Legislative Analysis and Public Policy Association  |  July 7, 2021

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Substance-related deaths and injuries among individuals in custody are a pervasive issue within correctional settings. A recent report from the Bureau of Justice Statistics (BJS) found that drug and alcohol intoxication deaths in custody more than quadrupled from 2000 to 2018. Individuals in custody who died of drug or alcohol intoxication had served an average of one day in jail prior to death. Moreover, untreated withdrawal exacerbates the risk of suicide, which was the leading cause of death in local jails as of 2018.

Medical intervention for individuals in custody is often times needed to mitigate the effects of withdrawal symptoms and prevent death. Through proper withdrawal assessment and management, correctional settings can play a pivotal role in addressing mental health disorders and substance use disorders (SUD).

In response to the growing deaths in custody as a result of SUD in correctional settings, the O’Neill Institute’s Addiction and Public Policy Initiative worked in collaboration with the Legislative Analysis and Public Policy Association (LAPPA) to develop the Model Withdrawal Management Protocol in Correctional Settings Act. This model state law is intended to provide state legislatures and policymakers with a comprehensive and evidence-based framework to better respond to withdrawal symptoms and related mental health crisis of individuals in custody and decrease mortality while in correctional settings.

Under this model act, states are required to ensure correctional settings implement a comprehensive withdrawal management protocol for initial and ongoing screening, assessment, and medical management of withdrawal from all substances, including alcohol. These protocols include procedures that ensure individuals in custody are properly screened, assessed, and treated immediately upon entry. Procedures must also include referral systems for individuals in custody that seek medical attention for needs related to intoxication or withdrawal.

The model act also requires that correctional settings provide ongoing training and education for correctional staff and health-trained personnel on administrative and clinical protocols to ensure evidence-based care is provided to individuals during their confinement. As such, correctional staff are required to receive training that allows them to better recognize the signs and symptoms of withdrawal, and to know the procedures for communicating withdrawal concerns to appropriate health-trained personnel.

To monitor and evaluate the efficacy of the implementation of withdrawal management protocols, the model act requires states to submit a yearly report that includes data collected from correctional settings. Examples of data elements that are to be included in the report are number of deaths in custody due to substance-related incidents, information about withdrawal management and substance use screening, assessment, and treatment of individuals in custody, and costs savings resulting from the implementation of management protocols.

Correctional settings lie at a key point of intersection for addressing mental health disorders and substance use. The implementation of the model act in correctional settings can help prevent substance related injury and death by addressing SUD and mental health, right at the individual’s arrival to the correctional facility. Moreover, continuous training and education by correctional staff and healthcare professionals can help effectively implement the model act, and better serve individuals with an evidence-based, trauma-informed framework throughout their incarceration.

Read the report here.

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