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An Inside Look at Addiction Treatment in Jail

Photograph of the Allegheny County Jail in Pittsburgh, Pennsylvania.

For many years, inmates at the Allegheny County Jail in Pittsburgh, Pennsylvania, who were in treatment for opioid use disorder (OUD) were treated very harshly by corrections officials, who denied prescribed medications to some inmates while refusing treatment to inmates who became addicted in jail.

These issues led to a settlement agreement between the U.S. Department of Justice and Allegheny County in December of 2023. At first, the facility cooperated by waking inmates up in the middle of the night and administering a full day’s dosage at one time instead of two smaller doses, as prescribed. Details are in a PublicSource investigation published January 23.

PublicSource is “Pittsburgh’s home for impactful journalism and community-driven storytelling.” Problems with OUD treatment at the Allegheny County Jail have been the subject of a series of articles by PublicSource health reporter, Venuri Siriwardane. So it is with great relief that she reports a turnaround in OUD treatment at the jail.

Corrections staff have stopped waking up inmates in the middle of the night to give them their medications. They are splitting dosage into twice daily upon request. They are treating people who became addicted in jail as well as those who were receiving treatment prior to incarceration. And they are getting results.

The Allegheny County Jail has installed a “dashboard” open to the public where anyone can see statistics on OUD treatment, updated weekly. The statistics show the scope of the problem and why correctional staff have become more interested in treatment than punishment.

  • From 2016-2020, there were 2,684 overdose deaths in Allegheny County.
  • Twenty percent of those deaths — more than 500 people — had been booked into the Allegheny County Jail at some point during the year prior to death.
  • Fentanyl‘s presence in overdose deaths in the county rose from 3% in 2013 to 85% in 2023.
  • In 2023, over half of those persons booked into the Allegheny County Jail had prior involvement with substance use services administered by the county.

The jail recently received accreditation from the National Commission on Correctional Health Care. They have also started using once-a-week injections of buprenorphine, which increases the likelihood of staying in treatment while making it easier for inmates to transition to treatment upon release. In 2024, the jail provided medications for OUD to 2,294 inmates. What a massive undertaking!

The result has been much happier inmates, according to one member of the Jail Oversight Board. The staff is pretty happy with the changes, too. Dr. Thomas Robertson, co-director of the Rethinking Incarceration and Empowering Recovery Clinic, told PublicSource:

Talking with some of the health care providers in the jail and coordinating care with them, it seems significantly better.

The RIvER Clinic, as it’s called, provides continuing care for substance use disorders for people released by the Allegheny County Jail. The RIvER’s “Post-Incarceration Care Model” outlines a community reinforcement approach to transitioning from jail to autonomy that includes immediate access to healthcare, behavioral health care, a social worker, a nurse navigator, and a community health worker.

The granularity of the data now being provided by Allegheny County on the OUD dashboard is stunning. In the first seven months of 2024, the jail released 987 individuals who had received OUD treatment during their incarceration. Within three days, two died from drug overdose. Within six months, 19 died from drug overdose. That’s 2%, which is way down from double-digit numbers the previous year.

Three-quarters of those released (76%) received treatment for OUD within six months. Half (52%) received treatment for mental health. Individuals aged 35-44 make up the largest group of OUD inmates, at 43%, yet only 29% of the total jail population. The percentage of inmates receiving OUD medication shrinks from 31% in the first three months of incarceration to 11% more than 12 months after confinement. The median time it takes for a released person to get OUD treatment is now two days.

The Allegheny County Jail story shows how a combination of persistent journalism and transparent analytics can lead to better outcomes for inmates, staff, and society in general.

Written by Steve O’Keefe. First published February 5, 2025.

Sources:

“Allegheny County Jail’s addiction medication program evolves after rough start,” PublicSource, January 23, 2025.

“Medication for Opioid Use Disorder (MOUD) in the Allegheny County Jail,” Allegheny County Analytics, January 9, 2025.

“Rethinking Incarceration and Empowering Recovery: RIvER Clinic,” Center for Inclusion Health, November 7, 2022.

Image courtesy of Wikimedia Commons, used under Creative Commons license.

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