This brief discusses the challenge of managing substance withdrawal in jails, provides an overview of constitutional rights and key legislation that addresses substance-use withdrawal of jail residents, and outlines steps for developing a comprehensive response to their substance use disorders (SUDs).
Among sentenced individuals in jails, 63 percent have an SUD, compared to 5 percent of adults in the general population. For the period 2000-2019, the number of jail inmates who died from all causes increased 33 percent, and the number who died from drug/alcohol intoxication increased 397 percent. The median length of stay in jail before death from alcohol or drug intoxication was just 1 day. Alcohol was involved in 76 percent of withdrawal-related deaths. Opioids were the drug most often involved in other withdrawal deaths studied. Counties, jail administrators, and jail staff have faced civil lawsuits seeking monetary awards and other relief for failure to provide withdrawal management services. Individuals who are incarcerated may file claims in federal court alleging violations of their rights under the U.S. Constitution. Other legal mandates that address this issue are reviewed in this brief. Five components are outlined for a comprehensive, proactive response to this crisis: 1) Establish withdrawal management policy that complies with legal, regulatory, and clinical standards; 2) Develop and implement withdrawal management protocols; 3) Ensure proper staffing and resources for the protocols; 4) Train staff in policy implementation; and 5) Continuously evaluate and improve policy content and implementation. 7 resource listings