From 2020 through 2022, 28 people died in the Pima County jail. That was a per capita death rate higher than some of the most notoriously deadly jails in the country. Another seven died in 2023. And then, starting in the fall of 2023, there was a sharp turnaround.
In the last 13 months, there has been a single death in the jail.
That may be due, in part, to how the county has started treating people in the jail who are addicted to opioids.
An Oct. 14 memo from Pima County’s Department of Detainee and Crisis Systems to the board of supervisors details how an opioid addiction treatment program in the jail has curbed both deaths and hospitalizations due to overdoses in the past year. The county hopes a recent expansion of the program — the costs of which come out of the county’s general fund — will pay off not only in reducing death and suffering inside the jail, but will also have a positive impact in the greater community.
“It’s a very expensive endeavor,” Deputy County Administrator Francisco García said. “It’s also a life-saving endeavor.”
Given the complicated nature of providing health care in the jail through a subcontractor, García said he could not immediately put a price tag on what the expanded opioid addiction treatment program costs county taxpayers.
The subcontractor that manages healthcare in the jail is NaphCare, a for-profit company headquartered in Alabama. The contract between NaphCare and the county, signed in 2021, is through Sept. 30, 2025 with a maximum fee of $62.9 million dollars.
There are a number of factors explaining how the jail went from having one of the highest per capita death rates in the nation to going more than a year without a single death. The most recent in-custody jail death was 59-year-old James Waddell, who died in a hospital on Oct. 18 from complications from a surgery, according to a Pima County Sheriff’s Department news release.
One of the factors seems to be the rapid expansion of medicating people who are dealing with substance use disorder, through medication assisted treatment, which gives people drugs to lessen symptoms of withdrawal and offers other basic forms of therapy.
“We have been able to crack the nut of finding folks who are substance-involved and connecting them with a life-saving service,” García said.
The county launched the jail’s medication assisted treatment program in 2015 At first, according to the memo, it was “a small pilot program targeting opioid-involved pregnant detainees,” but has since “expanded to serve a much larger proportion of the detainee population.”
Since the medication program has been treating more people, “the impact of the investment has been profound in terms of the prevention of intoxication related deaths in the facility (and the community), in custody overdoses, emergency medical transports, and connection to community resources and providers,” the memo reads.
According to the Pima County Office of the Medical Examiner, in 2022 and 2023, of the 18 people who died in the Pima County jail, seven of them were considered “drug deaths.”
In February 2022, Pima County’s audits found that NaphCare had “appropriately managed” only one of the 22 people inside who were undergoing withdrawal. The audit did not provide names of those who lacked medical care.
That same month, the county gave NaphCare a score of 5%, or five on a scale of 100, for dealing with withdrawals. The county’s thresholds for meeting care typically target a score of at least 90%. For managing withdrawal symptoms, it’s 95%. The county penalized NaphCare more than $175,000 for understaffing, and another $8,000 for failures to provide medical care or notify the county when their patients needed hospitalization.
Meanwhile, county-wide in 2022, there were “7,953 opioid-related hospitalizations,” which cost $339.6 million, or $42,700 per hospitalization. Since 2020, at least 500 people a year have been dying from overdose deaths in the county, according to a dashboard maintained by the medical examiner’s office. The number spiked in 2023 with 603 people dying of drug overdoses.
So far in 2024, the number of county-wide overdose deaths has dropped. An Oct. 23 county memo calculated a 17% decrease in overdose fatalities in Pima County. That has followed a slight nation-wide decrease. Still, more than 100,000 people died throughout the nation from drug overdoses in 2023.
The need to do something, García and other county officials recognized, was urgent.
Rolling out opioid treatment in the jail
While the county oversees medical treatment in the jail, NaphCare employees administer that care, including medication assisted treatment. The costs of that additional treatment for people addicted to opioids is on top of the existing $62.9 million dollar contract the county has with NaphCare.
After first initiating the program to pregnant women in 2015, four years later, officials expanded services to people who were already on similar treatment programs in the community. As of January, they expanded yet again, with each month of this year offering the treatment program to more and more people in the jail, according to García.
As of Aug. 31, 1,851 people have used the opioid treatment services in the jail, according to the memo.
García told Arizona Luminaria that as of Oct. 29, there were 637 patients currently in treatment. That makes up more than a third of the entire jail population, which García said is currently hovering between 1,500 and 1,600.
Jeffrey Alvarez, NaphCare’s chief medical officer, told Arizona Luminaria the Pima County jail is where the company runs one of their largest jail-based medication assisted treatment programs. NaphCare currently employs four people dedicated to the program, and they are hoping to increase that number.
A spokesperson for the company, Stephanie Coleman, added that “all patients with opioid use disorder are offered treatment when it is safe to start treatment clinically — typically within 24 hours after intake.”
Treatment doesn’t end upon release
One way the county is assessing the impact of its treatment plan in the jail is how many people are being transported to outside medical facilities due to overdoses. The county refers to these incidents as “Narcan send-outs,” in reference to the commonly used overdose-reversal drug Narcan.
In September 2023 there were 48 Narcan send-outs. A year later, in September 2024, there were only 18. That’s a 62% decrease.
The lack of drug-related deaths both inside and outside the jail is another indicator.
A 2024 study from the American Journal of Public Health found that people released from jail die from overdoses at a rate 15.5 times that of the general population. The study focused on jails and prisons in Minnesota.
It found that in Minnesota “drug overdose was the leading cause of death for people reentering their communities from both jail and prison.”
Of the 16 people known to have died within 30 days of being released from the Pima County jail from the beginning of 2023 until June 2024, 11 of them died of causes related to drug toxicity. The data comes from the county medical examiner, obtained by Arizona Luminaria via a public records request.
The ongoing post-release deaths are in part why people in the medication treatment program in the jail are now “being connected to a community provider upon release,” according to the memo.
That connection is being made in large part by employees of NaphCare, which was awarded a new contract to employ “release planners” whose task will be to “support successful reentry into society” of people with opioid addiction.
The $685,000 NaphCare contract began Oct. 1 and extends until the end of September 2025.
The post-release project was initially supported by a $1 million grant from the Office of Justice Program, a division of the U.S. Department of Justice. In early 2024, the program was awarded a $2.6 million grant from the Arizona Attorney General’s Office. While the money for the expanded in-jail opioid treatment program comes from the county’s general fund, the money for hiring release planners comes from the opioid settlement agreement.
That work will be overseen by the county’s Inmate Navigation, Enrollment, Support and Treatment team. NaphCare’s release planners, working in concert with the county, will make specific plans for medication management, identify support networks and provide instructions for “future care and follow up” for people released from the jail.
“We’re trying to do this because it’s the right thing to do,” García said.
“People deserve the best we can deliver. They certainly don’t deserve to be dead at the end of their stay in the jail.”
Republish our articles for free, online or in print.
