Camden County reduced overdoses among people in jail by offering medication for addiction

Hours after her release and just six block away from the Camden County jail, Crystal Quigley overdosed.

During her seven-day stay at the jail in 2020, Quigley had declined to participate in a newly launched addiction treatment program there. She had figured it wasn’t enough time to seriously consider starting treatment for her opioid addiction. But her brush with death immediately upon release demonstrated how dangerous the transition out of jail can be for people with addiction.

Two years later, Quigley found herself in the jail again. This time, she decided to try a long-lasting form of an opioid-based addiction medication. She’s been in recovery ever since, working a full-time job and taking entrepreneurship classes in the hopes of opening a recovery home for women in Camden.

“My life now is just completely different,” she said. “And I appreciate [the jail’s medication program], because they played a big part in helping me get to where I am.”

In part because of stories such as Quigley’s, the Camden jail’s addiction treatment program has been touted as a national model. Now, a new report released last month by the Camden Coalition, a local health care nonprofit independent from the jail, has found that participants in the program are significantly less likely to overdose in the year after their release than those who don’t participate.

“What stood out to us was actually to see on paper that we were having a positive effect,” said Sharon Bean, the jail’s population manager. “To be able to have that to support the program was really important to us.”

In February 2019, the Camden jail became the first in the state to offer all three medications available for opioid addiction. Upon admission, people in the jail can start taking buprenorphine, an opioid-based medication, or naltrexone, an opioid-blocking medication. In addition, patients who were previously taking methadone, another opioid-based medication, can continue taking it in jail.

The goals were twofold: Encourage more people to enter treatment, and help them to avoid an overdose when they’re released. Quitting opioids cold-turkey, as people incarcerated in Camden were forced to do before the program was launched, can cause people with addiction to lose their tolerance. Those who return to using drugs are at a higher risk for a fatal overdose, especially given the rise of the deadly synthetic opioid fentanyl.

Comparing people who participated in the treatment program with those who did not, the report found that 4.3% of participants overdosed in the first 30 days after their release, compared with 6.8% of nonparticipants, a difference that researchers consider notable, if not statistically significant.

Program participants were 41.2% less likely to overdose by the six-month mark, and 38.5% less likely to overdose by the year mark, the report found. (The report did not differentiate between fatal and nonfatal overdoses.)

The report also highlighted racial disparities among the program’s participants. While 37.2% of those eligible for the program were Black, only 26.7% of participants in the treatment program were Black.

It was unclear why, but the study authors speculated that some jail staff could be biased against offering treatment to Black patients, a reflection of a national trend, or that patients of different races might have had different experience with addiction treatment, and might be less willing to participate.

“It’s certainly an area for us to dig deeper into and figure out what might be causing that,” Bean said.

Jail officials say the report affirms their commitment to the program, which they hope other correctional facilities will implement.

“Addiction is an illness, just like any other,” said Karen Taylor, the Camden jail’s warden. “But I can’t treat individuals that are not here; who have overdosed.”

Camden’s model, the first of its kind in New Jersey, remains relatively unusual in county jails. Though other jails in Pennsylvania and New Jersey do offer addiction medications in some form, the way it’s dispensed can vary widely. As a result, access is limited in many places.

For example, some jails permit their population to take addiction medications only if they had started them before entering jail, or offer only certain forms of treatment. Jails in Philadelphia and Montgomery Counties, however, allow people incarcerated there to begin addiction medications while serving their sentences, as Camden’s jail does.

“An example like Camden, having a warden there who’s very outspoken and really spearheading this thing, is great,” said Alejandro Alves, the technical director for the overdose prevention program at the public health nonprofit advocacy group Vital Strategies. Last year, the organization released a report on the lack of addiction treatment programs at many Pennsylvania jails.

The group wants addiction medications to be offered universally, not left as a decision for to individual jails. “When do we get leadership to step up and say that this isn’t a choice?” Alves said. “That it’s not an experiment, but a basic right?”

Kirk Stuart, who was released from the Camden jail late last month, had been living on the streets before he was arrested. He had tried Suboxone, a form of buprenorphine that requires patients to take the medication daily, but found it hard to keep up with.

“Every day, it was, wake up, go to work, remember your medication, sometimes forget it. If you don’t have it, you feel sick,” he said. “Sometimes it would get stolen, then you worry about buying it. I had no money for it.”

In the jail, he began taking Sublocade shots, which offer a longer-acting version of buprenorphine. “I was a little skeptical about it, but there’s a total difference,” he said. “I couldn’t be happier with it.”

Now in recovery, Stuart is living in transitional housing that jail staff helped him secure before his release. Local officials say that stability after incarceration, too, is crucial for program participants’ success.

“Housing, transportation, and all these other things impact people’s ability to get well,” said Victor Murray, the community engagement director for the Camden Coalition.

The medications can be expensive — Sublocade costs as much as $1,800 for a single shot — and federal law prevents Medicaid, the publicly funded health insurance program for people with lower incomes, from covering most health care in jails and prisons.

This spring, the federal government said it would allow states to apply for a waiver to use Medicaid to cover some health care costs for incarcerated people up to 90 days before their release. In August, Sen. Cory Booker (D. N.J.) introduced a bill that would allow Medicaid to cover mental health and substance use treatments for the entirety of a person’s jail or prison term.

Officials say they hope the report on Camden’s success will encourage more funding for such treatments by helping to demonstrate how they are essential to health care.

“Nobody would ever question the use of diabetic medications or hypertension medications in jails,” said Rachel Haroz, the medical director of Cooper University Hospital’s Center for Healing, an addiction treatment clinic that works with many patients who come directly from the Camden jail. “We need to get there with addiction.”