Clark County Jail in Vancouver recently became the first jail in Washington state licensed to provide methadone on-site through a treatment program for opioid use disorder. A team of specialists at the jail also administer buprenorphine, another medication approved by the FDA to manage withdrawal symptoms and the cravings associated with drugs like fentanyl.
More than half of the jail population in Washington has an opioid use disorder, according to researchers at the University of Washington. Last year, Clark County Jail installed a vending machine in its lobby that dispenses free fentanyl test strips and naloxone to reverse potentially fatal overdoses. Joining us to talk about these harm reduction efforts and the opioid treatment program at Clark County Jail are Anna Lookingbill, the jail transition manager, and Matt West, the addiction medicine medical director at the jail’s Comprehensive Treatment Center, which is operated by Acadia Healthcare .
Correction: Methadone and buprenorphine are the two most commonly prescribed medications in the Clark County Jail opioid treatment program. Naltrexone can also be administered if requested by patients, but it is typically not prescribed to manage withdrawal symptoms from opioids.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The Clark County Jail in Vancouver recently became the first jail in Washington state that’s licensed to prescribe methadone on-site through a treatment program for opioid use disorder. That’s just part of the medication-assisted treatment that’s now available at the jail in response to the fentanyl crisis.
Anna Lookingbill is a jail transition manager. Matt West is the medical director for addiction medicine at the jail’s Comprehensive Treatment Center, which is operated by Acadia Healthcare. They both join us now. It’s great to have both of you on Think Out Loud.
Anna Lookingbill: Thank you.
Matt West: Thanks so much for having us.
Miller: Anna, first – can you just give us a sense for how common opioid use disorder is among people who are incarcerated at the jail right now?
Lookingbill: Absolutely. So I can give you our best estimate with the information that we have available to us. The University of Washington has done some preliminary research around the amount of folks experiencing opiate use disorders who are released from jails. So we’re using their statistic of approximately 53% of persons leaving local jails having a current opioid use disorder ...
Miller: More than half.
Lookingbill: More than half. And when you compare that with the non-incarcerated population, you’ll see estimates 7%, 12%. There’s some debate in how much the non-incarcerated population experiences opioid use disorder. It’s off the charts for people that are coming through our local jails.
Miller: How common are overdoses at the jail?
Lookingbill: So like any correctional facility, we have people who are arrested in the world and come into custody with us. Sometimes they’ll take drugs when they know they’re coming into custody. Like all facilities, we have challenges with contraband and other things like that. We have a lot of security measures that we put into place, but we have had a number of folks who have had overdoses we attribute to fentanyl within the facility. Fortunately, those folks were … there’s intervention provided with our medical personnel, our corrections officers, and folks have been able to be OK.
We have had officers who have experienced collateral impacts from being frontline to those likely fentanyl overdoses. So this has triggered us not only to consider and continue to try to improve our medication for opioid use disorder, our clinical treatment program that we’ll be speaking about, but also to implement some additional security measures to continue to decrease contraband. For example, we’ve made changes to how mail is handled by our facility …
Miller: That’s a way for fentanyl powder to be sent in.
Lookingbill: Yeah, absolutely true.
Miller: This is something we’ve talked about in Multnomah County as well. So it’s a combination of people who have drugs in their system when they’re booked and then some drugs somehow being snuck in.
Lookingbill: Yeah, absolutely. And that’s a problem across correctional facilities, that is not unique to Clark County. But when we’re talking about this 53% of persons experiencing an opioid use disorder that are leaving a jail, again, that’s our best estimate across the state of Washington. What that means in numbers of actual human beings, Clark County released 7,624 people in 2024. If we take that, times our rough cut of 53%, that’s 4,041 people who would benefit potentially from access to medication-assisted treatment, medication for opioid use disorder. That’s a huge number. That is bigger than most of our clinical treatment programs.
I’m looking at Dr. West. I mean, are you ready for 4,000 patients today? There’s a staggering amount of need found in jails and in correctional facilities, and I think we have a really unique opportunity to impact public safety by connecting people to this care when they’re experiencing incarceration in our systems.
Miller: Matt West, so there’s some contraband, drugs that are brought in illegally in Clark County Jail, as Anna was saying, as in jails or prisons all over the country. But I imagine that there are plenty of people who are addicted to opioids, who arrive in jail and then jail is this place where immediately they go into withdrawal. What is withdrawal like in a jail?
