Mass. jail changes addiction response with state's first in-house clinic
“You need to stand in front of your correction officers and explain to them what you’re doing and why. The process is so much smoother and when you do it that way”
FRANKLIN COUNTY, Mass. — Sara Lazarz sits in a room in the Franklin County House of Corrections to take part in the re-entry program. She suffered from panic as a result of trauma in her past. Now she’s in the process of overcoming an addiction to heroin as a result.
“This treatment center is amazing,” Lazarz said to MassLive in August 2019.
The Medication Assisted Treatment program, also known as MAT, which is the use of medications in combination with counseling and behavioral therapies, is effective in the treatment of opioid use disorders and can help some people to sustain their recovery.
The Franklin County House of Correction in Greenfield was the first in the state and among the first in the country to provide methadone in-house for its clients in an effort to subdue their addiction to opioids.
Massachusetts received a second-round State Opioid Response grant of $35,879,685 from the Substance Abuse and Mental Health Services Administration to support prevention, treatment, and recovery services.
“We received a one-time grant of $500,000 to support our program,” said assistant superintendent Ed Hayes. “The program costs us approximately $400,000 annually.”
The opioid-related death rate in Massachusetts has surpassed the national average, according to the Massachusetts Department of Public Health, there was an average of almost six opioid-related overdose deaths per day in 2017.
“Currently, we have 47 individuals in our MAT program,” said Hayes in November 2019. “Eight are methadone patients and 39 are buprenorphine.”
Since February 2016, the jail has run a MAT program according to Schwartz and on Sept. 1, became the first to offer an inhouse methadone clinic for the program’s clients.
From July 2018 through June 2019, 282 clients at the jail have received treatment using MAT.
Having a better understanding of clients who are housed at the house of correction and getting to know how they usually act is key. This means that all the staff need to know what the client is usually like so they can see any difference in their demeanor.
“[Part of the reason] they start at 5:30, 5:45 in the morning, getting these guys and women up, getting them to the clinic and getting them dosed is because we need to watch them during the course of the day,” said Franklin County Sheriff Christopher Donelan. “When they're in treatment groups or when they're doing some of the work, to see how they're reacting. Are they getting groggy and they’re sleepy.”
Donelan knows how important it is to treat his clients as patients rather than inmates, referring to it as a “locked treatment facility,” to address the opioid crisis that has affected Massachusetts particularly hard.
“We're trying to find that perfect spot, where we're reducing cravings, but we're not causing any type of lethargic response,” Donalen said.
One of the greatest challenges the jail has encountered since the clinic opened and one of its biggest successes is the dosing. For each person, who is on either the suboxone or methadone treatment, there is a myriad of different factors the medical staff need to take into account. Height, weight, metabolism, tolerance and history all take time to judge. Experience is a big factor.
In August, MassLive visited the facility and spoke to Sheriff Chris Donelan who said that when he first took over the role as sheriff in 2011 and noted that treatment facilities needed to be improved to address the treatment of the offenders that are sent to the jail.
As each person enters the jail, they are screened for narcotics through blood tests, criminal record and by asking the individual for their personal history.
“There's some self-reporting,” said Donelan. “But there's a lot that we look at in [their] history that needs to back that self-reporting.”
Mutual respect has worked to create a calm environment within his jail. In order to treat those affected, they first need to want to be helped.
The main difference between suboxone, also known as buprenorphine, and methadone is that buprenorphine is a partial-agonist (pain killer); methadone, like heroin, is a full-agonist.
Buprenorphine works by interacting with the same receptors of the brain that affect other drugs (like heroin and methadone), but it fools the brain into thinking that it is taking an opiate when in reality it’s not.
“Unless you drill down into the underlying substance abuse issue, the underlying trauma issue, the underlying mental health issue that's causing someone to feel like they can't be in a room full of people, without being high,” said Donelan. “We have to drill down and get to that, so you can conquer whatever mental health issue is whatever that trauma is so you have the strength to go forward on your own merits and deal with whatever issues confront you.”
“Based on the numbers of patients we've had in the year (we've maintained an average annual daily count of 40 persons),” said Hayes in an email. “The program costs an average of $27.40 per person per day.”
Donelan said earlier this year that it took 54 weeks and a 90-page application to achieve the methadone clinic.
The sheriff doesn’t hold back when talking about the challenges of setting the clinic up.
“You need to stand in front of your correction officers and explain to them what you’re doing and why and get their buy-in. The process is so much smoother and when you do it that way,” said Donelan. “When you have your security people talking to and understanding your treatment people (social workers, councilors) and talking to an in your medical people and that’s important too because it has to be a team approach.”
He observed that a significant number of the clients aren’t bad people, they have just come from difficult backgrounds and need help, not punishment.
“It’s changing the climate and culture from this attitude of ‘if you relapse and commit another crime, you’re just a dirtbag who can’t stay straight.’” explained Donelan. “To this climate and culture of ‘all right, you relapsed. Relapse is part of recovery, come on back. We’re going to run you through the whole program again and see how it works.’ You know, non-judgmental.”
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