The Role of Jails in Combatting the Opioid Crisis

To improve population health in poor communities, it is important to downsize the role of jails in the health care safety net.

Despite a proven evidence base and increasing calls from the President’s Commission on Combatting Drug Addiction and the Opioid Crisis to incorporate MAT into criminal justice settings, there remains reticence on the part of many jails to adopt MAT. National survey data suggest that utilization of these medications is very low in criminal justice settings. And the Pew analysis found that very few jails requested MAT from their health vendors. Of those that did, the majority restricted use to pregnant women. Although these data are from only a sample of the more than 3,000 jails across the country, they point to striking gaps in the ability for jails to treat people who use opioids while in jail or help them prepare to manage their health when they return to the community. This is especially troubling for people who are already using MAT prior to being detained but are not able to continue their MAT while in jail.

There are examples of jails that are already utilizing MAT. The New York City jail system has run an opioid treatment program with MAT since 1987 and, more recently, some jails have piloted programs with injectable naltrexone, a non-habit forming, long-lasting medication which blocks the effects of opioids. The MATADOR program in Middlesex County, Massachusetts, for example, combines the use of naltrexone with substance abuse counseling and continuity of care for participants upon return to the community. And, encouragingly, there are signs that other criminal justice stakeholders are beginning to embrace their role in combatting the opioid crisis.

Jails can never substitute for well-funded community-based healthcare services. To improve population health in poor communities, it is important to downsize the role of jails in the health care safety net. Vera’s recent report, Minimizing Harm, explains in detail the evidence against using incarceration as a response to drug use. And as the Pew analysis rightly notes, reducing the number of people with substance use and mental health disorders in local jails depends on further developing community capacity to treat these conditions. Until that capacity is developed, however, jails will remain a vital intercept for treating people with opioid use disorders. Further recognition of the fact that correctional healthcare is community healthcare is essential for reducing the burden of the opioid crisis—both for the people coming through jail and for the communities to which they ultimately return.

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