Faced with a flood of addicted inmates and lawsuits, county jails are struggling to adjust to an opioid health crisis that has turned many jails into their area’s largest drug treatment centers, NPR reports. More jails are adding some form of medication-assisted treatment to help inmates safely detox from opioids and stay clean behind bars and after release. There are deep concerns about potential abuse of the treatment drugs, as well as worries about the efficacy and costs of programs that jails weren’t designed or built 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,” says Andrew Klein of Advocates for Human Potential, which advises on jail and prison substance abuse treatment.
The National Sheriffs Association estimates that at least half to two-thirds of the jail population has a drug abuse or dependence problem. Some counties say the number is higher. “We are in a critical situation,” says Peter Koutoujian, sheriff of Middlesex County, Ma., one of the states hardest hit by the opioid epidemic. “We have to physically, medically detox about 40 percent of our population as they come in off the street,” he says, “and probably 80 to 90 percent of our population inside has some type of drug or alcohol dependence.” A growing number of jails are trying to expand the use of medication-assisted addiction treatment, including buprenorphine and methadone. Jails in states hardest hit by opioids — including Ohio, Kentucky, West Virginia, Rhode Island and Massachusetts — are moving fastest. The National Sheriffs’ Association has issued a best practices guide to jail-based medication-assisted treatment, in conjunction with the National Commission on Correctional Health Care.