West: Withdrawal in a jail is really not a pleasant experience and withdrawal in general is really unpleasant. There’s a syndrome of symptoms that people experience, ranging from muscle aches to stomach cramps, to nausea, vomiting, diarrhea, yawning and goosebumps. There’s a syndrome that we can recognize. You see opioid withdrawal and you know what it looks like. It’s unpleasant.
People who are outside the correctional facility usually have access to places that can do medically-supervised withdrawal, places like Hooper in Portland, where they can get medications to help support them through that period. And while that can be offered in the jail, sometimes it looks a lot different and the supports are different. I’m really hopeful that with the services we are providing we’re helping make that withdrawal experience and the overall experience of treating opioid use disorder more bearable and more pleasant for people.
Miller: Can you give us a sense for the range of medication-assisted treatments that you’re providing today?
West: Yes, so we’re offering the three FDA-approved medications for opioid use disorder. So that would be methadone and buprenorphine, well known as Suboxone or Subutex, and naltrexone as well. And it’s really important to us to be able to offer all three medications, because to me, what we’re doing in the jail is essentially bringing the standard of care that we know is in the community that exists for opioid use disorder, and making that the same standard of care available to people who are incarcerated.
Miller: One of the changes that’s been implemented recently is that in the past, doctors at the jail could continue medication-assisted treatment if people had prescriptions for it already, but they couldn’t start it. Now, you can do both – you can actually prescribe, say, methadone to people who are incarcerated there for the first time. How significant is that change?
West: To me, that’s enormous. There are some patients who will find that Suboxone or buprenorphine is better for them, and there are some people that find that methadone is better for them. It’s kind of an individualized decision that you can make with your patient. So it’s really crucial to me that all the options are offered to folks.
Miller: Anna, am I right that, as I said in my intro – I hope I’m right because I’ve already said this – that you’re the only jail in Washington where this is a case where people who are incarcerated can begin this kind of treatment?
Lookingbill: So we have to be a bit careful in our language and I want to make sure that I add a little bit to your concern about folks that are booking into the jail. Clark County Jail, like all other jails, we have a medical process that occurs when someone comes into custody with us. We’re interested if that person is currently taking medications for opioid use disorder, if they have a substance use disorder history, a mental health history … heck, if they have physical concerns of other needs that they might have. So I just want to make sure that it’s clear that we are screening for, doing our best to address medical needs when someone comes into custody.
There’s processes in place to manage withdrawals, but what there isn’t capacity to do is serve this incredible volume of need. A lot of times folks have a need for medication-assisted treatment, opioid use disorder. But in the world, perhaps they haven’t connected with care, right? Or they’re living in crisis or their substance use disorder is a piece of the behaviors that have brought them into custody with us.
So this ability to start people on medications, to your question about Clark County being the first jail, that’s really specific to being able to start new methadone prescriptions. To start a new methadone prescription, you actually have to be licensed. I’m looking at Dr. West to make sure I get the words in the right order, but you have to be licensed as an opioid treatment program in the state of Washington. That is an arduous process that involves federal licensure through the DEA … goodness, Board of Pharmacy was involved, Washington State Department of Health, Substance Abuse Mental Health Services Administration.
Clark County Jail is actually licensed as a branch site through Acadia. What that means is that methadone can be stored and directly dispensed from the jail. It also allows us to take a person who’s experiencing an opioid use disorder, typically methadone is for patients with long-term severe chronic opioid use – which, yep, that is something we see a lot of in the jail facility – and be able to start them on that medication when clinically appropriate and when the patient feels that that’s the best fit for them.
Miller: If I understand what you’re saying correctly, what you’ve described is an understandable set of bureaucratic hurdles at the federal or state levels as one reason why maybe this has been less common in the past. Is there also more of a cultural reticence here in corrections? I mean, there’s a reticence I think still, just society-wide, about what methadone means … and maybe some of that is based on misunderstandings. But do you see that within corrections, a sense that these drugs are crutches, for example?
Lookingbill: So I think you hit it right on the nose to say that language is still alive and well in the world. We call that moral …
West: Moral failing.
Lookingbill: There it is, moral failing. There’s this belief somehow that when someone is experiencing a substance use disorder, it’s because they’re not strong enough, they’re not good enough. There’s something wrong with them, that they now have an addiction. Something that their body and their brain tells them as important to their survival as breathing. So I think, in the early days when people didn’t understand medications for opioid use disorder, these are controlled substances. They’re being managed by a doctor, under the care of a doctor, in a very specific way to have a medical impact, not to help someone get high. So because of the type of medications, I think there was sometimes confusion.
