Jails as Drug Treatment Centers

As the nation's opiate epidemic continues to worsen – preliminary figures for 2016 show 59,000 overdose deaths nationwide, up 19% from 2015's record total – states are getting desperate for solutions. Some are trying approaches that would never have been considered a decade ago, for example Kentucky's experiment with installing full-fledged drug treatment centers in jails:

The sheer dimensions of the opiate-addiction epidemic are forcing new ideas. One of them, now being tried extensively in Kentucky, is jail not as a cost but as an investment in recovery. Jails as full-time rehab centers — from lights on to lights out.

Jailing addicts is anathema to treatment advocates. But as any parent of an addict can tell you, opiates are mind-controlling beasts. A kid who complained about the least little household chore while sober will, as an addict, walk through five miles of snow, endure any hardship or humiliation, to get his dope.

Waiting for an addict to reach rock bottom and make a rational choice to seek treatment sounds nice in theory. But it ignores the nature of the drugs in question, while also assuming a private treatment bed is miraculously available at the moment the addict, who is usually without insurance, is willing and financially able to occupy it. The reality is that, unlike with other drugs, with opiates rock bottom is often death. . . .

Jail may in fact be the best place to initiate addict recovery. It’s in jail where addicts first come face-to-face with the criminal-justice system, long before they commit crimes that warrant a prison sentence. Once in custody and detoxed of the dope that has controlled their decisions, it’s in jail where addicts more clearly behold the wreckage of their lives. And it is at that moment of clarity and contrition when they are typically plunged into a jailhouse of extortion, violence and tedium.

In the red state of Kentucky, a relentless opiate-addiction epidemic is changing long-held dogma about how to deal with addicts. Families who once supported a “throw away the key” approach to addiction are thinking differently now that their loved ones are strung out. Kentucky is also the only state that elects its jailers. This gives them more autonomy than their counterparts elsewhere. It also inspires more budgetary accountability to voters, and thus an acute awareness of the costs of cycling inmates in and out and back in again.

Kenton County is among the latest of two dozen Kentucky county jails that have started full-time “therapeutic communities” aimed at rehabilitation within their walls, providing inmates the services that private treatment centers offer on the outside. Much of the impetus has come from the state’s Department of Corrections, which a decade ago began transitioning its prisons away from pure lockups to providing drug treatment.

It will take years to find out how well this works, but meanwhile it certainly seems worth trying to me.