provide Smith with access to [medications] for her opioid use disorder during her 40-day jail sentence. Smith v. Aroostook County, ME
ACLU of Washington legal settlement
  • “Whatcom County Jail shall implement… maintenance of community based [medications for opioid use disorder], and induction of [MOUD] for persons diagnosed with OUD…” Kortlever et al v. Whatcom County, WA

 

Frequently Asked Questions

What is opioid use disorder?

Opioid use disorder (OUD) is a long-term medical condition. People with the condition are physically dependent on opioids and have brain changes that affect their thinking and relationships.

Why is providing medication for OUD a jail's problem?

Jails already are dealing with the consequences of OUD, including overseeing the care of people with a life-threatening and chaos-inducing disease. Starting a MOUD program helps jails address negative consequences of OUD before they result in serious medical and legal consequences for the jail.

They haven’t used drugs since they’ve been incarcerated for weeks to months – aren’t I robbing them of their clean time?
  • No. Symptoms of OUD look very different when someone has limited access to opioids. Not using opioids for a period of time does not mean a person is cured of their OUD, which is a chronic, relapsing brain disease.
  • Also, people’s time incarcerated and not using opioids lowers their tolerance – this puts them at greater risk of overdose when they get out.
  • While no one with OUD plans on relapsing after release from incarceration, 75% relapse to opioid use with 3 months.
What about diversion?
  • Yes, diversion of any medication in jail is possible and does happen.
  • However, local data show that diversion of buprenorphine is rare: approximately 5 cases out of 200 people started on buprenorphine in a mid-size Washington State jail were reported.
  • Training corrections staff on topics including workflow and inmate medication monitoring are effective strategies to reduce and prevent diversion.
  • Treating OUD with MOUD for people in jail actually can reduce diversion and contraband by reducing the demand on the inside.
  • Buprenorphine is incredibly safe and risk of related serious medical events and overdose is very low.
Isn't this just bringing drugs into the jail?

No. When prescribed at the appropriate dose, people do not get high from MOUD. Rather, MOUD is like medications for other diseases, like hypertension and diabetes – it stabilizes people’s symptoms, reduces chaos and suffering, and helps keep them alive.


 

Potential Benefits of Medication for OUD by Role

+ Facility administrator+ Jail staff+ People with OUD+ Community

TREATING SYMPTOMS OF OUD

is consistent with people’s constitutional rights to parity of treatment while incarcerated.

REDUCING RISK OF SUICIDE, ILLNESS, AND SELF-INJURY

decreases media and legal scrutiny and need for additional monitoring and transport to external medical facilities.

MIRRORING COMMUNITY MOUD SERVICES

decreases potential malpractice claims for medical providers working within the jail.

REDUCING CONFLICT AMONG STAFF AND PEOPLE INCARCERATED

improves staff retention and recruitment when work environment is less stressful.

REDUCING CHAOS

by helping to break the cycle in and out of jail that many people with OUD experience.

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LOWERING COSTS

of jail operations associated with staff monitoring and transporting, and over-burdened and overcrowded facilities.

OTHER BENEFITS

Improve efficiency by focusing jail resources on people at higher risk to community (this is helpful for jail administration and unions).

TREATING SYMPTOMS OF OUD

reduces staff burden related to monitoring and cleaning facilities of individuals in active opioid withdrawal.

REDUCING RISK OF SUICIDE, ILLNESS, AND SELF-INJURY

decreases time and effort needed for additional monitoring and transport to external medical facilities.

MIRRORING COMMUNITY MOUD SERVICES

helps address risk management related to major medical events from opioid withdrawal, illicit opioid use, and overdose.

REDUCING CONFLICT AMONG STAFF AND PEOPLE INCARCERATED

  • improves the corrections environment when needs from both perspectives are met,
  • reduces stress at work and increases employment satisfaction, which may decrease spill-over stress at home.

REDUCING THE CHAOS

by helping to break the cycle in and out of jail that many people with opioid use disorder experience.

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LOWERING COSTS

related to poor physical and mental health from being in a stressful work environment.

OTHER BENEFITS

Be a part of local and national efforts to address the opioid epidemic.

TREATING SYMPTOMS OF OUD

reduces suffering and treats a medical condition.

REDUCING RISK OF SUICIDE, ILLNESS, AND SELF-INJURY

via self-harm when symptoms of opioid use disorder are treated.

MIRRORING COMMUNITY MOUD SERVICES

helps people get used to MOUD in preparation for continuing their care after release.

REDUCING CONFLICT AMONG STAFF AND PEOPLE INCARCERATED

improves the corrections environment by creating collaborative versus adversarial interactions and relationships.

REDUCING THE CHAOS

improves the transition from jail back to the community, which also will reduces the risk of rearrest and reincarceration.

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LOWERING COSTS

of increased healthcare utilization post-release when OUD is stabilized during transition back to community.

OTHER BENEFITS

Help to reduce the very high risk of overdose people with OUD face upon release from jail.

TREATING SYMPTOMS OF OUD

helps people post-release: meet their legal requirements, reunite with their families, and function at work or school.

REDUCING RISK OF SUICIDE, ILLNESS, AND SELF-INJURY

lowers post-release risk of overdose, infectious disease, and other risks of death among people with opioid use disorder.

MIRRORING COMMUNITY MOUD SERVICES

across all care settings helps prevent people from falling through the cracks and ensures continuum of healthcare.

REDUCING THE CHAOS

by building a network of healthcare providers that include the jails and breaking the cycle in and out of jail that many people with opioid use disorder experience.

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LOWERING COSTS

of healthcare utilization and the criminal legal system, which reduces financial burden on community and taxpayers.

OTHER BENEFITS

Create collaboration among the legal system, public health, health care, social services, and communities to address the opioid epidemic.