Jail Resource Center

Guidelines for Managing Substance Withdrawal in Jails

Responding to the urgent need to assist state, local, and tribal government officials; jail administrators; correctional officers; and jail-based clinicians in the detection and proper management of acute withdrawal from substances among individuals in custody, the Bureau of Justice Assistance (BJA), in partnership with the National Institute of Corrections (NIC), formed a collaboration with Advocates for Human Potential, Inc. (AHP), the American Society of Addiction Medicine (ASAM), and the National Commission on Correctional Health Care (NCCHC) to develop guidelines to support the effective management of substance withdrawal in local jails. Collectively, they worked with an expert committee (EC) of medical and criminal justice professionals, who include addiction specialists, correctional health care providers, and jail administrators, to guide the development of the product.

Learn More About the Guidelines

Guidelines for Managing Substance Withdrawal in Jails slide.

Guidelines for Managing Substance Withdrawal in Jails: A Tool for Jail Administrators, Correctional Officers, and Jail-Based Clinicians

This webinar, presented by the Bureau of Justice Assistance and the National Institute of Corrections, introduces the Guidelines for Managing Substance Withdrawal in Jails.

Multiphase Review Process

The Guidelines for Managing Substance Withdrawal in Jails is being developed via a multiphased process, ensuring the development of practical guidelines for local jails to implement that are grounded in evidence-based practices.

The EC reviewed the initial draft guidelines and provided feedback to the collective development team (BJA, NIC, ASAM, AHP, and NCCHC).
The collective development team reviewed and addressed the EC’s feedback and produced an updated draft based on the feedback received and follow-up discussions with the EC.
External reviewers, consisting of clinical, corrections, and other key stakeholders have reviewed the revised draft guidelines.
The collective development team will work with the EC to review the feedback received from external reviewers to support the development of a final set of guidelines.

The publication of the guidelines is tentatively set for March–April 2023.

METHODOLOGY >

The Guidelines for Managing Substance Withdrawal in Jails is being developed using a modified RAND/UCLA Appropriateness Method (RAM). The RAM process is a systematic approach—encompassing a review of existing clinical guidelines and standards, literature reviews, appropriateness ratings, stakeholder comment and reconciliation, and document development^[1]. The process typically combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The modified RAM process used for the development of these guidelines combined the best available scientific evidence with the collective judgment of clinical and jail administration experts to yield statements about the appropriateness of specific procedures that can be applied to the implementation of withdrawal management services in local jail settings.

This process started with a review of existing clinical guidelines for withdrawal management and recent (2011–2021) literature on withdrawal management in corrections settings.
These reviews resulted in over 700 draft recommendation statements for consideration by the expert committee (EC) comprised of medical and correctional professionals. The EC has been an integral and important voice in determining and shaping the content.
Each recommendation went through multiple rounds of ratings related to both appropriateness and feasibility. Through this consensus process, the recommendation statements were narrowed down to approximately 150. Topics the EC felt should be included in the narrative of the guidelines were identified, and all were incorporated in the current draft of the guidelines.
Then, the guidelines, which include the narrative and recommendation statements, were drafted through a multiphase review process.

^[1] Fitch, Kathryn, Steven Bernstein, Maria Dolores Aguilar, Bernard Burnand, Juan Ramon LaCalle, Pablo Lazaro, Mirjam van het Loo, Joseph McDonnell, Janneke Vader, and James P. Kahan, 2001, The RAND/UCLA Appropriateness Method User's Manual, California: RAND Corporation, retrieved June 20, 2022 from https://www.rand.org/pubs/monograph_reports/MR1269.html.

Get the Facts

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Deaths From Withdrawal Are Preventable

Deaths from withdrawal in jails are preventable—as are the litigation and suffering by all associated with it. State, local, and tribal government officials and jail administrators can prevent deaths by establishing withdrawal management policy and protocols to comport with legal, regulatory, and clinical standards.

Litigation stemming from inadequate medical care increases costs to local governments, jails, and health care providers:

Large financial settlements or judgements
Attorney’s fees
Court-enforced remediation
Time
Resource use

See Managing Substance Withdrawal in Jails: A Legal Brief for more information on the scope of the challenge. This legal brief provides an overview of key legislation and significant court cases related to substance withdrawal and outlines steps for creating a comprehensive response for individuals with substance use disorders.

Featured Resources

Dying Inside: To End Deaths of Despair, Address the Crisis in Local Jails

Outlines the legal framework on the right to adequate care and treatment in jails for medical, mental health, and substance use disorders.

Publication — 12/5/2022

Managing Substance Withdrawal in Jails: A Legal Brief

Describes the scope of the challenge, provides an overview of key legislation and court cases related to substance withdrawal, outlines steps for creating a comprehensive response for people with SUD.

Publication — 2/1/2022

The Americans with Disabilities Act and the Opioid Crisis: Combating Discrimination Against People in Treatment or Recovery

How the Americans with Disabilities Act can help protect people in recovery from opioid use disorder (OUD) who are not engaging in illegal drug use from discrimination.

Publication — 4/5/2022

Standards for Health Services in Jails

Features recommendations for continuous quality improvement, clinical performance enhancement, patient safety, initial health assessment, pharmaceutical operations, and women’s health.

Publication — 1/1/2018

Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol Tip 45

Provides clinicians with updated information and expands on the issues commonly encountered in the delivery of withdrawal management services.

Publication — 1/1/2015

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management

Provides information on evidence-based strategies and standards of care for alcohol withdrawal management in ambulatory and inpatient settings.

Publication — 1/23/2020

The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update

Presents an update on evidence-based treatment of opioid use disorder.

Publication — 12/18/2019

Project Partners

Bureau of Justice Assistance

The Bureau of Justice Assistance (BJA) provides leadership and services in grant administration and criminal justice policy development to support local, state, and tribal law enforcement in achieving safer communities. To learn more about BJA, visit www.bja.gov. BJA is part of the U.S. Department of Justice’s Office of Justice Programs.

National Institute of Corrections

The National Institute of Corrections (NIC) is the only federal agency with a legislative mandate (Public Law 93-41 5) to provide specialized services to federal, state, local, and tribal corrections from a national perspective. To learn more about NIC, visit www.nicic.gov. NIC is an agency within the Federal Bureau of Prisons.

Advocates for Human Potential, Inc.

Advocates for Human Potential, Inc. (AHP) improves health and human services systems of care and business operations to help organizations and individuals reach their full potential. To learn more about AHP, visit www.ahpnet.com. AHP serves as a training and technical assistance provider for the National COSSAP Jail-based Treatment and Community Corrections Program.

American Society of Addiction Medicine

The American Society of Addiction Medicine (ASAM) is a professional medical society representing over 7,000 physicians, clinicians, and associated professionals in the field of addiction medicine. To learn more about ASAM, visit www.asam.org.

National Commission on Correctional Health Care

The National Commission on Correctional Health Care’s (NCCHC) mission is to support and improve the quality of health care in jails, prisons, and juvenile facilities. To learn more about NCCHC, visit www.ncchc.org.