Fatal drug overdose is the fastest growing cause of death in jails, with the median time served before a drug or alcohol-related death being just one day. [1] Many of these overdoses are caused when individuals ingest drugs during arrest, either to try and conceal evidence or to get “one last hit” before being booked in. A person is not fit for confinement if they enter jail and die from overdose within 24 hours — but how can we know if they don’t tell us at intake? Facilities should be working to identify and treat individuals for substance use issues before booking them into the jail.
Contraband control: Body scanners and immunity
Some jails have attempted to curb overdose and contraband by implementing body scanners or strip searches at intake. Despite readily available grants and funding for body scanners, some facilities remain hesitant to adopt body scanners due to perceived hassle or additional intake steps. [2] Many sites have also abandoned strip searches in fear of prosecution or because officers are not comfortable performing them. [3]
To prevent substances from entering the jail, some jails are offering individuals immunity for possession prior to entering the booking area. The deal being that a person can willingly turn over any illegal substances prior to intake without additional charges, but past that point they will be charged for introducing contraband to the jail. This strategy may deter people from ingesting drugs to conceal evidence, however the individual who wants that last hit likely isn’t considering the charge when they take drugs during arrest. Ultimately, a person struggling with addiction may attempt to conceal the drugs anyway if it means an opportunity to use during incarceration.
While a step in the right direction, even with body scanners and strip searches in place, there is no way to identify how much of a substance has been ingested or if overdose intervention is appropriate. Cutting down on contraband helps prevent overdose after intake but does little to intervene in the moment. During these first critical hours, that may mean the difference between life and death.
Screening challenges: Self-reporting fails
People enter jail with no health information, meaning correctional healthcare professionals rely on self-reporting and intake screening questions to determine if an individual is fit for confinement. If a person does not disclose substance use or lies about it, it is impossible to treat it. The medical team has few other options to know to connect a person with the appropriate overdose, withdrawal, detox, or addiction care.
Self-reporting is a notoriously unreliable method of determining past substance use, as people are reluctant to report drug use due to stigma and fear of additional charges. Even in a survey where participants were told they would take a drug test afterwards, more than half of the participants who tested positive to cocaine or heroin lied about using the substances during intake screening. [4]
Drug testing: A lifesaving tool
Drug testing on arrest (DToA) has been in place in the United Kingdom since 2003 and has been shown to reduce drug use and drug-related arrests. [5] Since 2021, over 90% of positive tests in the UK have resulted in referrals for assessment to determine treatment. Of those referrals, over half went on to receive treatment. [6] By contrast, only 10% of people with diagnosed substance use disorders in U.S. state prisons received treatment in 2021. [7] This doesn’t even factor in the many incarcerated individuals with undiagnosed substance use issues.
Implementing drug testing at intake would allow for immediate intervention and targeted support based on the amount and type of substances found in a test. It is often a condition of bond to submit to drug testing already, however positive tests can lead to additional charges or probation/parole violations. These deterrents act as barriers to people seeking addiction care in the jail. Similar to how contraband can be handed over prior to intake, drug testing can be implemented before booking to determine if a person is fit for confinement or if medical intervention is appropriate before continuing.
For drug testing at intake to be effective, there should be immunity for positive tests. The purpose of drug testing at intake is to save lives by connecting people to treatment. Drug testing may be done by a nurse at intake or pre-intake determine appropriate care, and the result treated as protected health information (PHI) under HIPAA. This would not prevent the records from being subpoenaed against the individual, however, and additional legislation will be key to ensuring that proper immunity is granted for individuals seeking life-saving addiction care in jail.
References
1. Wang L. (2021.) Rise in jail deaths is especially troubling as jail populations become more rural and more female. Prison Policy Initiative.
2. Police Grants Help. (2018.) How to fund drug detection and interdiction equipment for prisons and jails. Corrections1.
3. Egan P. (2023.) Michigan prison officers protest new strip-search policy for transgender inmates. Detroit Free Press.
4. Hunt D, et. al. (2015.) Telling the Truth About Drug Use: How Much Does It Matter? Journal of Drug Issues, 45(3), 314-329.
5. Ministry of Justice. (2017.) The effect of drug and alcohol treatment on re-offending. Gov.UK.
6. Home Office. (2024.) Summary: Drug Testing on Arrest (DToA) programme. Gov.UK.
7. Widra E. (2024.) Addicted to punishment: Jails and prisons punish drug use far more than they treat it. Prison Policy Initiative.
About the author
Spark Training is a nationally recognized center of excellence that sets the standard for training and compliance through high-quality programs and quality improvement. Recently awarded Best Correctional Training Company 2024 – USA in the sixth annual Education and Training Awards hosted by Corporate Vision.