By Morgan McKenzie
Greeley Tribune
GREELEY, Colo. — As overdose deaths in incarcerated settings continue to rise in Colorado, the need for adequate substance abuse treatment grows more apparent.
More than half of Colorado county jails, including the Larimer County Jail, have turned to medication-assisted treatment (MAT) to combat these issues. But 27 counties, including Weld, don’t implement the program due to concerns about potential ramifications.
Larimer County partnered with Colorado Opioid Synergy Larimer and Weld (CO-SLAW), a program of the North Colorado Health Alliance, to start an MAT program. MAT is a two-part system of counseling services and an FDA-approved medication to treat substance abuse addictions — specifically opioid addiction — for the thousands of incarcerated inmates going in and out of the jail.
MAT stops withdrawal symptoms and cravings because the medicine addresses the physiological needs of people who have a use disorder. The three medications used are:
- Methadone, which helps with cravings and withdrawals,
- Injectable vivitrol, which helps with cravings, and
- Buprenorphine, which helps with cravings and withdrawals.
Lesley Brooks, assistant medical director at North Colorado Health Alliance, said the program has helped more than 1,500 inmates at the Larimer County Jail as of August. The program persists as one of the most successful jail MAT programs in the country, she said.
“MAT is evidence-based and life-saving,” Brooks said. “Studies have been done to look at the effectiveness of MAT (with buprenorphine) alone vs. MAT plus counseling. And the addition of counseling did not decrease opioid use beyond what was achieved with MAT alone. Ideally, we want persons involved in both MAT and counseling, but we know that the medication saves lives.”
Larimer County ‘taking out the emotion’
Larimer County Sheriff’s Office Lt. Staci Shaffer said many inmates have responded well to the MAT program since they started it about three years ago.
Shaffer said she sees the value MAT offers to inmates when it comes to recidivism, relapsing and overdose deaths — something she believes one does not have to be a medical professional to realize after consulting with people in the field of medicine and addiction.
Larimer isn’t the only county in the state pursuing this treatment. In total, 37 out of 64 jails in Colorado have formalized medication-assisted treatment, according to the Colorado Department of Human Services.
Shaffer indicated Weld County Sheriff Steve Reams has been long-opposed to MAT in the Weld County Jail.
“I think the generalization that Reams is against it isn’t 100% fair,” Weld County Sheriff’s Office spokesman Joseph Moylan said. “With that said, I think it just comes down to the philosophical difference of opinion.”
While the Weld County Jail has looked into implementing the program for the past several years, Moylan said the jail staff is sticking to what they believe is a viable treatment option as well: detox protocol.
For Weld County inmates struggling with addiction, treatment includes IV fluids and habit-forming medication to abstinence until they are released from jail. Upon release, there are plenty of places in the county to get addiction treatment services, which are provided to those once they are released from jail, Moylan said.
Not even court orders are 100% effective in getting those struggling with addiction to comply with receiving treatment, he added, so those seeking treatment must take the initiative themselves.
“The services already exist in the county ... we just don’t think that a jail should be a place that people are seeking out as a rehab option,” Moylan said.
Shaffer said jail leaders must “take out the emotion” about the medication prescribed through the MAT programs and advocate for treatment being solely between the doctor and the patient.
Larimer County Sheriff Justin Smith may have had similar concerns as the Weld County Sheriff’s Office, according to Shaffer, but once he learned the science, realized the jail could manage the program and saw the results, he jumped on board.
“I’m just really impressed that he came full circle to embrace the program and made that adjustment for himself and for the health and welfare of the inmates in our facility,” Shaffer said.
MAT evidence
In December, Sherrie Daigle, the state Department of Corrections inspector general, reported her agency has found more drugs in the past two and a half years than in the history of the Inspector General’s Office, according to a Colorado Sun article. From April 2020 to May 2021, there were at least three fatal overdoses inside a state prison.
Colorado has seen a spike of more than 600% from 2001 to 2018 in the number of people who have died of drug or alcohol intoxication in state prisons, data from the Bureau of Justice Statistics indicated. As for county jails, overdose deaths increased by more than 200%.
With current approaches to opioid use disorders in jails and prisons, outside of MAT, relapse rates exceed 75% after a release from custody, and overdose death rates are 10 to 40 times higher for previously incarcerated people than for the general population, according to a report from the Substance Abuse and Mental Health Services Administration.
