Jail management of arrestees/inmates enrolled in community methadone maintenance programs

Anecdotal evidence suggests that many jails fail to adequately detoxify arrestees/inmates who are enrolled in methadone programs, but there are few empirical data. The objective of this study was to assess how jails manage arrestees/inmates enrolled in methadone programs. A national survey of 500 jails in the United States was conducted. Surveys were mailed to the 200 largest jails in the country in addition to a random sample of 300 of the remaining jails (10% sample). Jails were specifically asked about management of opiate dependency among arrestees/inmates enrolled in methadone programs. Weighted logistic regression analyses were conducted to assess predictors of continuing methadone during incarceration and use of recommended detoxification protocols. Among the 245 (49%) jails that responded, only 1 in 4 (27%) reported they contacted the methadone programs regarding dose, and only 1 in 8 (12%) continued methadone during the incarceration. Very few (2%) jails used methadone or other opiates for detoxification. Most used clonidine. However, half (48%) of jails failed to use clonidine, methadone, or other opiates to detoxify inmates from methadone. Weighted logistic regression models showed that moderately large jails and those located in the South and Midwest were significantly more likely to continue methadone. Very large jails, those with an estimated prevalence of opiate dependence of 6%-10% among arrestees/inmates, and those located in the Northeast were significantly more likely to use recommended detoxification protocols. Very few jails provided continuous treatment to arrested persons on methadone, and half failed to detoxify arrestees/inmates using recommended protocols. These practices jeopardize the health and well-being of persons enrolled in methadone programs and underscore the need for uniform national policies within jails.