Editor’s note: The following story was reported by The Utah Investigative Journalism Project in partnership with the Daily Herald.

Many incarcerated Utahns still have a hard time getting their hands on addiction medication, even during the opioid epidemic.

“It’s a feeling that is, I think, indescribable to most people who’ve not experienced (withdrawal). It feels like the worst anxiety and panic attack that you’ve ever had in your life,” Dr. Elizabeth Howell said. She’s an addiction psychology and medicine specialist at the University of Utah.

“The symptoms make people feel like they’re going to die,” Howell said. “You feel like you’re going to crawl out of your skin. People are just absolutely miserable when they’re in opioid withdrawal.”

Luckily, there are highly effective medications in treating opioid withdrawals, the most important being methadone and buprenorphine. These medications work to ease withdrawal symptoms — shakes, chills, muscle spasms, panic attacks — as well as reduce opioid cravings. They bind to the same receptors as drugs like heroin or oxycodone.

These medications, however, can be difficult to obtain for people who are incarcerated. Records from some Utah jails show that the quality of withdrawal care can be markedly different from one county to another.

One example: While Salt Lake County jail provides methadone to some inmates (roughly 446 administrations from the start of 2020 to September 2023), neighboring Utah County doesn’t provide it to anyone.

Howell said that although opioid withdrawals are not usually life threatening, leaving jail without treating a drug use disorder very much is.

“The risk of overdose death is huge when someone leaves the incarcerated situation,” Howell said. “One reason for that is you’ve not been using for a while and you’ve lost some of your tolerance. And if you’ve lost your tolerance, then you are at high, high risk of overdose death.”

“Their underlying addiction has not been treated. They’ve just gone through withdrawal, which is not treatment for addiction,” Howell said. That lack of treatment puts people in serious danger – and can also put jails in legal jeopardy.

A lesson hard learned

Lack of access to methadone isn’t just detrimental to addiction treatment; some legal experts say it infringes on the rights of people with addictions.

“Legal Action Center has long argued that the failure to provide this medication to people who are incarcerated violates the Americans with Disabilities Act and other federal anti-discrimination laws, as well as the constitutional right to be free of cruel and unusual punishment,” said Sally Friedman, the senior vice president of legal advocacy at Legal Action Center.

Prison Policy Initiative, a nonpartisan think tank concerned with incarceration, reports that only 24% of U.S. jails continue a medication-assisted treatment, or MAT, for people who already were on one before they were incarcerated. That number drops to 19% for people who weren’t on medication. In most cases, an MAT is required to administer methadone.

Friedman said there are two major reasons that methadone isn’t available as a treatment option in most jails across the country.

“There’s enormous stigma against people who have substance use disorder, especially if they inject drugs. And so, it’s not viewed as a medical issue,” Friedman said.

“There is also the potential that they’ll be diverted for unauthorized purposes. And so people in the jails or prisons will sell their methadone or buprenorphine. And what prison officials don’t understand is that the reason that people have smuggled in, let’s say, methadone or buprenorphine for years is because they don’t provide it,” Friedman said.

Administrative hassle also keeps jails from easily adopting methadone into their treatment plan.

Dr. Andrew Klein, a senior scientist for criminal justice at Advocates for Human Potential, helps jails set up methadone treatment programs.

“In order to offer methadone in your jail, you either have to become an OTP (opioid treatment program), which means you have to be certified by (federal and state agencies). Or what you can do is you can become a satellite clinic and you partner with a preexisting OTP,” Klein said.

This can be a big hurdle for some organizations, but not impossible.

“It’s certainly doable. The jails in Massachusetts were given six months to do it. They all were able to do it within six months,” Klein said.

One of the reasons that change occurred so quickly was due to successful lawsuits against county jails for their failure to provide methadone.

However, Klein said stigma and outdated mindsets about addiction also contribute to lack of treatment.

“A lot of sheriffs believe that the more agonizing the withdrawal is, the better the lesson will be. It will convince people not to do drugs when they get out because they don’t want to have to go through withdrawal again,” Klein said.

Howell said it doesn’t work like that.

“Most people I’ve treated have gone through withdrawal numerous times, but it has never been a deterrent for them to use again,” Howell said.

Moving toward methadone

Dale Bench, the health services administrator for Utah County jail, said the county wants to set up an MAT, which would allow it to provide methadone to inmates.

“I’m in charge of making sure the patients all have the quality of care to a level that’s constitutionally mandated,” Bench said. “Offering a medication that will help them not go through severe withdrawals, for their health and their mental stability, that’s beneficial. So our motivation for it is just better care.”

While the motivation for starting an MAT is simple, implementing one isn’t easy.

“You have to have a provider that understands the medications, that understands the health of an addict and withdrawals. You have to educate your staff to understand the treatments and the importance of … controlling the actual medication,” Bench said.

It’s unclear how many people going through Utah County jail would benefit from an MAT. However, it’s likely a significant portion of the jail’s population: Prison Policy Initiative estimates that roughly half of Americans in state prisons have a substance use disorder.

For Bench, addiction medicine already accounts for a significant portion of the care that Utah County jail provides.

“A lot of our care that we deliver here is helping those that are having withdrawals. … So we don’t just let them withdraw without any assistance. And so there’s certain medications that our provider will prescribe and we will give,” Bench said.

Those medications include ones for managing symptoms like nausea and vomiting, as well as some medications for more severe withdrawals.

“But the severe withdrawals, we do have medications that we do. We like to do (buprenorphine). And then we also do clonidine, which helps with their blood pressure,” Bench said.

Utah County records indicate from January 2020 to August 2023, the jail administered buprenorphine 2,559 times. Clonidine is used to treat high blood pressure in a variety of patients and was administered 48,918 times in the same time frame.

Despite the availability of those medications, the lack of methadone still worries experts. One of the big reasons for that is fentanyl.

“Now that fentanyl is so ubiquitous, we might in some people precipitate worsening withdrawals (with buprenorphine)” Howell said.

This means that for people who’ve used fentanyl, buprenorphine may not be enough and could even bring on more severe withdrawals.

“This is actually a hot topic in the addiction field right now, (what) is the best way … to do withdrawal for people who’ve been using fentanyl. We have proponents of several different methods and they can all tell you that their method is the best. And some will say you need to use methadone,” Howell said.

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