For years, the Benton County Jail in south central Washington was a revolving door.

Inmates addicted to opioids would endure days in withdrawal, vomiting in buckets, moaning on the cement floor, overcome with anxiety. Then, upon their release from the jail, their cravings for opioids would be stronger than ever and they go right back to life on the streets, committing more crimes. 

“We’d book the same people over and over again,” says Lieutenant Josh Combs, a supervisor at the jail. “In fact, we have retiring correctional officers who practically raised some of them. They’d see people in their 40s who’d been coming through the jail since they were 18.”

These days, the door has stopped revolving.

Among inmates who test positive for opioids, two-thirds don’t come back. And among the one-third who find themselves back in custody, most are booked on Department of Corrections (DOC) violations — failing to report to their probation officers, for example, or leaving the state without permission — rather than on new criminal charges.

And when they do land back in jail, the officers barely recognize them.

“People who used to come in dope sick and miserable now come in wearing clean clothes — they don’t look like they’re on the verge of death,” says Lt. Combs. “They say, ‘I got a job. I got a place to live. I got my kids back.’”

Officers who’ve known them for years will say, “Wow, I didn’t think this guy was ever going to make it.”

What’s changed: Benton County Jail now offers medication-assisted treatment (MAT) to inmates who test positive for opioid use.

In a state-funded program administered by Ideal Option, inmates take a daily dose of Suboxone, a medication that dramatically and quickly — within an hour — suppresses withdrawal and cravings.

Upon their release, patients are referred to a nearby Ideal Option clinic for continued treatment, as well as help finding housing, employment, and any counseling they may need.

In one year, more than 1,400 Benton County Jail inmates have been through the program. About 70% of them have shown up for their post-release appointments, a much higher compliance rate than community residents who schedule appointments on their own.

“That high percentage is a huge deal when you look at the population we treat,” says Viktoriya Broyan, Ideal Option’s jail program coordinator. “They’re not just dealing with opioid use disorder (OUD) but they’re also dealing with housing, transportation, and everything else.”

Sixty days after release, 49% of former Benton County Jail inmates on MAT are still enrolled at Ideal Option; after 90 days, 45% remain as clinic patients.

“That’s a lot better than the 91% that would relapse without treatment,” notes Jeff Allgaier, M.D., Ideal Option’s co-founder, who is board certified in addiction and emergency medicine.

Dr. Allgaier credits the Benton County Jail command staff for adopting a forward-thinking, science-based approach to opioid addiction rather than retaining the punitive mindset that dominates at most jails.

“Benton County Jail is a model of what a jail should be,” says Dr. Allgaier, noting that Benton County Jail is among the first jails nationwide to offer MAT. “The command staff are pioneers and courageous.”

The inmates, for the most part, appreciate the medication, Lt. Combs reports.

“I’ve had hardened convicts breaking down and crying, saying, ‘I can’t believe you guys are doing this for us.’ They see we’re trying to help them make a sustainable change.”

What the medication provides inmates isn’t just relief from vomiting and diarrhea but also clarity of mind.

“They’re not on that ping-pong-ball ride between being in withdrawal and being high,” says Lt. Combs. “They’re finally able to see what normal feels like again and remain there.”

That stability gives Ideal Option staff an opening to talk about recovery.

“It’s an opportune time for us to intervene and say, ‘Hey, there’s another life that’s possible – is that something you’re interested in?’” says Skyler Glatt, social worker and Ideal Option’s director of community development.

For Nathan, a 30-year-old construction worker who’d served five or six stints at the Benton County Jail, the answer was clear: yes, he wanted a different life.

Addicted to opioids for a decade, Nathan had started with pills and then, looking for a cheaper supply, switched to heroin. “Then I was running out of veins to hit,” he recalls, and began smoking fentanyl.

All the while, he was living on the street, sleeping in friends’ cars, shoplifting and committing identity theft, lying to his parents for money.

After every arrest, he’d suffer miserable withdrawal behind bars.

“Coming down in jail is the worst,” he says. “Your body aches, your nose runs. You’re just lying in your bunk moaning and crying. Your anxiety is through the roof, and you’re super depressed. One time I had a seizure. I got double blurry vision, and one of my eyes went cross-eyed for two weeks.”

Each time he was released, he’d return to using, usually within days. Once, he overdosed and had to be revived by Narcan and taken to the ER.

When he found himself back at Benton County Jail the fall of 2019, he jumped at the opportunity to take medication.

“Suboxone makes coming off opioids so much more tolerable,” Nathan says. “It’s instant relief, not just for your body but your mind. Without it, my mind’s racing and time goes by so slow.”

Medication afforded Nathan the chance to think rationally.

“All you have in jail is time and your thoughts, and for the first time, with the medication, I didn’t think about getting high after I got out.”

Upon his release, Nathan kept his Ideal Option appointment and has stayed in recovery for over four months. He found a room in a sober-living house and regularly sees his five-year-old daughter.

“I got her a scooter, and I take her to the park,” he says.

Nathan is working odd jobs and seeking a full-time construction job.

“My main goal right now is saving enough money to buy a house and provide for my kid. I’ve always worked in construction. When I’m not using drugs, I’m actually pretty good at it.”

Lt. Combs isn’t surprised by turnaround stories like Nathan’s, but there’s still pushback.

“In law enforcement, drug addiction is a crime,” he says. “Possession of narcotics is a crime. Now we’re going to turn around and give drugs to drug addicts? How is that a good idea? That sounds crazy.”

He also hears: “Why should our tax dollars pay to treat their drug addiction? Their addiction was their choice.”

When faced with pushback like this from colleagues, Lt. Combs shares the research that shows that OUD is a disease that should be treated like any other medical condition.

“I tell them, ‘Your doctor doesn’t take away insulin or stop providing medical care if you don’t follow weight-loss recommendations, right?”

Lt. Combs also focuses on how MAT helps society as a whole. When released inmates aren’t withdrawing from or craving opioids, demand for street drugs declines. So does the number of overdose deaths and trips to the hospital.

“I tell them we have the choice, as a society, of paying for addiction treatment or paying for incarceration, HIV and hepatitis C, property crimes, drug-fueled violence, and the child abuse and human trafficking that goes along with drug addiction.”

He added: “Society is going to pay this bill one way or another. How do you want to pay it?”

Today, only about 7% of Benton County Jail inmates who receive MAT are getting booked back into the jail on new criminal charges.

Ideal Option staff have hope for them, too.

“The fact that you were able to get them even thinking about treatment is big,” says Viktoriya, the jail program coordinator. “Maybe they’ll come back in two months or five months. Everybody is ready at different points in their life.”

Nathan, for one, says the timing of his final arrest, along with the introduction of the MAT program, was just right.

After a previous stint in jail, he’d gone to inpatient rehab and had remained in recovery for six months, but he hadn’t been offered medication and eventually succumbed to cravings. Another time, he’d enrolled in Ideal Option on his own but didn’t take his medication every day.

“I just wasn’t ready,” he said.

By the time he landed back in Benton County Jail the final time, his perspective had changed.

“I realized I was tired of that life. Medication played a big role in that.”

Now, he says, “I feel like a totally different person, like a productive member of society. I’m not having to look over my shoulder or duck down every time a cop drives by. I feel 100 times happier.”