From the Field: The Opioid Crisis and Evolving Challenges in Jails and Prisons

By Fred W. Meyer, MA, CJM, CCHP

By now, we should all be well aware of the human tragedy associated with the opioid epidemic raging across the United States and many parts of the world. According to the Centers for Disease Control and Prevention, drug overdose deaths in America have increased over 600% in the past two decades. While deaths from heroin and commonly prescribed opioids have elevated in recent years, other synthetic opioids such as Fentanyl have exploded.

As if this wasn’t enough, substances referred to in the community as “Tranq” and “Frankenstein” have increased the potency and dangers related to opioid abuse. These two substances have often been consumed unknowingly and substantially increase the risk of death.  With the spread of these drugs, additional risks to life, health, and safety have presented in our jails and prisons.

The better known of the two drugs is a sedative utilized in veterinary medicine called Xylazine (aka Tranq). This drug is often added to fentanyl to prolong the perceived effects for the user. Overdose deaths related to this drug started in the Northeast and have been travelling westward at an alarming rate. According to the US Drug Enforcement Administration, fentanyl and xylazine mixtures have been found in 48 of 50 states. This drug is often associated with skin infections that are sometimes life-threatening as well. Due to the fact that xylazine is not an opioid, naloxone does not reverse its effects on a person. Health care professionals need to be aware of this and provide supportive measures due to the risk of nonresponse for those who do not respond to naloxone.

The newer and currently less-known additives are called Nitazines (aka Frankenstein Opioids). These substances were created in the 1950s and were reported to have unacceptable levels of toxicity related to sedation and respiratory depression. The drug found in the United States has been reported as being manufactured in unregulated laboratories in China. Nitazines are reportedly cheap to produce and may be up to 40 times stronger than fentanyl. These drugs may be reversed with the use of naloxone, but it might require multiple doses to have an impact. Again, additional supportive measures and monitoring are required.

While visiting jails and prisons across the country, medical and jail administrators have consistently expressed a need to make extra efforts to collaborate and provide leadership for all staff working in our detention and correctional facilities. It’s clear that more institutions are implementing Medication-Assisted Treatment (aka Medications for Opioid Use Disorder – MOUD). Effective programming can provide improved care, reduce the frequency of adverse events, and may even impact violence and disorder in secure environments. Medical and custody staff should all receive training on these topics as they may act as “force multipliers” to improve operations. We all need to educate, support, and empower those providing care and custody in this ever-changing world.

As always, the National Commission on Correctional Health Care is here to support you. To the health care, custody, and support personnel keeping our facilities safe and incarcerated people healthy, thank you!

References

American Academy of Family Physicians (2023). Opioid Epidemic Updates: “Frankenstein Opioids” and Xylazine-Induces Skin Ulcers. https://www.aafp.org/pubs/afp/afp-community-blog/entry/opioid-epidemic-updates-frankenstein-opioids-and-xylazine-induced-skin-ulcers.html

Centers for Disease Control, National Center for Health Statistics (2023). New Analysis Looks at Drug Overdose Deaths Involving Xylazine. https://blogs.cdc.gov/nchs/2023/06/30/7408/

Drug Enforcement Administration (2023). DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine. https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

National Commission on Correctional Health Care (2018). Jail-Based Medication-Assisted Treatment:Promising Practices, Guidelines, and Resources for the Field. https://www.ncchc.org/wp-content/uploads/Jail-Based-MAT-PPG-web.pdf

Fred Meyer is the managing director of NCCHC Resources. Contact Fred at [email protected].