Why One Alaska Clinic Is Giving Addiction Treatment Before People Go to Jail

A small tribal clinic in Alaska is taking an unusual approach to preventing overdose deaths: giving people addiction treatment shots before they go to jail. The Ninilchik Community Clinic serves both tribal and non-tribal patients on Alaska's rural Kenai Peninsula, where staff have witnessed firsthand how incarceration can derail recovery and lead to fatal overdoses.

Federal data released by the Biden administration revealed a sobering reality: up to 1 in 4 overdose deaths nationally in 2021 involved people recently released from jail or prison. This makes formerly incarcerated individuals among the most vulnerable populations for drug-related deaths.

What Makes Recently Released Inmates So Vulnerable to Overdose?

The science behind post-incarceration overdose risk is straightforward but deadly. When people with opioid use disorder are incarcerated without proper medication treatment, their bodies lose tolerance to opioids in as little as two weeks. Dr. Sarah Spencer, who works at the Ninilchik clinic, explains the danger: "There is no population that's at higher risk than people who have been recently incarcerated. And a big part of that is because it only takes two weeks for people to lose their tolerance to opioids."

This creates a perfect storm for overdose when people are released. Their bodies can no longer handle the same amount of drugs they used before incarceration, making even familiar doses potentially fatal. Many studies have shown that medication for opioid use disorder makes recovery more likely and reduces the risk of overdose death.

Tips for Implementing Pre-Incarceration Addiction Treatment Programs

Alaska's Department of Corrections (DOC) currently provides limited addiction treatment options for inmates. According to their email response to questions, they only give short-term medication treatment to people who were already receiving it before incarceration, and no one gets treatment past 30 days unless they're pregnant. Upon release, some people receive a list of treatment providers they can contact.

This approach falls short of best practices, according to healthcare providers. The current system creates several challenges for people struggling with addiction:

• Treatment Interruption: People already receiving medication-assisted treatment have their care abruptly stopped after 30 days, potentially triggering withdrawal and cravings
• Limited Access: New patients cannot start treatment while incarcerated, missing a crucial opportunity to stabilize their condition during a controlled environment
• Inadequate Transition Planning: Released individuals must navigate finding treatment providers on their own, often without immediate access to life-saving medications

One patient, identified only as "H" to protect her privacy, experienced this treatment gap firsthand. She says the Alaska Department of Corrections denied her medication during a previous incarceration, and she started using illicit opioids again when she got out. "It happens superfast. You run into people. You see people. It's just - there's a thousand different ways," she explained.

What Does Successful Prison-Based Treatment Look Like?

Rhode Island offers a compelling model for comprehensive addiction treatment in correctional facilities. In 2016, the state began offering treatment for substance use disorders to anyone eligible in Department of Corrections care. The results were dramatic: within a year, there was around a 60% reduction in overdose death rates among people recently incarcerated.

Dr. Jennifer Clarke, who developed Rhode Island's program as medical director at the state's Department of Corrections, describes the transformation: "I heard multiple times - people would tell me, this was the first time I could really participate in the behavioral therapy." Before the program, she felt like she was "practicing medicine with one hand tied behind my back."

However, implementing such programs isn't simple. Clarke notes that Rhode Island's program required $2 million in funding to start, backing from the governor, and had to overcome logistical hurdles and stigma. "I was called, frequently, a drug pusher," she recalls, adding that she relied on data and science to convince skeptical medical staff.

Despite Rhode Island's success, other states have been slow to adopt similar programs. A recent study in the Journal of the American Medical Association representing over 3,000 U.S. jails found that fewer than half offered some access to medication for opioid use disorder.