美国国家公共电台 NPR County Jails Struggle With A New Role As America's Prime Centers For Opioid Detox

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The opioid abuse crisis in this country is overwhelming America's county jails. The jails weren't built to become the largest drug treatment centers, but that's what they are in many states. The National Sheriffs' Association estimates that between half and two-thirds of today's jail population has a drug or alcohol abuse problem. As NPR's Eric Westervelt reports, to deal with the opioid epidemic¹, more jails are struggling to expand what's called medication-assisted treatment.

ERIC WESTERVELT, BYLINE²: Felipe Chavez walks the hall of what looks like a regular hospital wing - small doctor's offices with padded exam tables and that disposable medical paper. He looks younger than his 23 years - sleepy eyes and loose-fitting clothes, like a teenager in baggy³ pajamas⁴. But the hunter orange of everything he's wearing - down to the plastic slippers⁵ - all show he's in the San Mateo County jail's medical clinic, in Redwood City, Calif., where he gets his regular dose of methadone. Chavez is serving somewhere between four months and four years for selling fentanyl and other opioids, drugs he says have ruled his life since a sports injury years ago.

You're 23?

FELIPE CHAVEZ: Yeah.

WESTERVELT: When did you start using opioids?

CHAVEZ: Twelve.

WESTERVELT: Wow, age 12.

CHAVEZ: Yeah. I was using oxycodone - 30 milligram pills. And I was smoking them. Then I went to heroin⁶, then heroin went to fentanyl and then, yeah, just slowly worked up the ladder.

WESTERVELT: Yet Chavez is one of the lucky ones here. Because he was in a local methadone program before he got arrested again, he's been allowed to keep using that synthetic⁷ opioid substitute in jail. Methadone and a couple of other drugs help jailed addicts⁹, like Chavez, temper cravings and, in theory, stay off more powerful and destructive opioids.

CHAVEZ: It's all about if you want to get clean or not. You know, the methadone is just there to help. I mean, you got to dedicate to the methadone because you got to start somewhere, you know?

WESTERVELT: With the medication-assisted treatment here, Chavez says, I just feel more normal, like a normal person. More research is needed. But so far, studies have shown that medication-assisted treatment works well in reducing fatal overdoses, relapse and the spread of infectious diseases, such as HIV.

But this kind of drug-based approach is relatively¹⁰ new in San Mateo, as it is for many jails across the country. For nearly a quarter-century, this jail's flagship addiction¹¹ treatment program has been an abstinence-based approach called Choices.

CARLOS MORALES: Everybody here is an addict⁸. Everybody is in recovery. Some of these folks will be going to prison - a small segment of them...

WESTERVELT: Carlos Morales is the county's director for correctional health services. He shows me around the Choices wing. About 100 inmates¹² linger around plastic padded tables and in chairs outside their cell doors.

For decades, this kind of cold turkey, abstinence and talk therapy program has been the model for county jails across America. But a rise in fatal overdoses of inmates nationally - some died from dehydration¹³ during detox or overdosed just after they were released because drug tolerance¹⁴ had dropped - prompted Morales to rethink the abstinence-only model.

MORALES: Dead addicts don't recover, so this is our opportunity to engage this population.

WESTERVELT: Morales has pushed to add medications to the jail's drug treatment toolbox.

MORALES: We know that the potential for overdosing - if you're an opioid users, you come in here, you detox and you go out - 40% chance of OD'ing. And we have a potential to do something about it.

WESTERVELT: Only a dozen opioid addict inmates are undergoing some form of medication treatment here. Morales wants to expand those numbers and increase the voluntary use of the drug naltrexone - known by its brand name, Vivitrol - for inmates getting released. Vivitrol blocks the effects of opioids and alcohol for about a month. But it's slow going. There are deep worries about costs and safety. Inmates can hoard¹⁵ and then sell, trade or abuse some of the treatment drugs. Medication-assisted treatment has proved a hard slog for jails across the country.

Scientist Andrew Klein consults with jail drug treatment programs in almost every state. He says only about 12% of the nation's roughly 4,000 county jails now offer some form of medication-assisted treatment for opioids or other addictions¹⁶.

ANDREW KLEIN: Although this number is not - you know, it's not the majority of jails. Five years ago, it was zero. And the number is increasing every week. So jails are - especially with the opioid epidemic - scrambling¹⁷ to catch up.

WESTERVELT: The scramble¹⁸ is especially tough for jails in more rural counties. Carrie Hill directs the National Sheriffs' Association's Center for Jail Operations.

CARRIE HILL: Even if they wanted to provide medication-assisted treatment within the jails, there may not be a methadone clinic for 60 miles. Or we may not even have the doctors who have the necessary licenses¹⁹ to provide certain medications.

WESTERVELT: Hill's group is working on solutions that include mobile units - a kind of opioid addiction van - that could deliver treatment drugs to hard-to-reach jails. Peter Koutoujian is a leading voice on the issue. He's the sheriff of Middlesex County, Mass. - among the states hardest hit by the opioid epidemic.

While he supports expanding medication for inmates, he's wary²⁰ of making it the centerpiece of problem-solving. That kind of thinking, Koutoujian says, got us into this crisis in the first place.

PETER KOUTOUJIAN: Medication-assisted treatment is very important. But people have to remember, if you do the medication without the treatment portion - the counseling and the support - it will fail. And we will just fall prey²¹ to another easy solution that just simply does not work.

WESTERVELT: This August, Massachusetts will start a pilot program in jails in seven counties to add all forms of medication-assisted treatment for opioid addicts. And the jails will carefully track data on efficacy, including relapse, recidivism²² and overdoses.

Eric Westervelt, NPR News.