How to give incarcerated people a fighting chance against opioids

By Libby Jones 

The overdose crisis has wreaked havoc on the health of Virginians, claiming over 1,000 lives each year across the Commonwealth – and 107,000 across the United States. A closer look into these staggering numbers reveals an even more alarming truth: some members of society, specifically those battling opioid use disorders behind bars, are significantly more at risk of dying from an overdose.

People released from jails or prisons are 40 times more likely to die of an overdose in the first two weeks after release than the general population. But we know what works to save their lives: jail- and prison-based programs that provide medications for opioid use disorders (MOUD) to incarcerated individuals reduce the risk of fatal overdose by 80%. 

The Fairfax County Sheriff’s Office is working collaboratively with the county’s public health and social services systems to prevent fatal overdoses in our community. In late 2020, the Sheriff’s office used grant funding to establish the Medication for Addiction Treatment (MAT) program, in which every person with a substance use disorder is offered during the jail booking process following arrest. Fairfax County offers FDA-approved MOUD that prevent overdose and help incarcerated individuals maintain their recovery. 

Programs like the one in the Fairfax County Adult Detention Center are few and far between. Nationwide, just 12% of jails and prisons offer MOUD to incarcerated individuals. While some states, including Rhode Island and Maryland, have created laws and initiatives to ensure incarcerated people have access to life-saving medications, federal legislation and funding is needed to guarantee no individual behind bars is left behind. The bipartisan Reentry Act does just that. 

By allowing Medicaid payments for medical services thirty days before an incarcerated person is released, the Reentry Act gets incarcerated people the critical health insurance they need to access MOUD treatment prior to leaving jail, putting millions of people on a reliable course of recovery as they transition out of incarceration and onto a path toward a healthy, fulfilling life. 

The impact 

Fairfax County has created a safer, healthier community for everyone who calls the county home. Evidence-based addiction treatment services equip formerly incarcerated individuals with the skills to reenter their communities healthier with the tools necessary to maintain their recovery. 

This program has had immediate results. In 2022, more than 800 people received MOUD at the Fairfax County Adult Detention Center. And at release, they ensure that formerly incarcerated individuals receive two doses of naloxone — the medicine that reverses the effects of an opioid overdose. At a time when national overdose death rates were continuing to climb, Fairfax saw a precipitous drop. In 2021, 111 people died from an overdose in Fairfax County. In 2022, that number dropped to 82. 

Why now? 

While local and statewide efforts are a great start, they have not moved the needle far enough toward finding a reliable solution. It’s evident by the number of record-breaking overdose deaths the U.S. saw in 2021, the first time the number of lives lost at the hands of opioids and other drugs reached over 100,000. 

The health inequities we see inside prison reflect what we witness in our communities. Virginians of color are disproportionately impacted by OUDs, and consistently jailed at a higher rate. Those in poverty are also more likely to end up incarcerated. And with the recidivism rate of drug offenses at 77%, it’s a challenge for this group to overcome poverty and stay out of the criminal justice system without OUD treatment prior to leaving jail. 

Grants that fund these initiatives are never assured long-term. An overarching federal policy like the Reentry Act would fight against outdated federal regulations and stigmas about addiction and establish a standard that no matter where someone is incarcerated in the U.S., they can access lifesaving treatment. 

It’s part of a larger tide that’s already begun to turn in Washington. Last year’s omnibus package included the bipartisan Mainstreaming Addiction Treatment (MAT) Act, which makes buprenorphine more readily accessible, including in jails. Such national, mainstream policies help remove the stigma from those already impacted by being incarcerated. 

Congressional leaders and federal agencies must continue proposing and passing laws like the Reentry Act that benefit all OUD patients, giving at-risk individuals in jails and prisons the chance for treatment at a time when their journey to recovery and survival is at a crossroads. In Fairfax County, we see firsthand that access to treatment brings those recovering hope and a greater chance of living a long, gratifying life by ensuring jail is not a contributing factor to relapse or death. With the Reentry Act, access to treatment when it’s needed most will be possible, saving the lives of millions of people across Virginia and beyond. 

Libby Jones is the program director of the Overdose Prevention Initiative, a program of the Global Health Advocacy Incubator. The Overdose Prevention Initiative advocates to ensure evidence-based treatment and harm reduction services that help save lives are within reach by advancing federal policies that address the disparities, inequities, and stigma in the addiction treatment system.