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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National Public Health Emergency Declared in Face of Opioid Crisis; TASC and Partners Collaborating to Offer Solutions and Strategies

(Chicago) – Drug overdoses killed more than 64,000 people in the United States in 2016, according to the Centers for Disease Control and Prevention. That’s an average of 175 people per day.

On October 26, President Trump declared the opioid crisis a national public health emergency, “directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis.”

In his announcement, the President indicated that a new policy would overcome the Institutions for Mental Diseases (IMD) exclusion that disallows Medicaid payment for certain services at substance use disorder treatment facilities that have more than 16 beds. He also discussed measures to confront illegal drug trafficking, improve safe prescribing practices, and develop non-addictive painkillers.

No requests for federal funding were attached to the announcement.

“What’s important for people to know is that, with funding, there are solutions that can be brought to bear on this crisis,” said TASC President Pam Rodriguez. “From Chicago to Rockford to the Metro-East region of Illinois, and from Maryland to Ohio, we have been working closely with communities severely affected by this crisis. We are finding and delivering solutions together.”

Nationally, the Addiction Policy Forum, of which TASC is a partner, shares innovative approaches happening in communities across the country, from home-based treatment to family recovery initiatives. Earlier this week, APF shared eight priorities to address addiction in the United States, from helping families in crisis to expanding treatment access to reframing criminal justice.

Collaborative Solutions and Strategies for Justice Systems

Opioid use disorders are highly prevalent among criminal justice populations, according to the National Institute on Drug Abuse. Furthermore, a Washington State study showed that the risk of dying within the first two weeks of release from prison are 12 times higher than for other state residents, with overdose being the leading cause of death.

Working with expert researchers, justice leaders, and practitioners across the country, the Center for Health and Justice at TASC has developed collaborative opioid response strategies and solutions for all points in the justice system, beginning with law enforcement and through to parole.

“As first responders, law enforcement officers often are on the front lines of the epidemic. Not only can they carry naloxone to revive individuals who have overdosed, but can save a lives again by placing people in treatment instead of arresting them,” said Jac Charlier, national director for justice initiatives at the Center for Health and Justice at TASC.

“When police, treatment, and communities work together, there’s an array of public health responses that can happen pre-arrest, before people enter the justice system.”

To this end, TASC is a founding partner in the Policy, Treatment, and Community (PTAC) Collaborative, whose mission is to increase health and public safety by widening community and behavioral health and social service options available through law enforcement diversion. Sharing research and information on robust partnerships to confront the opioid crisis in local jurisdictions, the PTAC Collaborative will hold its inaugural conference on pre-arrest diversion in March 2018.

TASC’s Center for Health and Justice also has worked with partners to develop collaborative responses for jails, courts, and reentry phases of the justice system, as well as tools and strategies that span the continuum, including rapid assessment and treatment capacity expansion.

Additionally, the American Association for the Treatment of Opioid Dependence released a fact sheet earlier this week on the use of medication-assisted treatment for opioid use disorder in the justice system. TASC participated in the expert panel cited in the report.

“Families and communities are hurting,” said Rodriguez. “We’re joining forces with policymakers, justice leaders, and practitioners to help people and communities get the services they need. We need to keep people alive.”

To learn more, visit the Center for Health and Justice (CHJ) at TASC, or contact Jac Charlier, national director for justice initiatives at CHJ.

IACP and TASC Announce National Initiative to Combat the U.S. Opioid Epidemic and Mainstream Pre-Arrest Diversion Programs

(Chicago)  – The International Association of Chiefs of Police (IACP) and Treatment Alternatives for Safe Communities (TASC) have come together to promote an initiative to create robust alternative-to-arrest diversion programs for state, county, and local law enforcement agencies across the United States, in line with the White House announcement responding to the national opioid emergency.

The IACP/TASC collaboration seeks to greatly improve the means, ease, and speed with which law enforcement can partner with substance use and mental health treatment providers so that police can help people in need access treatment as rapidly as possible. This collaboration is particularly timely given the announced national opioid epidemic emergency. For example, “Naloxone Plus” models are specially designed for law enforcement and treatment partnerships to prevent future overdose deaths.

“At this critical time for our communities, law enforcement efforts to connect people with drug treatment could not have greater urgency,” said IACP President Donald De Lucca, chief of the Doral, Florida, Police Department. “Law enforcement officers, working side-by-side with treatment providers and community, will together help form the solution.”

To launch this effort, IACP and TASC will work through the Police, Treatment, and Community (PTAC) Collaborative, the first national effort to build a multi-disciplinary approach that ensures law enforcement, treatment professionals, and community members collaborate as equal partners to reduce crime in the United States.

The IACP and TASC initiative will: 1) identify the many variations on the concept of diversion across the United States, pinpointing programs with the most promising and measurable outcomes; 2) launch a significant nationwide pilot implementation approach using the identified promising models; 3) leverage the resources of the IACP Center for Police Research and Policy at the University of Cincinnati to measure and evaluate the results of the pilot implementation to ensure an evidenced-based approach; and 4) launch one of the largest pre-arrest diversion initiatives in the United States, seeking a sea change in policing (and justice) practices.

While diversion to treatment is not a new concept, this initiative adds a critical element that’s been missing: a dynamic and sustainable partnership that brings together TASC’s expertise in evidence-based responses to substance use and mental health disorders, along with IACP’s expansive and knowledgeable law enforcement network.

“We know from four decades of research and experience that formal connections to treatment can improve access and outcomes,” said Pam Rodriguez, president and CEO of TASC. “Across the U.S., prisoner reentry programs, court intervention programs, and prosecutorial diversion programs have proven successful for decades. Their lessons can be applied even earlier in the justice system—ideally before people even enter it.”

“This initiative can yield value across the U.S., including safer communities, healthier families, and officers returning home safely from duty,” said De Lucca.

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About TASC

TASC, Inc. has a 40-year history of bridging justice systems and community-based substance use treatment programs. Offering direct services to more than 20,000 people annually in Illinois, TASC works in partnership with law enforcement, courts, prisons, child welfare programs, and community-based service providers to implement evidence-based services that increase health and reduce recidivism.

About the IACP

The International Association of Chiefs of Police (IACP) is a professional association for law enforcement worldwide. For more than 120 years, the IACP has been launching internationally acclaimed programs, speaking on behalf of law enforcement, conducting groundbreaking research, and providing exemplary programs and services to members across the globe.

Today, the IACP continues to be recognized as a leader in these areas. By maximizing the collective efforts of the membership, IACP actively supports law enforcement through advocacy, outreach, education, and programs. Through ongoing strategic partnerships across the public safety spectrum, the IACP provides members with resources and support in all aspects of law enforcement policy and operations. These tools help members perform their jobs effectively, efficiently, and safely while also educating the public on the role of law enforcement to help build sustainable community relations.

About PTAC

 The Police, Treatment and Community Collaborative (PTAC Collaborative) was launched in April 2017 with a mission to strategically widen community behavioral health and social service options available through law enforcement diversion. The purpose of the PTAC Collaborative is to provide national vision, leadership, voice, and action to reframe the relationship between law enforcement, treatment, and community. PTAC promotes the development and dissemination of a wide variety of pre-arrest diversion efforts, not limited to any single approach. PTAC seeks to avoid issues of racial disparity in practice as pre-arrest diversion initiatives grow across the country. We welcome the participation of representatives from law enforcement and other criminal justice entities, behavioral health, research, community, advocacy and related organizations in any of the strategic areas.