Healthcare provision in correctional facilities is a constitutional requirement, but the environment presents unique challenges compared to community medicine. The crowded setting increases the risk of infectious disease transmission and complicates chronic health management. Medical intake screening is a standardized process designed to identify immediate health risks, existing conditions, and public health concerns upon admission. Injections administered generally fall into three categories: mandatory public health screening, voluntary treatment for substance use disorder, or maintenance therapy for chronic physical or mental health conditions.
Required Public Health Screening Injections
The crowded environment of a jail makes public health screening a priority due to the risk of communicable diseases. The primary injection procedure upon intake is screening for tuberculosis (TB), which remains a serious health threat in these settings. This typically involves the Tuberculin Skin Test (TST), where a small amount of purified protein derivative (PPD) is injected beneath the skin of the forearm.
The TST is a diagnostic tool, not a vaccine, requiring medical staff to check the injection site 48 to 72 hours later for an immune reaction. An alternative is the Interferon Gamma Release Assay (IGRA), which uses a blood draw instead of a skin injection. Beyond TB screening, facilities may offer routine vaccinations, such as those for seasonal influenza or COVID-19, to protect the entire population.
Injections for Substance Use Disorder Treatment
A significant portion of the jail population struggles with Substance Use Disorder (SUD), particularly Opioid Use Disorder (OUD). For these individuals, injections are offered as part of Medication-Assisted Treatment (MAT). The injectable formulation of naltrexone, known commercially as Vivitrol, is a common option for treating OUD and alcohol use disorder in this setting.
Naltrexone is an opioid receptor antagonist that blocks the euphoric and reinforcing effects of opioids. The extended-release injectable form is administered as a deep intramuscular injection, delivering medication slowly over approximately 30 days. This long duration improves treatment compliance and adherence, which is challenging with daily oral medication. Furthermore, the injectable form eliminates the risk of diversion or misuse, as naltrexone has no abuse potential.
Long-Acting Depot Medications for Chronic Conditions
Injections are administered to manage various long-term physical and mental health conditions. For physical health, patients with diabetes may receive insulin injections multiple times daily to regulate blood sugar levels. Other necessary maintenance injections may include certain vitamins, such as B12, for individuals with documented deficiencies.
For individuals with serious mental illnesses like schizophrenia, long-acting injectable (LAI) antipsychotics, or “depot” medications, are frequently used. These LAI medications, such as risperidone, paliperidone, or haloperidol, are administered every few weeks or months. The depot injection ensures consistent medication levels in the bloodstream, benefiting patients who have difficulty adhering to a daily oral schedule. Using LAIs promotes stability and helps prevent relapses within the facility.
Patient Rights and Refusal of Treatment
Individuals in custody retain the right to refuse most medical treatment, including injections. This right is rooted in informed consent, requiring a competent patient to voluntarily agree to a procedure after understanding its risks and benefits. Correctional medical staff must document any refusal of treatment in the patient’s medical record.
Exceptions exist when the health and safety of the entire facility population are concerned. An individual generally cannot refuse testing or treatment for a highly communicable disease, such as active tuberculosis, that poses a direct threat to others. Involuntary medication, including long-acting injections for mental illness, can be administered only under stringent legal conditions. This typically requires a court order or administrative hearing finding that the person is a danger to themselves or others. Refusing a mandatory public health screening, like the TST, may result in modifications to housing assignments, such as isolation, but rarely leads to a forced injection.