Updated: Nov 11, 2019
GARRETT LEONARD, 31, was in and out of jail in Washington from June 2017 through April 2019 for shoplifting charges. He says he was stealing to support his opioid addiction.
"When I went to jail the last time … I was withdrawing off fentanyl because most of the heroin in this area is laced with fentanyl, so it was the worst withdrawal I've had," Leonard says."They typically have an inmate in the detox tank for maybe three to four days, and I was there for eight days," he says, adding that he didn't eat for five of those days.
During a few of Leonard's stays, including that last one, he was sent to a local inpatient rehabilitation program. His last trip to the inpatient facility helped him stay clean, and he has now been sober for nearly eight months. Leonard takes Vivitrol, an opioid treatment medication that reduces cravings for the drugs, and attends weekly group support meetings.
Though this last stay proved to be successful for Leonard, he says he thinks he would have benefited greatly if the jails had provided him with opioid treatment medication, both during an initial detox and to maintain his sobriety afterward.
Jails, medical professionals and others around the nation are recognizing the importance of increasing inmates' access to opioid treatment medication, and researchers have found that this access is becoming a reality in Washington state. The criminal justice system and the opioid crisis are intertwined, with much of the nation's opioid addicted population cycling through jail or prison. Therefore, experts say that treating these people while they're incarcerated, where they don't have access to drugs on the street, is ideal.
"The jails are unfortunately the epicenter of where you find people who have substance abuse histories," says Marc Stern, an affiliate assistant professor in the Department of Health Services at the University of Washington School of Public Health. More than half of people in Washington with a substance abuse history go to jail in a given year, he says.
Besides his last stint in jail, Leonard would always become clean in jail but would return to drugs as soon as he got out.
"While you're sitting in jail incarcerated, that's really all you can think about as an addict is 'OK, when I get out, I want to get high,'" he says.
"So if they had a program at that time where I could have gotten on Suboxone or something, yeah, my likelihood of going back to exactly what I was doing definitely would have been way lower, and I would have really utilized (the program) if it were presented to me while I was incarcerated."
Suboxone is a medication that contains buprenorphine, which decreases a person's opioid withdrawal symptoms and cravings. Suboxone also contains naloxone, which deters people from abusing the medication. The naloxone ingredient is only activated if a patient injects the medication and would cause them to experience withdrawal symptoms.
Leonard now works as a certified peer counselor at a low-barrier Suboxone clinic called Olympia Bupe Clinic, which opened in January in Thurston County (which includes the city of Olympia), and is working with the county jail to ensure inmates are able to continue their opioid treatment medications while behind bars.
Stern co-authored a 2018 study with Lucinda Grande, a clinical instructor at the University of Washington School of Medicine and medical director of Olympia Bupe Clinic, which found that 14 out of the state's 33 jails are actively providing opioid treatment medications to inmates who need them. And some jails were in the process of trying to start a treatment program at the time of the study.
The most common medication the jails were administering was buprenorphine, and the most common use was for people who had already started an opioid treatment medication before their incarceration.
According to the report, 13 out of the 14 jails provide this maintenance medication. Seven provide withdrawal medication and an additional three provide treatment to pregnant women to prevent withdrawal symptoms. Six of the jails provide treatment for those not previously on medication at some point prior to an individual's release, for continued use once they re-enter the community. Three others provide this service only to pregnant women.
"The most important thing we found was all jails recognize (a lack of opioid treatment medication) was a problem and important issue but didn't understand the medications, laws around the use of medication and didn't know where to begin," Grande says. "And those who did didn't have the funding for it because the federal government does not allow Medicaid dollars to be used for medical services while incarcerated," she adds.
But Stern says the numbers in the report are "now out of date, which is a wonderful thing," as more jails are taking action to address the opioid crisis.
Stern and Grande say that Lewis County Jail, located south of Olympia, is an example of a prison that has made significant efforts in helping its inmates with opioid use disorder.
Lewis County Jail Chief Chris Sweet says his jail received funding through the Cascade Pacific Action Alliance, a community organization created under the state's Medicaid Transformation Project, to implement an opioid treatment medication program.
The jail's Health Services Administrator John Ackerman used some of the funding to partner with Medtriq Treatment Services, a company that provides medical services, including Suboxone treatment, in western Washington. Ackerman works for the jail's medical contractor, NaphCare.
Since March, when an individual enters Lewis County Jail, nurses conduct a standard assessment to determine if that person uses opioids and if they are a candidate for the treatment program, according to Ackerman. If they are a candidate, they undergo monitored stabilization using Subutex (a brand name for buprenorphine) before Medtriq providers initiate a formal maintenance program. They see the patient three times a week, perform drug testing, and give the patient a discharge plan to help bridge the return to the community. The program's funding pays for the patient's first counseling appointment with Medtriq outside of the jail and up to seven days of Suboxone, or until their Medicaid kicks in again.
"The idea is we're trying to eliminate barriers from the time they are discharged in jail to the time they walk into Medtriq and actually transition from inpatient to outpatient (treatment) because that's very critical in the first 24 hours because they could relapse," Ackerman says.
On average, he says the jail has between 15 to 20 people in the program, and they have had approximately 130 graduates.
As facilities such as Lewis County Jail have ramped up their efforts, others have been forced to offer opioid treatment due to court settlements.
In June 2018, the American Civil Liberties Union of Washington filed a case on behalf of Whatcom County Jail inmates who were denied opioid treatment medication. The ACLU alleged that the jail was discriminating against those individuals and that opioid use disorder is a chronic condition protected by the Americans With Disabilities Act.
"If somebody goes into jail with diabetes or a heart issue and their on medication for that, I don't think anybody would expect the jail to just cut them off of that and say 'you need to start changing your diet and exercise for it,'" says Mark Cooke, policy director of the Washington Campaign for Smart Justice at ACLU-Washington. "But with opioid use disorder, that's what was kind of going on even though there are these incredibly effective medications to treat opioid disorder."
Under a settlement, Cooke says the jail must now provide opioid medication treatment for withdrawal, maintenance and induction – treating those not currently on medication.
Additional ACLU-affiliated cases have been filed in Massachusetts and Maine, and there are also a few cases against the Federal Bureau of Prisons, according to Cooke.
"The legal issue is popping up in other places, and I expect that to continue," he says.
By Casey Leins
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