Why We Need to Expand Access to Addiction Treatment in Jails

June 17, 2024. By Joshua Tanner.

2023-24 Schweitzer Fellow Joshua Tanner

The United States finds itself in a continued battle with a raging opioid crisis that has disproportionately impacted marginalized communities. In 2020-2021 alone, American Indian individuals had the highest drug overdose death rates per portion of the U.S. population, while Black individuals have also experienced an alarming rise. During this time, North Carolina saw an unnerving 22% increase in overdose deaths, reaching the highest number of overdose deaths on state records.

The alarming rise in overdose death rates among marginalized communities highlights the need to act now to halt further exacerbation of health disparities in our population. While tackling this crisis will certainly require a multitude of initiatives, providing effective treatment for opioid use disorders is a critical, primary step. To do this, we have to focus on meeting people where they are, instead of putting further pressure on an already strained person to seek help. In the case of substance use disorders (SUDs), this is often in the criminal justice system.

Within the walls of U.S. jails and prisons, SUD is remarkably common, with most inmates endorsing usage, and drug offenses continuing to be the leading cause of incarceration in this country. Effective treatment for opioid use disorder exists and often involves medications such as naltrexone, buprenorphine, and methadone. However, access to treatment varies greatly among states and even within counties. While the U.S. Department of Justice has guided the continuation of active SUD treatment, initiation of treatment while incarcerated continues to be highly variable among jails/prisons.

As a person passionate about expanding access to these resources to some of our more vulnerable communities, I have led an Albert Schweitzer Fellowship project in a rural North Carolina correctional facility, in which I’ve focused on improving mental health care delivery and access to medications for opioid use disorder (MOUD) in the jail. Many members of the local community benefit from effective and safe methadone/suboxone treatment for opioid dependence and are allowed to continue this treatment if incarcerated. However, the initiation of treatment is not currently performed in the detention center.

During one of my days spent seeing patients in the jail, I sat in a quiet room, removed from the chaos occurring just outside. I had the opportunity to sit down with an inmate who had been through the jail multiple times. As we talked, she shared her journey with opioid dependence and the seemingly endless cycle of incarceration linked to drug offenses. Listening to her, I began to feel the weight of her experiences and the challenges she had faced. She mentioned feeling unsupported during and after her previous jail stays, expressing how helpful MOUD would have been for her. Her story wasn’t fully unique; it echoed the feelings of countless others I’ve heard from in the jail.

While the work continues to evolve in smaller counties such as the one I have worked in, some larger counties in NC have been able to implement comprehensive opioid use disorder treatment within jails. For instance, Buncombe County, providing both continuation and initiation of treatment, has seen a remarkable 22% reduction in overdose deaths following these interventions, echoing the necessity of treatment in our efforts to reduce health disparities within our state.

With this demonstrated success, we must begin our expansion of these resources across the state of North Carolina. This expansion is especially important in more rural areas of the state and to marginalized communities that bear a disproportionate burden of the opioid epidemic. As we confront the complexities of SUD treatment within the criminal justice system, we must recognize the incarcerated population as individuals who deserve equitable access to effective treatment. As this call for action is routinely echoed within the jail walls, may it be time for us to listen to those most affected and provide them with the treatment they need and deserve?

Writer Profile

Josh Tanner is a 4th-year medical student at UNC School of Medicine and is a 2023-2024 North Carolina Albert Schweitzer Fellow. He leads a project focused on improving access to mental health care resources for those facing incarceration. He will be completing his psychiatry residency at Yale, where he hopes to expand his skills in providing mental health treatment for vulnerable populations.