Studies involving jail settings have demonstrated that methadone, buprenorphine and extended-release naltrexone have shown to reduce illicit opioid use, according to the report. Evidence indicates that providing methadone or buprenorphine during custody and after release to the community correlates with substantially lower rates of opioid overdose and mortality.
“Somebody goes into the jail, and they sort of don’t need as much of the dosage if they have something to kind of sustain them,” Shaffer said. “Once they get out of jail, then they’re less likely to have that immediate overdose after having been off medication for a time.”
Other drug treatment approaches also show that re-arrest rates are nearly at 50% in the first year, the report said. However, data indicates retention in methadone or buprenorphine treatment is often associated with significantly lower rates of criminal activity.
Within the CO-SLAW and Larimer County Jail partnership, a decrease in the “unacceptably” high rate of risk of overdose can be seen by offering naloxone prior to discharge for inmates in treatment for their opioid use disorder, according to Brooks.
CO-SLAW coordinators also assure appointments are set up for people released from the jail as soon as they are released, Brooks said, meaning treatment continues outside the jail.
While CO-SLAW awaits a report with data to confirm that a high amount of Larimer County inmates who go through MAT programs are able to sustain recovery and not return to jail, data indicates the programs improve employment, education and self-perception of mood and wellness.
“I think our jails will enjoy greater staff satisfaction, greater stability of their incarcerated persons,” Brooks said. “And potentially again, we need the data to solidify this, decrease the revolving door of folks coming back through the criminal justice system with charges related to their substance use.”
Misconceptions about MAT
Many county jails including Weld County have yet to introduce MAT programs due to concerns of diversion and the idea of swapping out one addiction for another, according to Shaffer.
“We aren’t totally sold on the idea of treating an opioid dependence with another opioid that people are then going to have to rely on for a long term,” Moylan said about the Weld County Sheriff’s Office not implementing the program.
Though critics worry MAT involves giving an opiate to someone with an addiction, Shaffer explained, it’s a small, controlled amount to create a better mechanism for the brain to reset. This helps people struggling with addiction to stop focusing on the cravings and start focusing on themselves and their recovery journey.
“When somebody is in custody, and they are less distracted by all the other things going on in their world, they can’t do anything else but focus on themselves,” Shaffer said. “I like to call jails a ‘stopportunity.’ It’s an opportunity to stop doing what you were doing before that got you into jail. And this is a way for individuals to take advantage of that ‘stopportunity.’”
Critics also worry inmates will smuggle, sell or distribute medications in jail. If someone in the program at Larimer County Jail is caught doing so, the staff disciplines the inmate based on what the doctor suggests.
After a discussion between the patient and the doctor, the doctor will recommend solutions such as switching the method of medication from a strip to a shot or taking the person out of the program if they aren’t ready to fully commit.
“It’s about decision-making, and we decided to leave a medical problem in the hands of medical providers,” Shaffer said.
What’s next?
Part of a challenge among criminal justice partners is payment structure: How will the MAT programs be funded?
MAT is covered by Medicaid, Medicare and most insurances, but most Medicaid-eligible people don’t have their insurance to support them once they are incarcerated. As a result, those costs fall to whoever is financing the jail in the county.
The Behavioral Health Transformational Task Force in Colorado continuously looks into opportunities to allow a person to utilize Medicaid while incarcerated, Brooks said.
CO-SLAW helps cover the cost of treatment for participants in the Larimer County Jail’s program through grants.
Brooks believes it is critical to push criminal justice partners to understand the value of this treatment, including financial aspects and an incarcerated population that is easier to manage and contributes to staff satisfaction.
“As you can imagine, managing somebody in acute withdrawal can be really challenging,” she said. “If we can create buprenorphine, and other forms of MAT, we have the opportunity to eliminate withdrawal and therefore eliminate patient interaction that can be challenging for both staff and patients.”
One next step for CO-SLAW is working to use underutilized medications through expanding treatment programs to incorporate other use disorders from alcohol use disorder to tobacco use disorder.
“I think that deploying effective treatment as quickly as possible at opportune moments like incarceration is among the most critical things that we can do for our communities,” Brooks said.
NEXT: Maine’s Department of Corrections on what it takes to implement MAT services
(c)2022 the Greeley Tribune (Greeley, Colo.)