Getting methadone in prison: It takes work
When a correctional system entertains the idea of something established medicine accepts as gold standard – namely, medication-assisted treatment (MAT) with methadone or buprenorphine for opioid use disorder (OUT) – there is an uphill battle ahead, even for those within the system who believe in it. In Rhode Island, CODAC, the opioid treatment program (OTP) embedded in the corrections system, has put in the time, staffing, and most important the understanding of the psychology of wardens and custodial staff. “This is a very complex issue if you are looking at introducing it into your correctional system,” CODAC CEO Linda Hurley told attendees at the meeting of the American Association for the Treatment of Opioid Dependence (AATOD) in Baltimore last month.
The medication lines, the administration, the impact on overall operations, and the connection between good security and good programming are all part of understanding how corrections systems work,” said Hurley.
She doesn’t like to use the word “resistance” when discussing the feelings of corrections staff to methadone, for this reason: “They are trying to do their job.”
It’s true that a culture shift is required, she said. But this has to be done slowly, if possible, and it’s the job of the OTP to communicate and educate.
The first step when an inmate comes into a jail or prison is to find out whether medication for OUD is needed, and sometimes this is done through computer screening. This isn’t necessarily the most efficient way, though. “The fastest way is for the [corrections] nurse to just ask the question” about this, said Hurley. “If we had just brought nursing in right away, we would have saved time.”
It’s important to recognize that CODAC started with a leg up – it had 45 years of working with the state department of corrections, and a history of support. It’s also important for OTPs to know that CODAC, even though it is the in-facility treatment provider, is not trying to take patients away from other OTPs when the patients are released form the facility. “There have been times when people thought CODAC would grab our patients when they came out” of prison, said one attendee, cautioning others about some of the challenges they would face when trying to start a program like this.
Hurley responded quickly, saying the last time she heard that accusation it was referred to as “pirating.” At the end, 40% of the people who were released were originally receiving treatment from the correctional facility, and statewide CODAC has 48% of OUD patients, “so we are not increasing our number of patients” by virtue of having the corrections-based program. Nevertheless, she said, it’s important for OTPs to pay attention to this as a possible challenge.
As always, working together and communicating is key.