The amazing opportunity, at least I can speak to my own experience with Clark County Jail, is that our jail recognizes these as being life-saving medications that contribute to public safety. We’ve done a lot of work with our officers to provide training with our community partners, to make sure we bridge those resources. I think that Clark County Jail has really embraced how much medication for opioid use disorder, we know it reduces overdoses post release. It keeps people alive. We also know that people who are on these medications are less likely to have problematic behaviors in the community. Doesn’t mean crime doesn’t still happen. It does, but it reduces criminal activity and it improves compliance with treatment.
So for us, continuing to expand the service is about not just protecting humans and keeping people alive, but it also supports public safety in our community.
Miller: Matt, some people might be at the jail for one night, some for 364 days. What does that mean in terms of your ability to give them appropriate medical care?
West: That’s a great question because when people are using substances, oftentimes, due to the nature of addiction, people are going to be exposed to behaviors that may lead to criminal activity, that may lead to incarceration. So it seems to me like a no-brainer that we should really be offering these medications to people who are adults in custody, who may end up in jail because of their substance use. This seems like the perfect opportunity, really, to have an individual who is in custody and you can offer them these medications, where it may be much harder for them when they’re out in the community to be able to access treatment, whether it be due to being houseless or or other things.
Miller: But do you have a sense when you first encounter somebody, a patient or a prospective patient, how long you will be able to be their doctor?
West: I don’t. That is such an unknown factor to me every day. I have no idea whether I’m ever gonna see this patient again. They may have court tomorrow. They may be released that day, they may be headed towards prison. They may be transferred to a different county, precinct. But the fact that this individual [is] in front of me … it is an opportunity to make an intervention. It’s such a positive inflection point in their life.
Miller: Anna was talking earlier about the different licensure questions and security questions. What are you required to do in terms of security, given that you are giving, say, methadone to these people?
West: Security is not something that I’m used to out in the community, but it’s something I’ve had to learn about since being in the jail. And we have a lot of great people that are part of the program. It’s really not just myself or one other individual. It’s a whole team effort between our nurses, who are supervising our adults in custody who are dosing, to our wonderful corrections officers, who really do great work with security, monitoring our patients who are taking their doses and making sure that things are happening in a safe manner.
Miller: Anna, who is paying for all of this?
Lookingbill: I’m grinning at you. I recognize that listeners can’t see my grin. My grin is because we have multiple funding streams in place and we’re actually in the process of applying for some additional funding to continue expanding our program. So at a broader brush, different conversation for a different day, but generally speaking, medical care in jails is born on the back of the city, the county or the entity that has that jail. Jails cannot bill Medicaid. And so that’s part of why you get a really different experience of medical care. There’s 50 jails in Washington, right? Depending on your facility, what that tax base looks like and what resources that community has put into medical care in the jail.
What that means in Clark County is that our medical services are bound up in a large contract. And then additionally, as the legal landscape for jails around MOUD has continued to change …
Miller: MOUD … ?
Lookingbill: Medications for Opioid Use Disorder (MOUD). It’s a newer term than MAT, because if you want to be technical, there’s MAT for other things than just opioid use disorder. So when that came out, they shifted MOUD to speak specific to the buprenorphine, methadone, naltrexone …
Miller: You’re explaining one acronym by saying how it’s different from another one.
Lookingbill: I’m sorry.
Miller: That one is Medication-Assisted Treatment (MAT).
Lookingbill: Yeah, and that’s the original language that was used to refer to buprenorphine and these medications. It has shifted to being more specific to medications for opioid use disorder.
Miller: Just when I learned what that meant.
Lookingbill: I know.
Miller: So essentially, it’s Clark County taxpayers who are paying for this.
Lookingbill: In the context of this specific program, it’s currently funded by a combination of different grants. So we are the recipients of a grant from the Washington State Healthcare Authority, medications for opioid use disorder in jails. So we got into that in the first cohort back in 2021, that provides the lion’s share of our funding for this particular program. Additionally, we are the recipients of some local opioid abatement council funding. That’s the piece of the program that is really around expansion and helping take people who have a need for medication, but are not currently on it, to be able to start them. And then the RFP for that funding has opened, so we’re in the process of writing an application for this year’s funding with the goal of expansion of those services.
