Save Lives, Avoid Liability: Managing Substance Withdrawal in Jails

More than 60% of persons detained in jails have a substance use disorder, compared to 5% in the general population[1]. When these persons abruptly stop using substances, they often undergo withdrawal. Left untreated, persons withdrawing from substances - many of whom also have other medical and mental health problems - can quickly develop serious health complications, sometimes resulting in death.

Under the Fourteenth Amendment and the Americans with Disability Act, pretrial detainees cannot be denied reasonable health care and appropriate medications for substance use disorder and withdrawal. Municipalities are seeing an increase in lawsuits, including wrongful death claims, alleging inadequate health care, often resulting in large settlements or judgments against sheriffs, correctional staff, and healthcare staff.

Municipal officials and jail administrators can save lives and mitigate the risk of liability by working with jail health care providers to develop and implement jail policies, procedures and training to properly recognize, manage and treat persons at risk of experiencing substance withdrawal and those who are going through withdrawal. A good place to start: Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Governmental Officials, Jail Administrators, Correctional Officers, and Health Care Professionals published in June 2023 by the U.S. Department of Justice[2].

Devised by clinical experts (including substance use disorder specialists) with experience in criminal justice settings in collaboration with experts in jail administration, these comprehensive guidelines rely on evidence-based medical practices and account for the practical constraints under which jails operate. While the guidelines cover topics on substance-specific withdrawal management common to all jails, small jails or jails with limited resources will also find useful recommendations on how to meet the standard of care for managing substance withdrawal.

The key components of effective policies for managing persons at risk for substance withdrawal include:

• Intake screening to flag withdrawal risk. All persons admitted into jail should be observed and screened by healthcare staff or well-trained corrections staff to identify persons at risk of or experiencing substance withdrawal. This is crucial for identifying persons in need of immediate clinical assessment and those who need to be closely monitored for the emergence of signs of withdrawal.
• Clinical assessment and diagnosis. Healthcare staff should evaluate the person to gauge the risk and expected severity of withdrawal and complications based on the person’s medical and mental health conditions and history. This helps determine whether the jail can manage the the withdrawal process onsite, or whether the person should be transferred to a higher level of care.
• Withdrawal management by healthcare professionals. The level of care, including medications, should be appropriate for the level of severity of the withdrawal and the potential for health complications.
• Monitoring for withdrawal signs and symptoms. Because the onset and intensity of withdrawal is unpredictable, all persons at risk of withdrawal should be monitored frequently by corrections staff and healthcare staff in consultation with a physician.
• Training. Corrections staff should be well trained to recognize signs and symptoms of withdrawal and know when to immediately transfer the person to an external facility.

[1] https://sheriffs.org/publications/Jail-Based-MAT-PPG.pdf; https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf

[2] https://bja.ojp.gov/news/new-resource-guidelines-managing-substance-withdrawal-jails

*The views and opinions expressed in the Public Risk Management Association (PRIMA) blogs are those of each respective author. The views and opinions do not necessarily reflect the official policy or position of PRIMA.*