Averting Crisis: Safe Withdrawal in Jail Settings

(Chicago) – Lawsuits and news coverage across the country point to an alarming issue faced by jails: people are going into withdrawal from opioids, alcohol, or other substances while in jail and facing extreme discomfort and sometimes death. From 2010 to 2015, families in at least six states were awarded nearly $11 million in compensation for loved ones who died while being denied routine withdrawal management care in jails.

Jurisdictions can save lives and reduce their possible exposure to costly and time-consuming litigation by creating and enacting policies that ensure adequate care for individuals experiencing withdrawal while in jail. In order to support these efforts, the Center for Health and Justice at TASC has developed a brief for jail administrators, public safety leaders, and county and state policymakers. This brief contains information about safe withdrawal management in jail and resources to aid in developing these procedures.

As the opioid crisis continues, jails across the country are encountering people who are actively using heroin and other opioids and who may go into withdrawal while in jail. Abrupt discontinuation of non-opioid substances, including alcohol and benzodiazepines, can also cause withdrawal.

Jail administrators and personnel play an instrumental role in addressing these issues. They are legally responsible to care for the health and safety of people detained in their facilities and are often involved in identifying and addressing acute and chronic health issues, including substance use disorders. As the opioid crisis endures, jails face a growing need to save lives and reduce their own exposure to litigation risk by ensuring safe withdrawal from illicit opioids and other substances while in jail.

  • A recent national survey found that only 22 percent of individuals serving sentences in jails who met diagnostic criteria for substance abuse or dependence received any type of drug treatment while incarcerated, and only 2 percent of them were provided withdrawal management services.
  • Between 2014 and 2016, at least 20 lawsuits were filed alleging that individuals in jail died from opiate withdrawal complications.
  • Previous court rulings have indicated that failure to provide incarcerated individuals medical treatment for withdrawal symptoms or forcing them to go through withdrawal without proper medical supervision may be a violation of constitutional rights.

“Providing adequate care to people going through withdrawal in jail is a win-win-win—counties reduce their exposure to risk, people going through withdrawal in jail avoid the possibility of an unwarranted death sentence, and their families and friends don’t lose their loved one to a really horrible death,” said Brad Bullock, TASC’s area administrator in southeast Illinois. “From both an ethical and a pragmatic standpoint, enacting these procedures is the right thing to do.”

Several advisory organizations provide guidelines or standards on the provision of care for individuals who are going through withdrawal syndrome while in correctional custody, including the Federal Bureau of Prisons, the World Health Organization, and the National Commission on Correctional Healthcare. These organizations call on jails that do not already have sufficient withdrawal management protocols to develop them, and to hire and train staff to respond to withdrawal and the associated symptoms.

There is consensus that medically supervised withdrawal is ideal whenever possible. Partnerships with local medical providers can help jails safely manage withdrawal syndrome. Additionally, relationships with drug treatment providers can help jails connect people to needed treatment upon release.

The Center for Health and Justice at TASC helps states, counties, and local jurisdictions develop practical, collaborative strategies for improving community health, reducing re-arrest, and saving public dollars.

For more information, please contact Laura Brookes, TASC’s director of policy.

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Best Practices for Jail Medicaid Enrollment: TASC in Modern Healthcare Article

(Chicago) Modern Healthcare has published an article on best practices for Medicaid enrollment at jail intake, noting approaches which TASC has helped implement in Cook County and is sharing with other jurisdictions around the country.

Harris Meyer writes:

Like inmates throughout the country, most people entering the Louisville Metro Jail lack health insurance and many suffer from long-untreated chronic conditions.

At least partly as a result, some people, particularly those with serious mental illness and drug or alcohol addiction, keep getting re-arrested and returning to jail, increasing costs to taxpayers.

In Louisville, Kentucky, there are processes to sign up people for Medicaid at jail intake, as well as provide support at release for individuals with multiple needs who often cycle in and out of jail. The program is based on initiatives begun at Cook County Jail in Chicago.

In these locations and in a number of jurisdictions across the country, the aim is to increase the number of people who have Medicaid when they are released from jail, so as to improve their access to healthcare in the community and reduce their likelihood of recidivism.

…But there are tough challenges, including poor coordination between local jail authorities and state Medicaid agencies, lack of funding to hire enrollment assisters, and chaotic conditions during jail intake, said Maureen McDonnell of the Chicago-based not-for-profit Treatment Alternatives for Safe Communities. In addition, there is sometimes political opposition to offering public health insurance to accused lawbreakers.

“Typically, these programs start with a motivated jail director, county commissioner or county behavioral health director who sees the writing on the wall about how many people have substance abuse and mental health conditions,” said McDonnell, who advises jail officials around the country in starting Medicaid enrollment programs. “The current national focus on mental health and substance abuse is helping a lot.”

Through these collaborative approaches, and with Medicaid coverage, people with long-untreated substance use, mental health, and other medical conditions may have new means to access healthcare services. Read the full article at modernhealthcare.com.
Modern Healthcare (MH) best practices for helping people in jail get Medicaid, including input from TASC. Source and image credit: Modern Healthcare

Modern Healthcare (MH) best practices for helping people in jail get Medicaid, including input from TASC. Source and image credit: Modern Healthcare