As recently as July, the Allegheny County Jail was dosing people in its custody with addiction medication in the middle of the night. Advocates called the regimen “triggering” and “detrimental,” and doctors in the community said they wouldn’t treat patients that way. Now, the jail is dosing people at a more reasonable time and offering more types of medication — improvements that some of those same advocates are praising.
Jail health care staffers are administering medications for opioid use disorder [MOUD] around 7 p.m. each night. They previously woke patients up during the overnight shift — often at 3 a.m. — to administer a single, large dose of buprenorphine, a practice officials said was due to logistical challenges around MOUD programming in a correctional setting. Patients typically take buprenorphine during daytime hours and can split dosing to minimize side effects.
The jail is also preparing to offer methadone to all patients who would benefit, not just pregnant people or those with prescriptions — groups it had restricted access to in the past. It found a provider organization to run the program and expects to launch it “very soon,” Holly Martin, deputy warden of health care services, told PublicSource. And it’s offering buprenorphine in long-acting injectable form to more people — an option that could give them more time to connect with care after they’re released.
“I’m proud of the staff here [and] what they’ve done to get this program up and running over the past year,” Martin said.
The jail expanded access to MOUD in December 2023 to comply with the county’s agreement with the U.S. Department of Justice, which investigated a complaint from a man who said he’d been denied continuation of methadone after his arrest — an alleged violation of the Americans with Disabilities Act. The agreement resolves the claims and stipulates the county must offer medication to all people with opioid use disorder, including those who weren’t receiving treatment on the outside.
The expansion got off to a rocky start: A PublicSource investigation in May showed how the late-night wake-up calls disturbed sleep and could exacerbate illness. Another PublicSource investigation in July found that the jail’s efforts to connect people with post-release care — an essential step to reduce overdose risk — sometimes miss the mark. The jail stopped its late-night dosing that same month.
Jail officials said they’ve made significant progress over the last year. Spokesperson Jesse Geleynse touted the facility’s recent accreditation from the National Commission on Correctional Health Care. And it gave oral MOUD to 1,805 patients and injectable MOUD to 489 patients last year. Those are triple-digit-percentage increases from 2023, he wrote.
In response to questions, a county official and a low-barrier provider said they’re seeing the difference.
“They’re so much happier that they’re not getting woken up in the middle of the night,” said County Councilor Bethany Hallam, a member of the county’s Jail Oversight Board who speaks with incarcerated people during her jail inspections.
“Talking with some of the health care providers in the jail and coordinating care with them, it seems significantly better,” said Thomas Robertson, an internal medicine doctor and co-director of the Rethinking Incarceration and Empowering Recovery [RIvER] Clinic. The jail refers people to the Allegheny Health Network program, which provides free health care, including buprenorphine treatment, to recently incarcerated people.
Robertson and another doctor said the jail’s program still isn’t on par with the best care available in the community. Some advocates say that’s impossible to achieve in the carceral system, which is built to punish rather than heal. And Hallam is concerned about how much time it could take to connect people with MOUD after they enter the facility.
The public can keep an eye on the jail’s program by reviewing a new dashboard showing outcomes for those receiving MOUD within its walls, released this month by the county’s Department of Human Services. A department spokesperson wrote that county and jail officials will use the dashboard to monitor key indicators of the program’s effectiveness, including racial, gender and age disparities.
If people who qualify aren’t engaging in treatment, “we will be able to make changes in how screening and follow-up are being done to encourage uptake,” she wrote.
‘We just said we’re doing it’
During an interview last year, a former jail official explained why staff was administering MOUD late at night: There weren’t enough nurses trained to treat addiction. A nurse and corrections officer must wait with people while they take their medication — a 10-minute process. And the rest of the jail population has to stay in their cells during the medication pass.
The jail needed more resources than usual for a med pass because “they want to watch people closely,” said Sarah Bleiberg Bellos, a staff attorney at the Pennsylvania Institutional Law Project [PILP]. It was “treating this disease differently from other diseases for no medical reason,” she told PublicSource last year. Another prisoners’ rights lawyer said jails often prioritize security protocols and concerns about drug diversion over patients’ wellbeing.
Need Suboxone at the Allegheny County Jail? Get up at 3 a.m.
PublicSource asked Martin how the jail was able to start dosing patients at an earlier time, given the requirements it had put into place around the program. “We had a lot of discussions,” she said. “We worked out the pros and cons, and we just said we’re doing it.” The jail also expanded staffing for the program: It now has 14 nurses dedicated to MOUD and managing detox, up from two at the beginning of last year. And two more prescribing providers for substance use recovery joined the only one it had.
Robertson said these improvements are having downstream effects on the RIvER Clinic’s patients, some of whom are arriving “in a more stable state” than those previously released into its care. “When people are on more appropriate treatment in jail, that translates to a smoother transition to care” and “helps them continue on their path to recovery.”
