Breaking the Cycle of Incarceration and Relapse Starts Behind Bars

I recently saw the news alert titled St. Charles County uses millions in opioid settlements to boost jail treatment program

Counties in every state are struggling to use the opioid settlement funds coming in yearly for the next 15 years or so. Most counties have received their yearly allocation for the past three years, and the funds are just sitting there. As the funds grow, there is an obvious temptation to use them in rather creative ways that may not directly benefit patients.

Treatment of addictive disorders, including alcoholism, is a relatively low-cost proposition. It is different from treating a heart attack or stroke. The major costs are personnel, training, and medications. A very critical component of successful treatment is seamlessly transitioning the patient to long-term care after release. Few correctional facilities have done this successfully.

I propose a radically different idea. Jails and prisons should partner with treatment centers that can guide correctional staff on effective detox protocols, provide individual and group therapy via telehealth, and even provide psychiatric services via telehealth. The appropriate medications can be administered by jail or prison staff. This way, the patient becomes familiar with the treatment center outside the prison.

Another important consideration is to assess the patient and start treatment within days of entering the correctional facility. It is critical to continue maintenance medications throughout the stay in prison. Prison can inadvertently become an “incubator” for addiction if treatment is not continued throughout incarceration. Fortunately, several highly effective medications, such as buprenorphine and naltrexone, are available in sustained-release formulations that need to be administered only once a month. These medications are expensive, but worth the investment and represent a responsible way to expend opioid settlement funds.

Another critical component is training. Correctional staff, including peer support personnel, should be familiar with detox protocols and the pharmacology of FDA-approved anti-craving medications. It is even more important to educate inmates about these medications. Too often, medications are viewed as a form of punishment. The opioid settlement funds present a great opportunity to finally break the cycle of arrest, incarceration, and rearrest. The goal should be to drastically reduce recidivism caused by relapse to drugs or alcohol. We have the tools, and now we have the funds. Let’s put the two together.

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