Detoxification in nation's jails falls short

December 21, 2004

Very few jails in the United States continue methadone treatments for opiate-dependent inmates, and half fail to follow standard methadone detoxification protocols, according to a national survey by the University of Rochester Medical Center.

These practices jeopardize the health of inmates - many of whom have voluntarily sought treatment -- by exposing them to pain and suffering, risk of relapse, overdosing or getting rearrested after release from jail. Likewise, they expose the jails to a greater risk that illegal drugs will be used in-house, and raise constitutional questions about the right to medical treatment for arrestees.

Kevin Fiscella, M.D., M.P.H., associate professor of Family Medicine and Community and Preventive Medicine and a former medical director of a methadone program, is lead author of the study, which is in the December 2004 Journal of Urban Health: Bulletin of the New York Academy of Medicine.

Fiscella believes the research highlights a lack of coordination between jails and community methadone clinics, the need for uniform policies regarding methadone maintenance programs in jails, and improved education for health-care workers in jails.

Researchers surveyed 500 jails, including the 200 largest jails and a random sampling of the remaining 300. Of the 245 (49 percent) that responded, only 1 in 8 jails (12 percent) said they continued methadone treatments for withdrawal while inmates were incarcerated. About half (48 percent) failed to use methadone, clonidine, or other opiates to detoxify inmates, which is the appropriate method. The largest jails were more likely to follow established protocols.

About 14,000 to 17,000 people, or 10 percent of persons enrolled in methadone maintenance programs, are arrested annually in the U.S. Among heroin addicts not on methadone, the number may exceed 250,000 arrests per year. The New York State Academy of Family Practice funded the research.

University of Rochester Medical Center

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