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RSAT Forum > Monthly Discussion > January 2023: Suicide Prevention Best Practices for Individuals with OUD in Jails View modes: 
skeller - 1/11/2023 11:34:10 PM
January 2023: Suicide Prevention Best Practices for Individuals with OUD in Jails

Question: Recently, our jail has experienced a record number of suicides of persons who enter under the influence of opioids.  Our regular suicide prevention practices aren’t working.  What are other jails doing to address this? 

Answer: There must be special attention and programming to prevent suicides specifically among individuals entering jail who are withdrawing from opioids as well as other drugs, including prescription medications like benzodiazepines, and alcohol.  Does your jail follow withdrawal protocols that mitigate both the pain and discomfort of withdrawal and reduce cravings? Does it allow persons entering with prescriptions for agonist or antagonist opioid medications or antipsychotic medications continued access to these medications?  Does it offer SUD treatment?  All of these have been associated with dramatic reductions in jail and prison suicides.

While individuals withdrawing from these substances may not have prior histories of suicide ideation or attempts, withdrawing from these substances may significantly increase their risk of suicide.  And, of course, as you know, a very high proportion of persons entering jail with SUDs also have co-occurring mental illness so they would be at risk for suicide even without substance use disorders (Suicide Prevention Resource Center (October 2007). What Corrections Professionals Can Do to Prevent Suicide,

The U.S. Justice Department examined six suicide deaths over several years that occurred in a New Jersey jail.  It found all of the individuals were withdrawing from opioids at the time.  Its investigative teams that included correctional and mental health experts concluded that the jail “failed to protect the inmates from harm by not providing MAT to individuals at significant risk of harm from opioid withdrawal.” In short, it found providing FDA-approved medication for opioid withdrawal mitigates the very real risk of suicide for these individuals. The gold standard for opioid withdrawal is tapering persons off the opioids with diminishing doses of methadone or buprenorphine or inducting them on these medications for long term medication-assisted treatment along with counseling and recovery support.  The full Justice Department report can be found at on the RSAT-TTA website.

Recently, the National Commission on Correctional Health Care and American Foundation for Suicide Prevention released a “National Response Plan for Suicide Prevention in Correction,” in 39-page publication entitled Suicide Prevention and Resource Guide. It provides a basic foundation of correctional suicide prevention programming, focusing mostly on mental health interventions. However, as it clearly asserts, “At present there are no known validated suicide risk assessment instruments designed specifically for use in correctional settings.” One of the reasons for this is that in the nation’s jails, according to the Bureau of Justice Statistics, almost half of the suicides occur within the first week of admission, when persons entering jail are in the process of withdrawing from opioids and other drugs or alcohol.

It should also be noted that even after the first few weeks, the despair many persons with substance use disorders feel who have been unable to sustain recovery and lost hope also make them high risk for suicide, especially after the first year of incarceration. Correctional suicides have been found to be correlated with levels of hopelessness and depression (Bonner, RL. (2000). Correctional suicide prevention in the year 2000 and beyond. Suicide and Life-threatening Behavior, 30(4), 370–376.). Researchers have surmised that persons with substance use disorders may have “declining motivation to live,” manifested by a range of behaviors “from engagement in increasingly risky behaviors despite a lack of conscious suicidal intent to frank suicidal ideation and intent.” (Oquendo, M.A., Volkow, N.D. (2018) Suicide: A Silent Contributor to Opioid-Overdose Deaths. The New England Journal of Medicine.)

Ironically, one of the vehicles often employed in jail and prison suicides is contraband drugs taken to induce overdose deaths.  While these deaths are almost always ruled as “accidental,” research outside of prisons and jails now finds that at least 30% of these overdoses are intentional. (Oquendo, M.A., Volkow, N.D. (2018) Suicide: A Silent Contributor to Opioid-Overdose Deaths. The New England Journal of Medicine.). There is reason to believe, given the greater concentration of persons with substance use disorders and mental illness in prisons and jails, that rate of intentional overdoses is even higher. The provision of RSAT programs can offer people hope and mitigate risk of suicide.  Treatment that includes medication-assisted treatment may also dry up or lessen demand for contraband drugs, so it becomes more difficult for people to commit impulsive, non-premeditated suicide in reaction to bad news or other transitory circumstances or trauma.