This week, the St. Clair County jail will start offering some inmates a chance to get on medications that can help them kick opioid addiction.
The state-funded pilot program, which will start with 12 inmates, puts the county among the small but growing ranks whose jails offer addicted inmates some form of medication assisted treatment.
Deborah O’Brien, program coordinator for the St. Clair County Sheriff’s Department, says that among the roughly 400 local inmates the jail houses on any given day, at least 75% have some kind of substance abuse problem.
O’Brien says she was compelled to look into the possibility of a MAT program after last summer, when “it seemed almost every day somebody that we knew as an inmate died of an overdose.”
“We’re sort of a rural community, so we know almost all of the people that come into our jail who are local,” O’Brien said. “And we know they’re going to be our neighbors when they leave here. So we want to be able to have them improve their lives and make better choices.”
O’Brien says that a combination of MAT and therapy “is really the optimum way to go, if medication is going to be beneficial for them. And with opioid use, it generally would be beneficial.”
The St. Clair County jail will offer the program to 12 inmates at a time, who join after several rounds of screening. After consulting with the inmate, a doctor will decide which of three medications — Vivitrol, suboxone (buprenorphine), or methadone — is appropriate for them.
O’Brien says methadone, which is the strongest opiate-based replacement option among the three medications, will only be offered to inmates who come into jail undergoing methadone treatment. Suboxone is a milder opiate-based replacement and maintenance medicine, whereas Vivitrol works by blocking the effects of opiates that blocks the effectiveness of opioids and should prevent people from experiencing any kind of a “high.”
A solid body of research shows that MAT is generally more effective — many say substantially more effective — at combating addiction and promoting recovery than traditional abstinence-based treatments. However, the idea is still controversial, and there are some concerns about introducing it in a jail setting.
Some sheriffs and jail administrators worry that drugs like methadone and suboxone could be diverted within the jail. Others don’t feel that jails are set up to accommodate such a program, even though county jails are now usually the largest de facto drug treatment centers in any county. There are also concerns about cost.
There’s also some stigma within the traditional recovery community about MAT, says Lauren Rousseau, a professor at Cooley Law School and the president of the Northwest Wayne chapter of Families Against Narcotics. Groups like Narcotics Anonymous promote an abstinence-based approach and can consider MAT a type of alternative addiction, where one opioid-based drug replaces another and the patient isn’t really “clean.”
And there’s still a pervasive mentality that forcing inmates to go through a painful, cold turkey in jail is justified and even desirable.
“It’s part and parcel of viewing addiction as a moral failing that maybe deserves to be punished, instead of treating it as a disease, and treating it humanely,” Rousseau said.
Rousseau says failing to treat addiction in jail has another consequence — putting inmates at hugely increased risk of a deadly relapse once they’re released.
“You walk out that door, and you’ve had no treatment. Your tolerance is bottomed out, and you are craving like heck. And you don’t know how much to use anymore,” she said. “So it’s a wasted opportunity, and it’s a huge positive step to be moving toward some type of treatment and offering these medications.”
Rousseau says the St. Clair County model looks like “an ideal thing.”
“They’re going to have medical professionals working with prisoners to determine which [medication] is the best fit for them. That, to me, is a perfect world,” Rousseau said. “And that is something I think should be offered in all jails.”
Several other Michigan counties, including Kent and Eaton, have implemented some form of MAT in their jails. Oakland County is running a pilot program in its jail with the same state grant funds St. Clair County is using. More jails nationwide are implementing MAT programs, and more may have to — in a possible precedent-setting case, a federal court ruled just last week that a Maine jail had to allow an incarcerated woman to continue her Suboxone treatment while in jail.
Deborah O’Brien says she doesn’t know how effective the program will be, but it’s still worth the effort.
“If we only did twelve people throughout the year, and of those twelve just one of them didn’t come back to jail and was in recovery, I think that’s an improvement,” O’Brien said. “I’d like to see significantly higher than that, but really any kind of a win is a win.
“I think that there’s hope, but the person has to really want it. And this just gives them another tool to make it if they decide that’s what they want.”
