states support incarcerated individuals in need of withdrawal management by requiring state or local correctional settings to provide withdrawal management services, via either statewide law or protocol/policy, as of June 2023.
Withdrawal management protocols outline a comprehensive approach to the treatment, monitoring, and long-term recovery plan of individuals in a correctional facility who are experiencing withdrawal from drugs or alcohol.Best practice guidelines for withdrawal management recommend that, for individuals in custody who are intoxicated or undergoing withdrawal, correctional facilities should: (1) allow qualified healthcare professionals to monitor those individuals within a safe housing environment; (2) incorporate specialized treatment for pregnant and postpartum individuals; (3) create defined protocols to prevent suicide and self-harm during and after cessation of substances; and (4) initiate or continue clinically appropriate medications, including medication for addiction treatment (MAT), such as buprenorphine and methadone.
In addition to medical management, proper protocols specify screening, assessment, and continued care procedures.Without withdrawal management protocols, an inmate’s withdrawal from drugs and alcohol can be fatal. This issue is particularly important for jails, which house a population that shuffles between in-custody and release.
Justice-involved individuals are at elevated risk for dangerous withdrawal outcomes
Individuals with co-occurring substance use and mental health disorders comprise 15 percent of people arrested annually.This population is at an elevated risk of severe withdrawal symptoms and complications.
There is a significant unmet need for comprehensive withdrawal protocols
From 2000 to 2019, mortality in jails due to drug or alcohol intoxication increased by 397 percent,indicating a critical need for screening and timely delivery of treatment and services. Withdrawal from substances such as opioids, in the absence of MAT, places individuals at higher risk of subsequent overdose death, as detoxification lowers an individual’s tolerance to substances but does not treat the underlying chronic disorder. Withdrawal without appropriate medical monitoring and the initiation of MAT contributes to high rates of relapse and overdose deaths following release from incarceration.
Beyond the compelled withdrawal from illicit substances, some facilities require incarcerated individuals to cease MAT and any prescription opioids used to manage pain.However, in most instances individuals who undergo forced withdrawal from MAT later experience an aversion to such treatment after release, due to the severity of withdrawal symptoms. Such forced withdrawal from MAT may, therefore, act as a barrier to future treatment initiation. Moreover, rapid discontinuation of opioids can be especially dangerous for pregnant individuals, causing premature labor, fetal distress, and miscarriage.
By providing clear protocols and training and education on SUD and withdrawal for all correctional staff, individuals at risk for overdose, withdrawal, or other medical issues may be better identified before these issues reach a critical point.