Miller: Is any of that opioid settlement money from drug makers who helped hook America on opioids?
Lookingbill: Yes, so those things are happening at a federal level that is then allocated to states. States are then breaking it down with a formulary across cities and counties. This has to do with Clark County specific opioid abatement council funding.
Miller: So I mentioned that you’re the jail transition manager for Clark County. How do you think about people exiting the jail after they’ve gotten services from Dr. West and others, and sticking with this treatment?
Lookingbill: I think that we have to recognize that – we’ll talk about release in a split second – before someone comes to jail, often, there were a lot of barriers, challenges, problems, things, unmet needs going on in their life, right? Everyone’s story is different. But over and over again, what we hear are experiences of people who experience homelessness, people who experience the inability to access other types of behavioral health supports, mental health, substance abuse – there’s all this unmet need. An event that occurs, the person is brought to jail, whether or not they are innocent or guilty or what should occur, that is handled by the courts. The jail’s not involved in the adjudication side. They spend a limited time with us.
You had asked about pretrial. Over 90% of our population is pretrial or pre-adjudication. What that means is they don’t have a release date. So it makes this service quite complicated. Then something occurs, maybe they take a plea deal, maybe they are sentenced, maybe they’re exonerated, maybe they bail, right? Something happens, then the person then leaves the jail. So that person’s ability to go from whatever they were experiencing prior to incarceration, hopefully they can connect with this program or some of the other services we offer in our reentry program during incarceration, to then have places in the community that they can connect to the resources that they need. Sometimes it works out that way and sometimes it doesn’t. So any small changes, small movements that people can make.
One additional thing we’ve added to this particular program, to help support folks as they’re as they’re on their way out of Clark County jails, we’ve added a peer support component. So those are a person with lived experience with both opioid use disorder and incarceration, who is able to walk alongside people as they decide what’s going to be next for their recovery journey. They don’t tell them what to do. They are present with them as the person decides what’s going to be the best fit. Sometimes that’s a pickup from jail and helps the person access sober housing. Sometimes that’s making a medical appointment so that their next dose is in place for their medication. Sometimes that’s accessing another sober support resource.
When we hear stories from folks post incarceration, sometimes they call us, sometimes they stop by, sometimes life happens, and they come back and see us again on the incarceration side. But the stories we hear about the people who do the best or who have the medical component, but then they also have that support with them as they’re navigating what comes after incarceration.
Miller: But they are able to keep their prescription current?
Lookingbill: Absolutely.
Miller: Let’s say that they got methadone for the first time in jail. They were there for a month-and-a-half. When they leave, they can still get methadone?
Lookingbill: Yes, please. That’s a really, really important thing that that person we are planning for and transitioning that person to medical care to continue their medication.
Miller: Matt, what do you hear from your patients about what this means for them?
West: I hear a lot of positive feedback, but I brought with me today a patient testimonial from a patient who was referred to us who overdosed in the jail. He says, “This program literally saves my life, gives me a chance to live life sober, meaningful, and with a purpose. I know it takes a lot of hard work and dedication to become a successful person in life, and this program will be a stepping stone, helping me moving forward in the right direction. I’m so thankful and blessed to be on this program because ever since having been on it, I’ve had zero desire to use fentanyl. But more importantly, I want to stay away from using drugs altogether.”
Miller: What made you want to practice medicine in a jail?
West: Well, I did my addiction medicine training at OHSU and one of your previous guests, Dan Hoover, who talked about deflection recently, he gave me the opportunity to spend some time in the Clackamas jail. And so I got to see what carceral medicine looks like. And also, part of my training, I was in some of the Acadia clinics seeing what a methadone clinic looks like.
So these combinations of influences came together. The job became available and I said, “Oh yeah, I want to do that.” That is very interesting to me because I really want to take care of patients who are impacted by the social determinants of health and I can’t think of anyone who’s more impacted currently or more underserved than our incarcerated population.
Miller: Matt West and Anna Lookingbill, thanks very much.
Lookingbill: Thank you.
Miller: Matt West is the addiction medicine medical director at the Clark County Jail’s Comprehensive Treatment Center. Anna Lookingbill is a jail transition manager for Clark County.
Contact “Think Out Loud®”
If you’d like to comment on any of the topics in this show or suggest a topic of your own, please get in touch with us on Facebook, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983. The call-in phone number during the noon hour is 888-665-5865.