With their thin mattresses, small cells, and mediocre food, jails are uncomfortable places for any person to spend time. But if you’re coming down off an addictive drug like heroin with no fix in sight, the hard beds and lack of privacy is even more hellish. Withdrawal from opiates — often called dope sickness — is agonizing.
“I would experience a sickness so terrible I would do almost anything to prevent it: cold sweats, nausea, diarrhea, and body aches, all mixed with depression and anxiety that make it impossible to do anything except dwell on how sick you are,” local journalist Brian Rinker writes in Kaiser Health News.
Detoxing cold turkey is excruciating, miserable, and entirely unnecessary. Pharmaceutical drugs such as buprenorphine and methadone can help slowly wean people off opiates in a more humane manner, by limiting cravings and withdrawal side effects. Naltrexone provides similar relief for both people who use opioids by blocking opioid receptors, and can assist those who are chronic users of alcohol.
These solutions have been around for years, but up until now, medication-assisted treatment (MAT) has been reserved for only a few select institutions. A handful of California prisons launched programs in 2017, but county and city jails have yet to receive state funding for the medication and treatment, despite that’s arguably where it’s most needed due to higher turnover. When people who use drugs are locked up, they emerge days, weeks, or months later with a weaker tolerance. If they use the same amount that they used to, there’s a high risk of fatal overdose.
Assemblymember David Chiu hopes to change this. On Tuesday, he announced Assembly Bill 1557, which would allocate state funds to any jail who wants to participate in a three-year medication-assisted treatment pilot programs.
“We can’t expect individuals struggling with addiction to treat themselves while incarcerated,” Chiu says. “Increasing access to proven, medically assisted treatment programs will help reduce recidivism and substance use across California.”
The Drug Policy Alliance has been fighting for these treatment options to be available in jails and prisons for years. “People with substance use disorders, including opioid use disorder, deserve access to treatment wherever they are,” Laura Thomas, their deputy state director for California, tells SF Weekly. “It is among our moral failings as a society that we deprive people who are incarcerated of treatment for their substance use and mental health issues.”
It’s a method that’s had proven success. The Rhode Island Department of Corrections has seen a 61-percent drop in overdoses among recently released detainees, and thus, a 12-percent drop in overdose deaths statewide. And it’s a valuable opportunity to offer substance-use treatment to people who may not have had the option to visit a doctor or pay for a stay in rehab, potentially breaking the cycle of addiction and recidivism.
The bill has also won the support of San Francisco Mayor London Breed, whose sister died of an overdose, and whose brother is currently in prison. “To help those suffering from addiction, we have to meet them where they are with proven, effective treatments, whether that means doing outreach on our streets or in our jails,” she says. “If we can get people help while they are incarcerated, we can reduce the number of people in our community struggling with substance-use disorder.”
San Francisco’s Department of Public Health has a long history of supporting harm reduction efforts for people who use drugs, and despite not having state funding for MAT in its jails, has been operating them for years with money from the city’s General Fund. That said, the limited funding has affected the scope of what jail health services can institute. Methadone treatment is provided for 250 patients a year, and buprenorphine for 600 patients — the latter at a cost of $46,000 annually.
While AB 1557 does not come with a set budget for county programs, there is a desire among San Francisco’s jail health workers to expand the scope of treatment, both to reach more people, and keep them on the medication for longer — not just for the unpleasant detox period.
“This bill is a strong step in the right direction and recognizes the San Francisco jail health system’s foresight in providing not just methadone access but buprenorphine induction and treatment for people who are incarcerated here,” Thomas says. “Until we fully decriminalize drug use, we must provide this level of care. I hope that this bill passes and that other county jail systems choose to provide treatment as well.”
The California Assembly will hear the bill in April. If approved, San Francisco’s jail could receive state funding to enhance its current MAT programs by Jan. 1, 2020.