As fentanyl use increases, the Clark County Jail is grappling with more people experiencing withdrawal from drug use while in custody.
An estimated 3 in 4 inmates there have opioid use disorder — almost 3,000 a year, said Anna Lookingbill, jail transition manager.
The jail’s medication-assisted treatment program for inmates withdrawing from opioids ended last year after budget cuts. Now, jail officials are looking to resurrect the program.
“We know we don’t have the funding or the medical capacity or the bandwidth to treat all that need,” Lookingbill said. “We’re not there yet.”
Fentanyl, an opioid often smoked in the form of powder or pills, has flooded Clark County since the pandemic. Between 2018 and 2022, the number of fentanyl-related overdose deaths rose by about 500 percent, according to county data.
The drug is highly addictive and stopping use causes severe symptoms, including dysphoria, vomiting, diarrhea and fever. Treatment with such medication as buprenorphine or methadone can help sustain recovery.
Inmates who have already been prescribed opioid treatment medication can continue their medication while in jail. That’s happening more frequently than it used to, Lookingbill said.
“That really is a testament to the availability of medication-assisted treatment in Clark County. We’ve seen tremendous growth,” she said.
However, if someone isn’t already on the medication to keep them from withdrawing, the jail can’t start them on treatment medication (unless they’re pregnant). When jail staff notice someone suffering from withdrawal, they alert the medical team, Lookingbill said.
Withdrawal can be insufferable. The symptoms come on quickly and intensely and can last a week, according to American Addiction Centers.
Last year, a 24-year-old man killed himself in the Klickitat County Jail while experiencing fentanyl withdrawal. The jail does not provide medication-assisted treatment.
Clark County Jail officials hope to receive funding for medication-assisted treatment from the Opioid Abatement Council, which manages settlement money the county received by joining other local governments in a lawsuit against opioid distributors, manufacturers and national pharmacy chains.
Lookingbill said receiving that funding would make the jail the first in Washington to have a certified opioid treatment program — again.
The jail once had the ability to start medication-assisted treatment for inmates and acted as a branch site of Vancouver Comprehensive Treatment Center, an outpatient treatment service. The program lasted from March to June 2023 before budget cuts curtailed it, Lookingbill said.
“We’re really hopeful to get this additional funding, so that we can actually have jail be a place that people are able to start on those opioid use disorder medications supervised by medical personnel,” she said.
However, the jail is facing the same problem it was when it first applied to be a branch site for treatment: It doesn’t have room.
“We have one little program space we use for everything,” Jail Services Director David Shook said.
When Columbia River Mental Health Services, a treatment center, considered partnering with the jail in 2019 for a treatment program, the nonprofit said it would need an appropriate space to dispense the medications.
Now, the jail will have to figure out how to overcome the same barrier. There are plans in the works to expand the jail by opening a new medium-security housing facility by the end of 2025.
If the jail does receive funding, which would happen around July, the opioid treatment program would also include peer support from someone with experience of opioid use disorder or incarceration.
The jail currently helps people receive housing assessments and food stamps, Lookingbill said. People undergoing opioid treatment while in jail are provided with naloxone — an opioid overdose reversal medication — upon their release. Last month, the jail installed a naloxone vending machine in its lobby.
People are more at risk of a drug overdose after leaving jail because their tolerance has decreased, said Dr. Alan Melnick, Clark County Public Health director.
“The biggest risk for overdose is two weeks after getting out of jail,” Melnick said in August during a roundtable discussion on fentanyl. “Because you go into jail, you get detoxed, you’re taken off your medications, and then you go out and use the same amount (of drug) you were using before and die.”
Lookingbill said the jail connects inmates with services in the community so they will be successful when they’re released and won’t have to return. However, a more important goal for Lookingbill is keeping people alive once they leave.
“The reality of fentanyl is that we know incarcerated populations die at a significantly higher rate post release from the facility,” she said. “It’s important, and it’s absolutely public safety aligned for us to try to help people stay alive and then have opportunities to seek care and to seek treatment.”
