Sunday, June 30, 2019
The Cincinnati Enquirer
CINCINNATI
The “dope boys” hang out near the jail awaiting newly freed inmates with addiction. They’ll hand you a free sample to get you back. Triggers to use drugs again – the corners where you’ve used, for one – are all around, and any plans for a fresh start easily evaporate.
“In here, it’s black and white,” said Ashley Pels, a Hamilton County jail inmate, looking around the recovery pod for women. Get released, she said, and “it’s like ‘The Wizard of Oz.’”
The opioid receptors in her brain just “light up,” she said, and her cravings roar back.
There’s a big chance of relapse after release, and some who do will die. If they survive, three of four ex-inmates such as Pels will end up returning to their addiction – and potentially returning to the crimes they committed to support their addiction.
It’s a vicious cycle for the addicted and their families, one that has safety, financial and other consequences for the rest of society. But since May, health care providers at the Hamilton County jail have been using medicine to help break the connection.
Fifty-two inmates now are receiving buprenorphine, an FDA-approved medication that is to temper cravings. They represent about 3 percent of the jail’s daily population.
It may seem like a small number and a simple change. But the jail’s health provider, NaphCare, is among a fraction of programs to start medical treatment behind bars.
Jails and prisons across the country have been slow to get on board with this kind of medication-assisted treatment, and addiction specialists say that’s just wrong.
Medical studies show that buprenorphine and other opioid treatment medications can keep people safe from overdose and death.
“Addiction is a disease. Even if an individual does not have access to substances during incarceration, the disease remains if it is not treated,” said Lindsey Vuolo, director of health and law policy for the Center on Addiction, a national nonprofit focused on the development of evidence-based drug policy.
“Within three months of release from custody, 75 percent of people who were in prison or jail with an opioid-use disorder experience a relapse to opioid use,” said Jon Berg, a public health adviser with the U.S. Substance Abuse and Mental Health Administration.
Yet the most recent U.S. Department of Justice data show that only 1 in 20 jails and prisons nationwide offer medication for addiction. Only 1 in 200 offers buprenorphine with naloxone, which is known commonly by its brand name, Suboxone.
That’s because buprenorphine, classed as an opioid, is often judged by criminal justice officials to be a simple substitution for heroin or other drugs. Medical experts say that’s not true: Buprenorphine stabilizes people and lets them function normally without euphoria when prescribed and taken correctly.
“I didn’t believe in it,” said Albany, N.Y., Sheriff Craig Apple, who speaks nationally on the opioid epidemic for the national Law Enforcement Action Partnership, an organization that promotes criminal justice solutions. Now he does.
In 2012, Apple started his Sheriff’s Heroin Addiction Recovery Program in Albany, providing counseling and only a non-narcotic medicine, FDA-approved naltrexone (known by its brand name, Vivitrol) in his jail. When inmates were released, they were directly transported to treatment centers.
The sheriff saw a direct decline in these inmates returning to jail.
But as of December 2018, Apple expanded the program to include all FDA-approved medications, including the opioids buprenorphine and methadone.
And the current recidivism rate – or rate of return to jail – among those who got the treatment is at 16 percent. It’s fluctuated from 12 percent to 20 percent, Apple said.
“The addiction isn’t making them commit the crime,” Apple said. “The lack of money and ability to feed their high is doing that.”