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What If He Has to Detox in Jail?

mother at table with son, he's deflated

Allies in Recovery member 123Peace is concerned about the likelihood that her son will detox from methadone in jail…

"Help – I need advice

My child has been an addict to heroin and is now on a large dose of methadone (since October). He has been in two sober houses in the last year and has had to leave due to using crack. Still using crack and staying with me.

He has been on probation and went to court recently (he tested positive for fentanol??+++) – they want to give him 2 1/2 years in jail – unless he has a plan: vivitrol, (which he tried and did not agree with him), IOP, counseling/therapy, etc.

He said he doesn’t care if he goes to jail – but just does not want to detox from methadone in jail..

Can you please let me know about detoxing off methadone in jail (medical attention, etc.)? He said that he would be so sick for months, that would consider suicide……..

Help – what if anything should I do????"

Dear 123Peace:

Did the court spell out the detail of the plan they propose: vivitrol, IOP, etc? They are not clinicians and cannot know what is best for your son.

Your son is right. Jails and prisons across this country, and even in Massachusetts where things can be more progressive, have limited protocols for addressing opioid dependency newly incarcerated inmates. If a person who is dependent on a drug lands in jail, health services are very limited in terms of medical care to help with detoxification. Methadone is probably the worst drug imaginable in this scenario.

Methadone is a long-acting opioid and can take three to four weeks to shake off both the physical detoxification and the lingering effects of the detoxification, like depression and insomnia. Being dropped from a high dose of methadone, without a careful taper, is frankly inhumane. Some jails now switch the person over to buprenorphine (suboxone) and quickly taper from that, but that in no way assures the person will be comfortable.

Just this week, I attended a chapter meeting of the Massachusetts American Society of Addiction Medicine in which this topic came up. We discussed ways to address this from a human rights, legal and/or legislative standpoint. It is a horrific situation.

Your son has the opportunity to avoid this. He needs to find and agree to an intensive long-term treatment plan. He may not be ready to stop taking drugs, but the forces around him are tightening. Assuming the court didn’t suggest exactly what the treatment should look for, here is what I suggest:

  1. He needs to tell his methadone case worker he is in trouble and needs more intensive help. They probably know this from the cocaine that is showing up in urine tests. It is their responsibility to refer him to a more intensive level of care. They should do everything in their power to get him there.

Your son may have burned some bridges with treatment providers, but there must be a place for him somewhere in the system. I suggest you call the Mass Help Line and get their suggestions (800.327.5050).

  1. Look at Module 8 and prepare yourself for a talk with your son.
  2. If your son is unwilling to go to more treatment and a jail stay is imminent, he should consider requesting a taper right away from the methadone. This is not a clinical suggestion on my part, but one based on the reality of what will happen if he goes to jail.
  3. I am going to reach out to you on email with a couple of other ideas.

I am shaking as I write this post. It is outrageous that we treat people who are sick with a brain disease in such inhumane ways. It is probably of little comfort to you now, but physicians and others in the field of addiction are increasingly concerned with the issues of opioid dependency and withdrawal within our criminal justice system. 



In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. Hello,

    My son is currently facing a similar situation. He has been on methadone for five months. He is just starting to stabilize on his dose. He has messed up on probation twice and may be placed in prison. I am really concerned about his physical and psychological health. He really detoxes hard. He becomes tachycardic, anxious, psychotic and suicidal. I cannot believe this is medically allowed! He has a brain disease of addiction and is taking a prescribed medication from a doctor. I have no problem with him experiencing some consequences of his poor choices but I expect that his life will not be endangered.

    1. I recently sat in on several conversations by doctors and researchers in Massachusetts who are very concerned about this. I am going to put our comments together and send them a copy. They are establishing a strategic plan for addressing some of the most disturbing problems in our system of care and in criminal justice settings.

  2. Hello,

    I am looking for a serious case manager? life coach? in western Mass. that would speak to my son who is on methadone, using crack/cocaine from time to time, has recently admitted to having mental health issues/depression (I was aware of this – but did not know how to approach him) and is HIV positive.

    He is looking for help – but of course in the wrong places, however I feel he would communicate with a serious, caring, and experienced person that would find him a place for his needs. He seems very serious about getting the right help and working with his mental health, depression and substance abuse. He only has MassHealth insurance. SAMHSA has been contacted, however, heard nothing as of yet.

    Any suggestions would be greatly appreciated.