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Exploring the Need for Withdrawal Management in Criminal Justice Settings


The Treatment Alternatives for Safe Communities (TASC) blog reports that, between 2010 and 2015, more than $11 million was awarded to families when their loved ones entered withdrawal in jail, received no treatment, and died. 

The studies reveal that many incarcerated people are in need of substance abuse treatment. While more inmates are now receiving addiction treatment, there is still a gap in the area of withdrawal management. What can healthcare professionals working in prison systems do to help inmates through withdrawal? Why is this important?

Addiction Treatment in Jail

The opioid epidemic has created new challenges for law enforcement as a high volume of inmates enter the system actively hooked on heroin, alcohol, or other substances, and then go into withdrawal during their incarceration. 

Administrators within the justice system are responsible for caring for the inmates under their purview. The legal ramifications of withholding treatment for the substance user in withdrawal are clear; jail administrators must take steps to ensure the health and safety of the opioid-addicted inmate. 

However, research has shown that only 22 percent of incarcerated substance users ever received treatment for their addiction. Only two percent received treatment for withdrawal symptoms. This means the justice system is playing Russian roulette with the lives of these inmates, with a high potential price tag paid to the family members left behind. A Mother Jones expose found 20 lawsuits alleging neglect leading to the death of an inmate in the nation’s jails between 2014 and 2016.

Addiction treatment

A Legal Action Center report suggests that jailers are ultimately liable for withholding medication-assisted treatment (MAT) for opioid-addicted inmates. The report suggests that withholding this treatment violates the United States Constitution and Federal anti-discrimination laws. The report suggests that failing to provide treatment for substance users in jail violates the Americans with Disabilities Act (ADA) and Rehabilitation Act of 1973, which prohibit discrimination on the basis of a disability. The report suggests that “individuals who have been denied MAT by the criminal justice system can meet all of these requirements.” 

Further, the report suggests that denying treatment for withdrawal is a violation of the Eighth Amendment of the U.S. Constitution, which prohibits “cruel and unusual punishment,” along with the Fourteenth Amendments’ Due Process Clause. 

Cash-Strapped Criminal Justice System and Addiction Treatment

From a business perspective, providing treatment for withdrawal is more cost-effective than settling a liability lawsuit. From a humanitarian perspective, it is simply the right thing to do. Various industry authorities recommend treatment for opioid withdrawal, including the National Commission on Correctional Health Care. The Federal Bureau of Prisons suggests that “whenever possible, the clinician should substitute a long-acting medication for short-acting drugs of addiction.” Further, they state: “Every effort should be made to ameliorate the inmate’s signs and symptoms of alcohol or drug withdrawal.”

However, the DSM-5 designation for substance abuse as a disorder does not remedy the stigma associated with substance use disorder. Whether the nation’s jailers are adopting a “wait and see” attitude toward substance use withdrawal or simply turning a blind eye to the suffering going on behind steel doors, it is clear that addiction treatment must become a stronger part of the U.S. criminal justice system.

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