Columbia River Mental Health Services announced Thursday it will be working toward a partnership with the Clark County Jail to provide treatment for opioid addiction in the correctional facility.
If the plan comes to fruition, the jail would be the first in Washington with a certified opioid treatment program, according to officials who spoke at the re-entry provider meeting at the Public Service Center in Vancouver. Opioids include heroin and prescription pain medications.
“Through our experiences, we’ve learned that our population with opiate use disorders need more services than we’ve historically provided,” said Clark County Jail Chief Ric Bishop. “We’ve learned that we need to do more.”
Generally speaking, the program would be an expansion of services offered at the jail since February. Columbia River Mental Health, a nonprofit that serves Medicaid patients, obtained a three-year, $1.5 million grant through the U.S. Department of Health’s Substance Abuse and Mental Health Services Administration in October 2018 for medication assisted treatment, or MAT services, within the jail.
The treatment method is described as the use of medicines combined with counseling and behavioral therapies. It’s currently part of the Clark County Sheriff’s Office’s re-entry program, which consists of classes and connects inmates to a group of community partners.
The MAT services at the jail provide inmates who are three weeks from release with counseling and daily doses of Suboxone — a medication that reduces symptoms of opiate addiction and withdrawal, said the mental health nonprofit’s director of nursing, Leesa Mercer.
A team of providers also helps with employment and housing needs, and departing inmates are given Narcan, an opioid antagonist that’s used to revive people who are overdosing on opioids, Mercer said.
Dr. Kevin Fischer, substance use disorder services medical director at the nonprofit, said the treatment is reaching 15 inmates each month. He said 76 patients have participated since February.
Early intervention
Fischer said establishing a certified opioid treatment program at the jail would allow more inmates to receive medication from earlier on in their incarceration. The program would add methadone as a treatment option. Methadone can only be legally administered at a certified treatment facility; the jail’s new program would essentially act as a branch site of the nonprofit.
Buprenorphine, an active ingredient of Suboxone, reduces the risk of death by overdose by 39 percent; methadone reduces the risk by 59 percent, according to Fischer.
“We’re meeting people in need where they’re at. We’re in the jail because that’s where the most severe cases end up,” Fischer said.
Sixty-three percent of sentenced jail inmates meet the criteria for drug dependence or abuse, in comparison to 5 percent of the total general population, according to a U.S. Department of Justice report.
A University of Washington School of Medicine report released in July 2018 estimated that 56 percent of the 47,751 Washingtonians who are regular users of opioids would be released from a state prison or jail within the year. A total of 25,510, or 53 percent of those people, were likely released from a jail, according to the report.
Treating opioid addiction while people are in the criminal justice system has gained traction in recent years due to what Fischer described as a “historic epidemic.” There were 47,600 overdose deaths involving any opioid nationally in 2017, according to the Centers for Disease Control and Prevention. There were 18,515 such deaths a decade prior, according to the CDC’s data.
Tackling addiction in the justice system saves lives, officials say. A study conducted in Washington, cited by the National Institute on Drug Abuse, found the risk of death from a drug overdose was 129 times higher in the first two weeks after release from prison when compared to the general population. Treatment involving methadone or buprenorphine during this transitional period decreases the risk by 75 percent, according to the study.
Hurdles remain
The stakeholders of the new Clark County Jail program have many hurdles to overcome despite their optimism about its effectiveness.
The grant funding medication assisted treatment at the jail will not pay for the potential partnership with Columbia River Mental Health Services. The nonprofit needs federal approval, as well as an appropriate space to dispense the medications inside the facility, Fischer said.
Chief substance use disorder officer Steven Morrison said Columbia River Mental Health will file an application with the U.S. Department of Health to establish an opioid treatment program branch site. The federal agency will review and certify the specifics of the program, Morrison said.
“About 175 to 200 individuals can be helped on any given day,” Morrison said. “We’re working with county and state officials to get the funding in place. It’s unknown what the costs look like right now.”
Part of the difficulty with funding is due to the fact that when people are charged and jailed, they lose Medicaid benefits.
Fischer said efforts are underway to continue Medicaid and MAT services for people who are incarcerated. The passage of Senate Bill 5830 during the most recent legislative session may have pushed those efforts forward. The bill requires state agencies to work together on initiatives to “promote a statewide approach in addressing opioid use disorder.”
