This document responds to urgent requests from the field for guidance as well as advancing the National Drug Control Safety of improving access to medication for opioid use disorder for populations who are incarcerated or are re-entering the community.
This document aims to help jail administrators, custody staff, jail-based health care professionals, local government officials, and community providers to do three things: unite around a shared understanding of appropriate policies and procedures for responding to individuals who are at risk for, or are currently experiencing withdrawal; to understand standards of care for managing withdrawal from alcohol, sedative-hypnotics (sedatives), and stimulants, and avoiding or minimizing opioid withdrawal through effective opioid use disorder (OUD) treatment; and to determine the level of clinical severity that can be managed with the jail’s available medical resources, setting thresholds for when individuals need to be transferred to a higher level of care at an external medical facility. The guidelines in this document first provide a brief description of the withdrawal management process, the recommendation statements crafted by the expert committee (EC), and supporting narrative, presented in five sections. The general guidance addresses issues that are universal to withdrawal management in jails; and the following sections focus on substance-specific considerations for alcohol, sedatives, opioids, and stimulants.