Berkshire County Sheriff talks how data can help fight opioid addiction behind bars
PITTSFIELD — If a new opioid bill is signed into law by Gov. Charlie Baker, five Houses of Correction will pilot a medication-assisted treatment program for addicts.
The Berkshire County House of Correction, overseen by Sheriff Tom Bowler, isn't one of them.
In an interview with The Eagle, Bowler welcomed the pilot program but expressed doubts about the efficacy of medication-assisted treatment in jails in place of an abstinence-based model.
"Here at the Berkshire County Sheriff's Office, we believe in clean, sober living. That's what we advocate for," Bowler said. "I really believe that someone who's addicted to an opiate, the one way they're going to get clean is if they're away from the [opiate] for a long period of time."
Still, Bowler is curious to see how a three-year pilot program plays out and calls it a "step in the right direction."
Echoing the position of the Massachusetts Sheriffs' Association, Bowler prefers the pilot program instead of a previously proposed statewide mandate that all county jails to provide medication-assisted treatment like methadone or buprenorphine (commonly known by the brand name Suboxone).
"This pilot program is going to give us an opportunity to really look at some data so down the road. ... We can try and create programs or a system that's effective and much more efficient for the community as well as the individuals," Bowler said.
The pilot program would be implemented in Hampden, Hampshire, Franklin, Middlesex and Norfolk counties. It would begin no later than Sept. 1, 2019, with annual reports from the Department of Public Health starting in 2020.
The pilot was just one facet of a dense bill attempting to address the opioid addiction epidemic passed by the Legislature and sent to Gov. Charlie Baker's desk for approval last week.
The program would require jails to provide voluntary medication-assisted treatment to any inmate who enters with a valid prescription. The treatment can only be altered or halted if a qualified addiction specialist makes such a determination.
The jail would be responsible for facilitating medication-assisted treatment, at least 30 days prior to the end of a sentence, for any inmate "for whom such treatment is determined to be medically appropriate by a qualified addiction specialist," the bill states.
The bill would also force jails to "make every possible effort" to connect inmates with an appropriate provider of medication-assisted treatment upon their release.
Jails in the pilot program will provide a status report every six months that details the costs of the program and prevalence of medication-assisted treatment, among other information.
"What's most important about this whole pilot program is the data we will collect," said Middlesex County Sheriff Peter J. Koutoujian, who serves as president of the Massachusetts Sheriffs' Association. Medication-assisted treatment "has proven to be an effective way to treat substance use disorder."
Funding for the pilot program, which will be implemented by the Department of Public Health in collaboration with the executive office of public safety and security, has yet to be appropriated.
Sen. Cindy Friedman, who spearheaded the opioid bill, wrote in an op-ed published in Commonwealth Magazine in July that medication-assisted treatment would "help close the revolving door of jail, reduce recidivism and provide inmates with treatment. If we fail to do this, there will be more arrests, more overdose deaths, and more money wasted."
From 2011 to 2015, the rate of overdose deaths overdose deaths among those that have been incarcerated was 120 times higher than the general population, according to state data.
Advocates for the new opioid bill also noted that 50 percent of deaths among those released from prison were related to opioids.
In Franklin County, the jail has already implemented buprenorphine treatment for inmates in 2016.
Franklin County Sheriff Christopher Donelan told the Greenfield Recorder this week that "When people leave here they are more stable. They have a doctor's appointment and a treatment regimen."
The pilot program will provide insight into potential cost issues, security issues and unforeseen consequences of integrating medication-assisted treatment into jails, Koutoujian argued.
"The Legislature was right to allow five offices to explore the potential of this while gathering the data," he said.
Koutoujian added no other state has implemented such a program at the county level. The jails, he argued, are "closer to the street" and return many more people to the general public than state prisons.
"We have a greater ability to impact our communities through this," Koutoujian said. "That's why this program is so necessary."
Bowler said his office collects some data. Since Jan. 1 of this year, the office has found that 88.8 percent of the population that enters the Berkshire County Jail and House of Correction that are on suboxone or methadone admit to also using other drugs
The situation is similar in Middlesex County, where Koutoujian reported that two-thirds of people who enter with a verified Suboxone prescription, and three-quarters who enter with a verified methadone prescription, have to be detoxed for a different drug.
"That's a big problem," Bowler said.
Bowler acknowledges that medication-assisted treatment "has its place," but questioned whether that includes the a jail.
"If properly implemented, abstinence and education and counseling in a long-term therapy program is much better," Bowler said.
Koutoujian, who shared some of Bowler's concerns, said the program could help illuminate which medication-assisted treatment is right for certain kinds of individuals. But he added that assuming medication-assisted treatment is the right approach for every person with substance use disorder would be "wrong-headed."
"I'm interested in seeing the data and making sure the data is real and valid. If it comes from my shop, I know I can trust it," Koutoujian said.
The Berkshire County jail already offers Vivitrol, a drug that can prevent someone from getting high off an opioid for up to a month, voluntarily for inmates who feel they will need it upon their release.
"There's a whole process that we have, and we've been successful," Bowler said.
The sheriff also laid out logistical challenges to implementing the program. The jail isn't federally authorized to provide methadone or Suboxone, so it would need to transport inmates to a clinic every day or contract with a vendor to bring it to the jail.
If the state eventually mandates the program be implemented in all jails, Bowler said he hopes the Legislature follows through with funding for it.
Bowler has advocated that the state fund four external case managers for his jail to follow up and help inmates stay sober after release.
"If I had those individuals, we could do a serious dent on the recidivism rate and the opioid epidemic," Bowler said.
Adam Shanks can be reached at firstname.lastname@example.org, at @EagleAdamShanks on Twitter, or 413-629-4517.
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