As overdose deaths in prison settings continue to rise in Colorado, the need for adequate drug treatment becomes more evident.
More than half of Colorado County jails, including Larimer County Jail, have turned to drug treatment (MAT) to combat these issues. But 27 counties, including Weld, are not implementing the program due to concerns about potential ramifications.
Larimer County has partnered with Colorado Opioid Synergy Larimer and Weld (CO-SLAW), a program of the North Colorado Health Alliance, to launch a MAT program. MAT is a two-part system of counseling services and an FDA-approved drug to treat drug addictions — specifically opioid addiction — for the thousands of incarcerated inmates entering and leaving prison.
MAT stops withdrawal symptoms and food cravings because the drug meets the physiological needs of people who have a drug use disorder. The three drugs used are:
- Methadone, which helps fight cravings and withdrawal,
- injectable vivitrol, which relieves food cravings, and
- Buprenorphine, which helps fight cravings and withdrawal.
Lesley Brooks, deputy medical director of the North Colorado Health Alliance, said the program helped more than 1,500 inmates at Larimer County Jail in August. The program remains one of the most successful in-prison MAT programs in the country, she said.
“The MAT is evidence-based and life-saving,” Brooks said. “Studies have been conducted to examine the effectiveness of MAT (with buprenorphine) alone versus MAT plus counseling. And the addition of counseling did not decrease opioid use beyond what was achieved with MAT alone. Ideally, we want people to participate in both MAT and counseling, but we know that drugs save lives.”
Larimer County ‘eliminates emotion’
Lt. Staci Shaffer of the Larimer County Sheriff’s Office 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 inmates when it comes to recidivism, relapse and overdose deaths — which she believes you don’t have to be a medical professional to realize. after consulting with people in the medicine and addictions field.
Larimer isn’t the only county in the state to pursue this treatment. A total of 37 of Colorado’s 64 prisons have formalized drug treatment, according to the Colorado Department of Human Services.
Shaffer said Weld County Sheriff Steve Reams has long opposed MAT in the Weld County Jail.
“I think the generalization that Reams is against is not 100% correct,” Weld County Sheriff’s Office spokesman Joseph Moylan said. “Having said that, I think it comes down to philosophical difference of opinion.”
As the Weld County Jail has looked into implementing the program over the past few years, Moylan said jail staff are also sticking with what they believe is a treatment option. viable: the detoxification protocol.
For Weld County inmates struggling with addiction, treatment includes intravenous fluids and habit-forming drugs until they are released from prison. Upon release, there are many places in the county to get drug treatment services, which are provided to those released from prison, Moylan said.
Even court orders are not 100% effective in getting people struggling with addiction to comply with treatment, he added, so those seeking treatment must take the initiative themselves. .
“Services already exist in the county…we just don’t think a jail should be a place people seek out as a rehab option,” Moylan said.
Shaffer said prison leaders need to “take the emotion out” of drugs prescribed in MAT programs and advocate for treatment to be solely between doctor and patient.
Shaffer says Larimer County Sheriff Justin Smith may have had similar concerns as the Weld County Sheriff’s Office, but once he learned the science, realized the jail could handle the program and seeing the results, he jumped on board.
“I am truly impressed that he has come full circle to embrace the program and made this adjustment for himself and for the health and well-being of the inmates at our facility,” Shaffer said.
In December, Sherrie Daigle, the inspector general for the state Department of Corrections, reported that her agency had found more drugs in the past two and a half years than in the history of the Office of Inspector General. , according to a Colorado Sun article. From April 2020 to May 2021, there were at least three fatal overdoses in a state prison.
Colorado saw a more than 600% increase from 2001 to 2018 in the number of people who died of drug or alcohol poisoning in state prisons, according to data from the Bureau of Justice Statistics. As for county jails, overdose deaths have increased by more than 200%.
With current approaches to opioid use disorder in jails and prisons, outside of MAT, relapse rates exceed 75% after 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 by the Substance Abuse and Mental Health Services Administration.
