Jails As Treatment Centers: One State’s Unconventional Response To The Opioid Epidemic
The state of Massachusetts has some of the highest rates of opioid addiction and overdose in the country. There were 1,913 fatal opioid overdoses in Massachusetts in 2017, many of which involved fentanyl and other synthetic opioids. Since courts in Massachusetts can send people to addiction treatment against their will with a legal order of civil commitment, some counties have started to force men with opioid addictions to report to jails for opioid detox.
Jails are not treatment centers, but jails outnumber rehab facilities in many areas of the United States. In many cases, they are the best facilities available for housing and medicating men under civil commitment orders for opioid addiction. Although a jail may not seem like an ideal environment for addressing substance abuse, jails actually stand at the forefront of the fight against illegal drugs. According to Peter J. Koutoujian, the Sheriff of Middlesex County, Massachusetts, about 80% to 90% of all jail inmates have a problem with alcohol or drug abuse, and about 40% of first-time jail inmates detox from illegal drugs while incarcerated.
Jails are also increasingly providing buprenorphine, methadone, and other medications which suppress opioid cravings. Nationwide, about 10% of jails use medication to treat inmates for addiction. In the words of Dr. Robert Spencer, correctional medical director for San Mateo County, California, jails have “an opportunity to provide an intervention and a possible way forward” to help inmates achieve sobriety.
The Hampden County Jail Treatment Program
Since some jails already serve as unofficial treatment centers across the country, Hampden County, Massachusetts started a program last year to dedicate part of its jail to treating addicted men. Although fatal opioid overdoses declined statewide in Massachusetts from 2017 to 2018, they still increased in Hampden County. This prompted Sheriff Nick Cocchi to establish the Stonybrook Stabilization and Treatment Centers program. As of now, the part of his jail which hosts the program is the only place in western Massachusetts where men can go when courts order them to report for opioid addiction treatment.
The men in the program are not prisoners and they are not serving time for criminal activity. They do live in the jail for a few weeks under the supervision of jail guards, but separately from the actual inmates. Once they fully detox from opioids, they leave the jail and go to a nursing home where treatment professionals provide them medications and counseling to keep them on the path toward recovery. Men stay in the program, which includes time at the jail and time at the nursing home, for an average of 47 days. Since the program started in May 2018, over 850 men have completed it and less than 5% have relapsed and returned. The apparent success of the program resulted in the Massachusetts state legislature apportioning $1 million to continue funding it as part of the state’s 2019 budget.
Why Is There Opposition To This Program?
The program has weathered some criticism from people who are concerned about stigmatizing addicts and wasting state resources. Bonnie Tenneriello, a Prisoners’ Legal Services attorney, questioned why “we [are] giving money to a sheriff to run treatment programs rather than funding civilian treatment.” She has also claimed that housing addicted men in jail only reinforces the idea that addicted men are criminals or that addiction is a moral failing. Additionally, other opponents of the program have disputed whether compulsory treatment for addiction is actually effective.
Tenneriello’s organization recently filed a class-action lawsuit to force the state of Massachusetts to release all men under civil commitment from jails and prisons. The lawsuit arose after ten men claimed that they suffered maltreatment while they were participating in an addiction treatment program in a state prison, not in the Hampden County Jail. Women who have opioid addictions are also subject to civil commitment in Massachusetts, but they always go to rehab facilities. Only men go to jails for addiction in Massachusetts.
Sheriff Cocchi dismissed these objections. In reference to treating men for addiction in western Massachusetts, he said, “let us continue doing what we’re doing. No one else is doing this work out here, but we’re doing it, and we’re doing it well. Why shouldn’t we be applauded and supported?”