Opioid treatment in jails needs 3 drugs, experts say

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Capital News Service

LANSING — County officials, medical professionals and the Center for Behavioral Health and Justice will meet through an online summit May 5 to discuss their experiences with the Opioid Treatment Ecosystem (OTE) program in county jails.

The program began in 2019 to address overdoses among recently released inmates.

Brad Ray, the director of the center at Wayne State University, said his research into the opioid epidemic found that 33% of individuals who died of accidental overdoses had been released from a county jail within the previous year. 

That was the most frequent similarity among the victims, he said.

Ray said that the highest risk for overdose comes within the first few hours after release. And people freed from incarceration are 129 times more likely to die from a drug overdose within the first two weeks than the general public. 

“What’s crucial to remember about addiction is how quickly a dependence is formed,” Ray said.

With the rapid withdrawal that inmates experience, many who get out of jail think they can take the same amount of substances as before they were incarcerated. That leads to a high amount of overdoses, he said. 

Research shows that medically assisted treatment is the most effective way to treat opioid use disorder, according to Ray.

With funding from the Michigan Opioid Partnership, the center started OTE for counties that wanted help implementing more effective medical treatments in their jails. 

Currently, Jackson, Kent, Monroe, Muskegon, Washtenaw and Wayne are the six participating counties.

OTE funds the medical and technical equipment for the program. It also provides psychosocial services like group therapy, as well as forms of continuous care like discharge planning and Medicaid reactivation.

Each county has formed its own “change team” that includes jail and health administrators, as well as a project coordinator and data analyst from the center.

Rebecca Newman, the project coordinator for OTE, said that it’s crucial for change teams to form a “community of practice” where they can share their successes and struggles with the program.

The upcoming summit will be a chance for representatives of the six counties to do so.

“These county jails can be very isolated, so creating a space where you can come together and learn from each other is very unique,” Newman said. “It’s not a cookie cutter approach, so each county looks different.”

To participate in the program, a jail must use all three currently available forms of medication: methadone, buprenorphine and naltrexone. 

Naltrexone is the most commonly used because it’s a single shot every 28 days that blocks some effects of withdrawal, while the other medications reproduce the effects of opioid use without the sense of euphoria. 

Ray said it’s important that jails use all three as that’s been proven the most effective method. 

Few jails across the United States do that due to misconceptions, he said. 

“When we would call counties and would ask them if they wanted to do this, that is when we would hear a lot of the stigma,” Ray said. “Things like ‘these just substitute one drug for another.’”

A major goal of the program is to reduce the stigma behind those forms of treatment across the state.

Ray said counties need to understand the disorder from a medical or mental health perspective. 

The upcoming summit is an opportunity for other counties that might be considering those medications to learn more about the program, he said. 

County officials can register on the Center for Behavioral Health and Justice’s website.

“We’ve had a lot of officers say that, to be honest, we hear a lot that it’s a brain disorder, but we don’t know what that means,” Ray said. “There will be six different communities of practice to hear from.  

“There are nurses working in jail, community mental health leaders. This is where you get to tap into that knowledge,” he said.

He said he hopes other counties consider using the three medications and care modeled by OTE.

“Michigan has set a high bar, higher than the rest of the country,” Ray said. “That’s where we need to be.”

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