Advocates were glad to hear the jail will soon offer methadone to all who would benefit, which many jails in Pennsylvania don’t do, according to a 2024 PILP report authored by Bellos. Pittsburgh Comprehensive Treatment Center was contracted last year to run the program, but the jail “is still working through all the federal guidelines to essentially be like a dispensary,” Martin said. Methadone is more strictly regulated than buprenorphine and is often more stigmatized.
Jerome Maynor, 74, was denied continuation of methadone in the jail in 2021 — more than a year before the jail began administering the drug to people with prescriptions. He went through a detox that made him feel like he was “going to die” and wrote an essay about it for PublicSource. Reached while doing street outreach to help others battling addiction, he was “overwhelmed” by news of greater access to methadone in the jail.
“It should have [already] been taking place,” he said. “I don’t know how they got away with it for so long.”
A step in the right direction, but problems remain
While experts and advocates are thrilled with the jail’s progress, they pointed out problems that could still be causing harm.
Hallam said she’s aware of “numerous people” who’ve waited days after being arrested to continue their MOUD, which could lead to a painful and unnecessary detox.
“I have talked to individuals who talk about how sick they are waiting for medication that has already been prescribed to them,” she said. “That is definitely still a hold up and an obstacle in the process that I’m sure is able to be overcome, but hasn’t been yet.”
A majority of people in need were connected to MOUD within two days of their booking, according to the new county dashboard. But 30% waited three to seven days and some waited even longer.
Asked about delays, Martin said “as soon as they get booked into the jail, they’ll get their continuation done right then and there,” though the dashboard shows that’s not always the case. She said the wait to be inducted on MOUD varies on an individual basis and didn’t provide a typical timeframe. A provider assesses the person, including their medical history and drug screens, and determines when it’s safe to induct them. If a person is detoxing, they’ll provide medication to ease the process, she added.
“Ideally, someone’s able to manage their opioid use disorder and whatever else may be going on with them, health wise, without, you know, incarceration in the county jail.”
The dashboard also shows the demographics of those receiving MOUD in the jail and could reflect disparities. The jail’s population is 65% Black and 34% white, while those receiving MOUD are 31% Black and 69% white. A county human services official said those rates likely reflect unequal access to treatment in the community, due to the jail’s recent history of only giving MOUD to those who entered with a prescription.
“We’re already seeing a narrowing of that” because the jail is now offering MOUD to all who would benefit, said Stuart Fisk, a nurse practitioner and manager for coordination of opioid settlement funds at the county’s Department of Human Services, during an interview in November.
Robertson would like to see the jail provide a more generous take-home supply of oral buprenorphine. It offers a three-day supply to those being released — a number that hasn’t changed since PublicSource reported on post-release care in July.
“Three days runs out pretty quickly,” he said. “And it’s hard for some people to get into a treatment provider beyond the RIvER Clinic” within that time period. He noted the jail’s increased use of long-acting injectables, which last four weeks, will give more people time to get on their feet.
Martin said the jail isn’t planning to increase the take-home supply of buprenorphine. “We have not talked about that at all,” she said.
With Suboxone more available in Allegheny County Jail, post-release care becomes even more crucial
And while dosing patients once a day at 7 p.m. is far better than doing so at 3 a.m., it’s still not a regimen that’s recommended by doctors.
“In a perfect world … we’d like to see the buprenorphine pass twice a day,” said Robertson, explaining the medication likely works best when it’s dosed slowly, starting in the morning. “Some people want it three times a day.” He noted that he understands the logistical challenges of providing controlled substances in a carceral setting.
Martin said the majority of people receiving MOUD get dosed once a day, but the jail “can make an exception” if a provider determines they need a different dosing regimen. “A small handful” of people have received twice-a-day dosing, she added.
An advocate urged the public to take advantage of the dashboard because it reflects much more transparency than other local governments he’s worked with. It shows there are “a substantial number of people initiating treatment in the jail,” said Eric Hulsey, who left the county’s Department of Human Services in 2019 and is now a senior technical advisor for Vital Strategies, a public health advocacy organization.
As great as initiation of treatment in the jail is, Hulsey said it begs the question: What kept them from starting treatment in the community? He noted that many people face barriers while trying to access care.
“Ideally, someone’s able to manage their opioid use disorder and whatever else may be going on with them, health wise, without, you know, incarceration in the county jail,” he said.
Venuri Siriwardane is PublicSource’s health and mental health reporter. She can be reached at venuri@publicsource.org or on Bluesky @venuri.bsky.social.
This story was fact-checked by Rich Lord.
This reporting has been made possible through the Staunton Farm Mental Health Reporting Fellowship and the Jewish Healthcare Foundation.
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