Breaking the Cycle – Addiction Treatment in America's Jails
Substance use disorders (SUDs) are a significant public health issue within the U.S. criminal justice system. About two-thirds of individuals in U.S. jails and prisons have a substance use disorder. Despite this high rate, treatment options are inconsistent at best, scarce at worst. A 2024 national survey of jails revealed that about 7 in 10 offer any kind of substance use disorder treatment. Fewer than half of the surveyed jails offer medication for opioid use disorder (MOUD), and only 12.8% provide these medications to all individuals who need them. These gaps not only endanger the health of those incarcerated but also continue cycles of recidivism and overdose, particularly during the first week after release.
Why Treatment in Jails Matters
Incarceration presents a critical opportunity to address SUDs along with co-occurring mental health conditions. Providing treatment to individuals during this period can greatly reduce the risk of overdose after release and improve the chances that folks will continue treatment. Studies have shown that access to MOUD in correctional settings can decrease the risk of overdose death by up to 80% following release.
Barriers to Offering Treatment
Stigma and judgment: There remains a widespread belief that addiction is a moral problem rather than a medical condition. This stigma makes it harder for leaders and lawmakers to push to fund and implement programs that help people recover. Additionally, jail staff and even some healthcare professionals may carry this judgment, affecting how they provide support and treatment.
Resource limitations: Many facilities lack the necessary funding, trained staff, and other systems to provide comprehensive treatment. Jails may not have access to medical professionals trained to treat addiction, enough mental health specialists to address co-occurring disorders that contribute to substance use, or the space for private counseling or group support meetings. Treatment programs cost money, and many jails work with tight budgets. They may rely on short-term grants that don’t last long enough to build a strong system. Without the right people and tools in place, it’s hard to offer real, consistent help to the people who need it most.
Policy and legal challenges: Every jail is different, each following different rules depending on the city, county, or state it’s located in. Some jails have policies that allow only select medications to be offered for treatment, even if other medications are proven effective in saving lives. This patchwork of policies and inconsistent guidelines across jurisdictions creates confusion and slows program implementation.
Operational challenges: People often don’t stay in jail for long, making starting and continuing consistent treatment difficult. Plus, finding treatment in the community after folks leave jail, when they are most vulnerable, can be complicated unless jails and health clinics work together.
How to Get it Right
To expand and improve SUD treatment in jails, several steps are necessary:
Change the Laws: Make sure all jails are required to offer proven treatments, including medications for opioid use disorders.
Funding and Resources: Give more money and support – help jails hire trained staff and build programs that work.
Education and Training: Help correctional staff and healthcare professionals understand that addiction is a disease and that treatment helps.
Community Partnerships: Collaborations with community health organizations can ensure continuity of care after release, reducing the risk of relapse and overdose.
Collect Data: Keep track of what works – collect data to show which programs help the most, and use that information to identify areas for improvement, make better decisions, and maintain program funding.
Sacramento County’s Approach
Sacramento County has taken proactive steps to address SUDs within its criminal justice system. The Jail Diversion Treatment and Resource Center (JDTRC) provides comprehensive services for individuals with co-occurring mental health and substance use disorders, aiming to redirect them from incarceration and into treatment programs. The Sacramento County Sheriff's Office offers reentry programs that include cognitive behavioral therapy and other evidence-based treatments to help parolees transition from prison into the community. The programs also offer support to individuals navigating the criminal justice system at various levels of supervision and involvement.
Since 2019, Sacramento County Adult Correctional Health has expanded its medication-assisted treatment (MAT) efforts considerably, including:
Revised intake process
Created an MAT induction unit within the jail
Increased number of providers who are addiction medicine trained
Increased embedded SUD counselors offering group and individual SUD treatment
Provided ongoing training to jail staff and healthcare professionals
Improved data collection
Improved continuity of care post-release
Additionally, the county contracts with various community-based treatment providers to offer outpatient treatment, medication-assisted treatment, detoxification services, residential programs, and sober living environments. These initiatives indicate Sacramento County’s commitment to treating SUDs as a public health issue rather than only a criminal justice concern.
Making Room for Recovery
Helping people with addiction while they’re in jail can save lives and make communities safer. Jails don’t have to be places of punishment only – they can be places where people get the help and support they need. Those entering jails with substance use disorders will be reentering local communities, so treating SUDs in jails can improve overall outcomes for entire communities. When we treat addiction like the health issue it is, everyone benefits.
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Elizabeth Flanagan Balawajder, Ducharme, L., Taylor, B. G., Lamuda, P. A., Kolak, M., Friedmann, P. D., Pollack, H. A., & Schneider, J. A. (2024). Factors associated with the availability of medications for opioid use disorder in US jails. JAMA Network Open, 7(9), e2434704–e2434704. https://doi.org/10.1001/jamanetworkopen.2024.34704
Evans, E. A., Wilson, D., & Friedmann, P. D. (2022). Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder. Drug and Alcohol Dependence, 231(231), 109254. https://doi.org/10.1016/j.drugalcdep.2021.109254
National Institute of Health. (2024, September 24). Fewer than half of U.S. jails provide life-saving medications for opioid use disorder. National Institutes of Health (NIH). https://www.nih.gov/news-events/news-releases/fewer-half-us-jails-provide-life-saving-medications-opioid-use-disorder
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