According to the report, studies involving prison settings have shown that methadone, buprenorphine and extended-release naltrexone reduce illicit opioid use. Evidence indicates that administration of methadone or buprenorphine during custody and after release into the community is correlated with significantly lower rates of opioid overdose and mortality.
“Someone goes to jail, and they kind of don’t need that much dose if they have something to back them up,” Shaffer said. “Once they get out of jail, they’re less likely to have that immediate overdose after they’ve been off the meds for a while.”
Other drug treatment approaches also show that re-arrest rates are almost 50% in the first year, according to the report. However, data indicate that retention in methadone or buprenorphine treatment is often associated with significantly lower rates of criminal activity.
As part of the CO-SLAW and Larimer County Jail partnership, a decrease in the “unacceptably high” rate of overdose risk can be seen by offering pre-release naloxone to inmates undergoing treatment for their drug use disorder. opioids, according to Brooks.
CO-SLAW coordinators also ensure appointments are set for those released from prison upon release, Brooks said, which means treatment continues outside of prison.
While CO-SLAW awaits a report with data to confirm that a large number of Larimer County inmates who attend MAT programs are able to recover and not return to prison, the data indicates that the programs are improving the employment, education and self-perception of mood and well-being.
“I think our prisons will benefit from greater staff satisfaction, greater stability of their inmates,” Brooks said. “And potentially again, we need the data to solidify that, to reduce the number of people coming back into 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 diversion issues and the idea of replacing one addiction with another, according to Shaffer.
“We’re not totally sold on the idea of treating an opioid addiction with another opioid that people then have to rely on long-term,” Moylan said of the Weld County Sheriff’s Office, which did not. not implemented the program.
Although critics fear that MAT involves giving an addicted person an opiate, Shaffer explained, it’s a small, controlled amount to create a better brain reset mechanism. It helps people struggling with addiction stop focusing on cravings and start focusing on themselves and their healing journey.
“When someone is in detention and less distracted by all the other things going on in their world, they can’t do anything but focus on themselves,” Shaffer said. “I like to call prisons a ‘portunity of arrest.’ It’s an opportunity to stop doing what you were doing before you went to jail, and it’s a way for individuals to take advantage of this “opportunity to quit”.
Critics also fear that inmates are smuggling, selling or distributing drugs in prison. If anyone in the Larimer County Jail program is caught doing this, staff discipline the inmate based on what the doctor suggests.
After a discussion between the patient and the doctor, the doctor will recommend solutions such as changing the method of medication from a strip to an injection or removing the person from the program if they are not ready to fully commit.
“It’s about decision making, and we decided to leave a medical issue in the hands of medical providers,” Shaffer said.
Part of a challenge among criminal justice partners is the payment structure: how will MAT programs be funded?
MAT is covered by Medicaid, Medicare, and most insurance, but most people who qualify for Medicaid don’t have their insurance to support them once they’re incarcerated. As a result, these costs fall on whoever funds the county jail.
Colorado’s Behavioral Health Transformation Task Force is continually reviewing opportunities for a person to use Medicaid while incarcerated, Brooks said.
CO-SLAW helps defray the cost of treatment for participants in the Larimer County Jail program through grants.
Brooks believes it is essential to push criminal justice partners to understand the value of this treatment, including financial aspects and a more manageable prison population that contributes to staff satisfaction.
“As you can imagine, managing someone in acute withdrawal can be very difficult,” she said. “If we can create buprenorphine and other forms of MAT, we have the opportunity to eliminate withdrawal and therefore eliminate patient interactions that can be difficult for staff and patients.”
A next step for CO-SLAW is to utilize underused medications by expanding treatment programs to incorporate other use disorders, from alcohol use disorder to smoking disorder.
“I think rolling out effective treatment as quickly as possible at opportune times like incarceration is one of the most critical things we can do for our communities,” Brooks said.