PHILADELPHIA — Treatment for opioid addiction in Pennsylvania jails is so haphazard that one woman went into withdrawal waiting for access to medication. A man was refused medication because staff said he hadn’t shown enough “motivation to be sober.”
These are among the stories shared by incarcerated clients of the legal aid group Pennsylvania Institutional Law Project (PILP) in a new report that found access to opioid addiction medication in the state’s county jails is scattershot, often inadequate, and in many jails nonexistent — putting incarcerated people at risk for overdose when they’re released.
Researchers assessed the availability of opioid addiction medication in Pennsylvania’s 62 county jails — which hold people awaiting trials or sentencings and those serving short sentences, usually for minor offenses — through right-to-know requests, interviews with clients, and meeting minutes from jails around the state since 2018.
Last year, 5,319 people died of opioid overdoses in the state, and the Philadelphia region’s 1,214 deaths in 2020 made it among the nation’s deadliest major metro areas.
Addiction is a health issue affecting many people in jails and prisons. A 2017 study that looked at data from 2007 to 2009 found that 58% of people serving time in state prisons and 63% of people serving sentences in jails had some kind of substance use disorder. According to the National Institute on Drug Abuse, just 5% of addicted people in state prisons receive medication to treat opioid use disorder while incarcerated.
Studies show that people in prison are many times more likely to die of an overdose after their release than those who are not incarcerated, PILP researchers said. They conducted the report with funding from Vital Strategies, a nonprofit public health organization disbursing funding from Bloomberg Philanthropies to combat the state’s overdose crisis.
When someone is addicted to opioids, it is best practice to offer opioid-based medications to prevent painful withdrawal and to ease cravings for the drug. Some people will eventually taper off those medications; others will take it long-term. But experts agree their success rates with medication treatment are much higher than quitting cold-turkey.
The study — which looked at county jails because they’re often people’s first contact with the criminal justice system — found that nine county jails, most in the northern part of the state, offer no opioid addiction medication at all. Eleven jails offered medication only to pregnant people.
Sixteen jails allowed people who were already taking opioid addiction medications to keep taking them during their incarceration, and just three — in Philadelphia, Montgomery, and Franklin Counties — allowed people to start taking addiction medication from jail.
“Through the years, we’ve received reports and complaints from clients with distressing concerns,” said Su Ming Yeh, the executive director of PILP. “People have a right to this as part of their medical treatment in jail.”
Unlike state prisons, there’s no centralized system for county jails, so policies on opioid addiction treatment vary from jail to jail. At the state level, Gov. Tom Wolf directed the Pennsylvania prison system to offer addiction medications in its facilities in 2018, and the prisons have rolled out several medication programs since.
Kevin Rousset, the president of the Pennsylvania County Corrections Association — a professional organization of about 40 of the county jails around the state — says the association has had training and discussions about offering addiction medications in jails. But the association isn’t a governing body and has no overarching rules regarding addiction treatment.
Most jail administrators defer to their medical directors on how to treat addiction in inmates, Rousset said. (The Pennsylvania Department of Health provides health care in some county jails; others contract with private health-care companies.)
“We’ve educated jail administrators about it — but the implementation part, that’s where the rubber hits the road, and where resources come into play,” he said.
A spokesperson for Pennsylvania Attorney General Josh Shapiro said that although the office does not oversee county jails, local governments can use funds from the opioid litigation settlement that Shapiro negotiated — some $1.07 billion, divided among local entities around the state — to fund medication programs in jails.
The report’s authors also pointed out that some jails that do offer opioid addiction medication may not be offering the most effective types. Sixteen jails allow people incarcerated there to take only naltrexone — a kind of medication that keeps people from experiencing a pleasurable high when they take an opioid.
But some studies have shown that it’s not as effective against preventing overdoses as other treatment options, such as buprenorphine and methadone. These are opioids themselves, taken in controlled doses under medical supervision.
That’s a crucial distinction, the report’s authors said, because people leaving jails and prisons have often lost their tolerance — and if they relapse and use the same dose of opioids they had used in the past, they’re at high risk for an overdose.
Buprenorphine and methadone can help people with addiction maintain their tolerance and avoid an overdose. This is why Philadelphia first launched a program to provide medication treatment for opioid use disorder in its own jail — to prevent inmates from dying of overdoses after their release.
“We’ve come a long way in terms of the general public’s understanding of opioid use disorder, but there’s still a lot of stigma and misunderstanding about what these medications actually are and why people need them,” said Sarah Bleiberg Bellos, a legal fellow at PILP who worked on the report.
Bleiberg Bellos also collected testimony from PILP clients about their experiences getting medication treatment for opioid addiction while in jail, and was struck by how some had difficulties accessing medication even in jails that offered it. Some reported delays in getting their medication once they arrived at jail, causing them to enter withdrawal anyway.
One man incarcerated in a “large urban county jail” said he was accused of taking another person’s buprenorphine while standing in line to receive the medication. Though he was searched and none was found on his person, he was kicked out of the jail’s medication treatment program.
Bleiberg Bellos added that several jails weren’t able to provide or said they didn’t keep statistics on the race and gender of incarcerated people receiving medication treatment in jail, which makes it harder to track racial disparities in treatment access at a time when people of color are dying of overdoses at a higher rate than their white peers.
People of color also have less access to health care, insurance, and addiction medication in general, Bleiberg Bellos said. And because many jails allow inmates only to continue on addiction medications, not start a new course of medication, “if they don’t have it already, they’re not going to get it when they’re incarcerated,” she said.
Tracy Pugh, the senior manager of Vital Strategies’ overdose prevention program, said that the organization wants jails around Pennsylvania to provide buprenorphine and methadone to people with addiction. But it’s also important, she said, to reduce arrests for drug possession in general.
“People who commonly aren’t able to continue treatment, it’s often because they were arrested, incarcerated, or court-involved in some way,” she said. “We have to move away from a law enforcement response and toward a health and community response.”
