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Inmates Weigh in on Opioid Crisis

August 17, 2018

By Colin A. Young

State House News Service

BOSTON -- As five sheriffs work to establish a pilot program to expand medication-assisted treatment for inmates addicted to opiates, the Barnstable County sheriff’s office has brought new voices to the discussion of the program’s efficacy -- those of inmates themselves.

The opioid addiction treatment law signed by Gov. Charlie Baker last week calls for correctional facilities in Hampden, Hampshire, Middlesex, Norfolk and Franklin counties to run a three-year medication-assisted treatment (MAT) pilot program beginning September 2019. Some Bay State sheriffs already offer one type of MAT, but the pilot will make more inmates eligible and will make more medications available for treatment.

Those five facilities will supplement counseling with opioid addiction treatment medications -- methadone, buprenorphine or naltrexone -- for inmates who had a valid prescription when they entered the jail and inmates who are to be released within 30 days. An inmate’s participation in the program will be voluntary and contingent upon a recommendation from a qualified addiction specialist.

Last Friday, the Barnstable County sheriff’s office released a YouTube video in which clinician Tom Hostetter talks with six current inmates and one recently-released offender about their experiences with Suboxone -- the brand name for buprenorphine -- and their thoughts on Suboxone being available within jails.

“I think it’s a terrible, it’s a horrible idea to introduce that into a facility,” one inmate said.

Another inmate, identified only as Peter, said he was in three correctional facilities before Barnstable County and said Suboxone, which is an opioid that can be abused like other drugs, was one of the most readily available drugs in the facilities.

“It was chaos -- fights, gambling, people calling home to their families to try to get money so they could give it to another inmate to get Suboxones,” Peter said. “An eight-milligram Suboxone strip can be cut into sixteenths and those sixteenths of a Suboxone go for $20 a piece.”

Barnstable County Sheriff James Cummings said the video and the short press release that accompanied it should not be taken as a sign that he or his office is opposed to the pilot program or MAT in general.

“I’m interested in seeing how the five sheriffs offices that are going to run the pilot programs, how they are going to work out for them,” he told the News Service. “I’m not a clinician but Suboxone, in my experience, just doesn’t seem to work very well for the people we deal with.”

Cummings said he was the first sheriff in Massachusetts -- “in fact maybe even in the country,” he said -- to offer Vivitrol, the brand name for naltrexone which helps prevent relapse, to inmates who were to be released within 30 days. He said he was willing to use Vivitrol for MAT because, unlike Suboxone, it is not a narcotic and is not a drug that is commonly diverted for illicit purposes within correctional facilities.

“If the test sites can come up with a way to maintain the security of the facility and it shows some indication that it is helping people, we will certainly take a look at it,” Cummings said. “The common sense part of me says if we have something that works just as well --and studies have shown that Vivitrol is as good as Suboxone and methadone in treatment -- and it’s a non-narcotic, then why wouldn’t we do that?”

Middlesex County Sheriff Peter Koutoujian, who serves as president of the Massachusetts Sheriffs’ Association and worked with lawmakers on the MAT provisions of the law, said the video Cummings’ office released was “intriguing.”

“We all have the same concerns,” he said. “As sheriffs, we hear these concerns ... but I think coming from us they don’t nearly have the same weight than when they’re coming from the individuals who have gone through the trials and tribulations of addiction and then have gone through medication-assisted treatment.”

Koutoujian added, “We share the concerns about efficacy as well as security, and cost as well. I think it’s important to watch these videos to understand the other side of things.”

Koutoujian said Cummings and other sheriffs not participating in the MAT pilot are “absolutely correct in wanting to see how it would work before they start to do it.” He said that’s why every sheriff was on board with the program being run as a pilot, instead of a proposed mandate that all sheriffs provide MAT.

“Everyone, to a sheriff, has said if it can be shown to have efficacy and be done safely and have good effects, they’re all interested in participating at some level,” he said.

The law calls for extensive collection of data on MAT and Koutoujian said that data will be critically important when sheriffs make future decisions about the program and its effectiveness.

A female inmate interviewed in the video Cummings’ office released last week said she thinks that if Suboxone were available in a jail, inmates would bully or bribe others in the medication-assisted treatment program to get their hands on the Suboxone.

Koutoujian acknowledged the concern about diversion of Suboxone and said the pilot program will certainly carry costs for security enhancements. He said he believes security challenges are something the five sheriffs participating in the pilot will be able to overcome.

“With regard to Suboxone, it is diverted and it is the number one source of contraband in our facilities. If we bring it in, there will be an attempt to divert it,” he said. “We have to make sure that we are establishing and utilizing best practices to make sure we can stop that diversion from occurring.”

The pilot program is slated to launch in September 2019, thought the five participating sheriffs are expected to have plans for their programs in place by March.

“We’ve already begun to organize, to start to meet with our treatment staff and our fiscal staff and our security staff of all five offices to start to come up with some best practices, some protocols, some questions and some concerns,” Koutoujian said.

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