Allegheny County Jail must provide medications for those with opioid use disorder, DOJ says

PITTSBURGH — The Allegheny County Jail has agreed to offer treatment for people incarcerated who have opioid use disorder (OUD) with any FDA-approved medication, the Department of Justice said.

According to the Department of Justice, the medications will be given to those booked into ACJ whom such treatment is medically appropriate.

The Department of Justice also said the jail will pay $10,000 to an individual who’s allegedly denied access to methadone in violation of the Americans with Disabilities Act, which prohibits state and local governments from discriminating against people with disabilities and protects those in recovery from OUD, including individuals who are taking OUD medication at the direction of a medical provider.

“Too many individuals with opioid use disorder cycle in and out of jails because they can’t find a path to recovery,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “This agreement will ensure that Allegheny County Jail provides access to medications that can help break that cycle. These effective, evidence-backed treatments provide viable paths to recovery for those struggling with substance use disorders and help our communities begin to heal.”

The three-year agreement will see Allegheny County implementing new policies and personnel training programs to ensure that people with OUD who are booked into ACJ receive medically appropriate treatment for their disability.

“Allegheny County, like so much of the country, has been hit hard by the opioid epidemic,” said U.S. Attorney Eric G. Olshan for the Western District of Pennsylvania. “This agreement ensures that effective OUD treatment will be available to those in Allegheny County who need it most. We appreciate the county’s cooperation in reaching this agreement and look forward to continuing to collaborate in making improvements to ACJ and demonstrating what other jails and prisons must do to address the needs of individuals with opioid use disorder and comply with the ADA.”

According to the Department of Justice, the county will medically evaluate people for OUD at the beginning of their incarceration. This will ensure that individuals who are receiving OUD medication from a licensed treatment provider before they were booked will continue on that medication.

The county will also offer all individuals with OUD booked into the jail the option to receive treatment with any FDA-approved medically appropriate OUD medication, even if they were not being treated with that medication before their incarceration.

Allegheny County will not change or discontinue an individual’s use of a particular OUD medication unless doing so is based on an individualized determination by a qualified medical provider. The county also will not use incentives, rewards or punishments to encourage or discourage individuals at ACJ from receiving any particular OUD medication, the Department of Justice said.

The Allegheny County Jail administration released the following statement in response:

The work outlined by the Department of Justice agreement is work that has been underway for some time, and an effort that we have publicly reported on during that process. This agreement solidifies that work and sets definitive time frames for when the program will be up and running.

Currently, the Allegheny County Jail (ACJ) provides certain medications used to treat opioid use disorder (OUD) for anyone who is admitted to the facility that has a verified script from the last 30 days. Also known as continuations, the following four medications are currently offered:

• Methadone (started October 2022)
• Suboxone
• Sublocade
• Subutex

For individuals who do not have a verified script, starting them on MAT, also known as induction, has been in progress. Pregnant females who enter the jail have always been inducted on Methadone or Subutex. Similarly, induction for alcohol use of naltrexone and vivitrol has been provided for years.

The transition to allowing broader induction has taken some time to ramp up. Currently, six (6) out of 10 new substance use recovery nurses (SURN) have been hired for this expansion. They are currently undergoing training and are expected to start screening patients mid-December. Individuals who are arrested and held in intake who meet criteria for opioid use disorder, and express their interest in induction, will be assessed and their urine drug screen referenced. Where there is patient interest, they would be assessed to see if they meet criteria for opioid use disorder. If they are still interested in MAT, the SURN will then schedule the patient at the Addiction Medicine Provider’s next available clinic day (usually about 1-2 weeks). The provider will discuss dosage with the patient and determine what dose to start them on.

Methadone induction will be the next step in this process with an RFP issued to obtain a methadone provider with the goal to induct methadone by October 2024

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