Overdose deaths spike after incarceration, but Minnesota jails lack treatment

Karin Kelly had hoped her daughter's arrests could be turning points.

But Briana, who everyone called Cookie, cycled in and out of jails for years as she struggled with heroin addiction. She survived multiple overdoses.

"You hope your family member is going to get some help, and things are going to change," said Kelly, of East Bethel, whose daughter died after contracting endocarditis in 2022. "Instead ... they turn them out. They go back to using."

Minnesota's jails are filled with people who have substance use disorder, but a state survey found less than half of county jails provide medication for opioid addiction.

People go through painful and sometimes dangerous withdrawal symptoms, vomiting and shivering in jail cells. When they leave, their tolerance is low. One in five Minnesotans who died of an overdose had been incarcerated in the past year. The first two weeks after release are particularly deadly.

Corrections officials, people in recovery and state researchers say there would be fewer overdoses and less recidivism if facilities provided the medications and ensured people leaving lockup had health insurance and access to treatment. But they say the cost and staffing shortages prevent many jails from providing the help.

Medicaid funds generally can't be used to pay for someone's health care while they are in jail or prison, so the cost falls on counties and the state. Gov. Tim Walz's administration and others are pressing lawmakers to join other states applying for a federal waiver to allow Medicaid coverage of health care services, including substance abuse treatment, prior to someone's release.

Expanded access to addiction medication and mental health services could save lives, Kelly said.

"It still boggles my mind," she said of how the system treated her daughter. "It hurts me so bad that every single day I think about it, like: Why? Why? Why didn't they help her?"

Push to change 'ridiculous' system

At the Hennepin County jail, a health care worker handed out cups of medication Wednesday from a little yellow cart. Dylan, 35, of Minneapolis, was among those who received buprenorphine, which treats opioid use disorder.

"Any time that I've ever been incarcerated here, with Hennepin County jail, they've gotten me on it and it's definitely gotten me back on the right track," said Dylan, who violated his probation on a past drug possession and DWI conviction. He said he would be going to addiction treatment within a few days. The Sheriff's Office asked that he not be identified by his last name out of concern for his privacy.

"I have had friends that have died just recently, just last week, who just got out of jail," Dylan said, noting that fentanyl is easily accessible. "They think they can use the same amount again, and it's all over."

Dr. Tyler Winkelman, Hennepin Healthcare's division director of general internal medicine, helped set up the jail's opioid use disorder treatment program in 2019 with grant dollars. He said about 6,000 people received treatment there last year.

Hennepin Healthcare also has the state's only outpost of the national Transitions Clinic Network, where community health workers meet with people who are incarcerated. Workers provide information about the clinic and a business card, then follow up with phone calls after someone is released to try to prevent gaps in medication.

They can admit a couple of people a week into that program, Winkelman said. "There are a hundred people or more leaving the jail every week with opioid use disorder," he added.

Hennepin County Sheriff Dawanna Witt said providing opioid medication in jail was a no-brainer but comes at a great expense. She is pushing lawmakers to seek the Medicaid waiver to cover treatment and re-entry services.

"The current system is ridiculous," Witt said in statement. "We take people in our custody at some of the most vulnerable moments of their lives, and they are dropped from their insurance. It makes no sense."

The measure is in a House human services bill but not the Senate version. If legislators and the federal government approve the proposal, Minnesota could launch a program in 2026 at 10 corrections facilities. Inmates who qualify could start Medicaid coverage up to 90 days before release and continue it as they re-enter the community. They would get case management and could receive substance use disorder medications, counseling and peer recovery support services.

The bill is a starting point for a fundamental shift in jail and prison treatment and transition services, said Jeremy Drucker, Minnesota's first addiction and recovery director, who made the issue his top priority. He said it will take years to get services in every Minnesota corrections facility.

Inconsistent health care coverage can have grave impacts for people with mental health conditions and substance use disorders, Department of Corrections Commissioner Paul Schnell told lawmakers as he pushed for the proposal. He said 90% or more of the people at corrections sites would be eligible for Medicaid.

While addiction medication access is spotty across county-run jails, it generally is available in state-run prisons. Corrections Department staff said they have been part of a national effort to expand opioid use disorder treatment since 2016. The department has spent about $583,500 since July 2023 on opioid use medications like methadone and Suboxone and staff to provide the service, including nurses and workers who do release planning to connect people leaving prison with treatment and other services.

Different counties, different outcomes

Deyonta Green, of Champlin, had a Suboxone prescription but repeatedly was denied the medication as he vomited and struggled to sleep amid heroin withdrawals in the Anoka County jail, according to a recent lawsuit.

He later fell and suffered a brain bleed and skull fractures, the suit says. It condemns the county's decision to contract with Sartell-based MEnD Correctional Care.

Inmate care is "of paramount importance," said a spokeswoman for the Anoka County Sheriff's Office when asked about addiction treatment in the jail. Inmates are screened and assessed for withdrawals and contracted provider determines what treatment should be, she said, noting the county is looking at medication-assisted treatment program options and looks forward to implementing one soon.

Less than a third of the sheriffs, human services staff and others who responded to a 2021 statewide survey said they were aware of a process to screen people entering their correctional facilities for substance use disorder. And 42% of those surveyed said their local facilities offered medication for opioid addiction, with rural communities less likely to offer the service.

The lack of qualified staff and funding were the biggest roadblocks, but there also were concerns about liability and security with potential drug misuse. About 18% said government officials' opposition to the use of medications was an important barrier.

Although there's still a stigma around drug addiction, Association of Minnesota Counties Executive Director Julie Ring said she hopes elected officials, including sheriffs and county board members, are "beginning to view substance use as the medical condition that is."

Anne Emerson's fiancé died in 2017, about one month after he was released from jail. Ryan Anderson had struggled with addiction for years, and been off and on Suboxone. Emerson wishes Sherburne County Jail had offered him medication and set him up with health insurance and a peer recovery specialist.

"Just because someone is coming out of jail doesn't mean they deserve less care," Emerson said. "Everybody deserves to have insurance and resources and support."