One Massachusetts sheriff estimates that 80 to 90% of the prisoners in his jail have a substance use disorder.
By some estimates up to two-thirds of prisoners in county jails around the country have some sort of substance use disorder, which has made jails the nation’s primary detox and treatment centers, a role they are often ill-equipped for.
“It was never traditionally the function of jail to be a treatment provider, nor to be the primary provider of detoxification in the country — which is what they have become, so with the opioid epidemic, jails are scrambling to catch up,” Andrew Klein, a research scientist with Advocates for Human Potential, a company that works with jails to facilitate treatment, told NPR.
Peter Koutoujian, sheriff of Middlesex County, Massachusetts, says that jails have become a catch-all system for people who fall through the cracks.
“We have not been able to get our hands around it because, quite honestly, society has not gotten its hand around either preventing [drug-addicted] people from coming into our institutions or supporting them once they get back outside,” he said. “The fact is you shouldn’t have to come to jail to get good [treatment] programming. You should be able to get that in your own community so you don’t have to have your life disrupted by becoming incarcerated.”
And yet Koutoujian estimates that 80-90 percent of prisoners in his jail have a substance use disorder.
Increasingly, jails are stepping up to try to figure out how to help people get treatment while they are locked up. The National Sheriff’s Association recently put out guidelines for delivering medication-assisted treatment in jails. Still, many law enforcement officials are wary of using medication-assisted treatment, the established best practice for treating opioid addiction, because the medications can be diverted or abused in the jail. Only about 12 percent of jails offer MAT, but that is good progress, Klein said.
“Although this number is not the majority of jails, five years ago it was zero. And the number is increasing every week,” he said.
In order to save lives, jails need to consider not only keeping people sober when they’re inside, but also how to help them stay sober once they’re released, said Carlos Morales the director of correctional health services for California’s San Mateo County.
“We know if you are an opiate user you come in here, you detox, and you go out — it’s a 40 percent chance of OD-ing,” he said. “And we have the potential to do something about it.”
However, Koutoujian said that MAT alone is not the answer.
“Medication-assisted treatment is very important but people have to remember if you do the medication without the treatment portion — the counseling and the supports — it will fail. And we will just fall prey to another easy solution that just simply does not work.”