OGDEN — Substance abuse treatment professionals are chipping away at practices in Utah jails they say can force inmates to endure painful and dangerous cold-turkey withdrawals from narcotics addictions.
While taking methadone may reduce withdrawal symptoms for people addicted to heroin or other narcotics, jails have been reluctant to allow it due to concerns about medication security and potential abuse.
“That’s cruel and not good medical treatment,” said Jerry Costley, who used to run an outpatient addiction treatment program in Ogden.
Without help for narcotics addictions while they’re behind bars, inmates “are at risk for using when they get out, or overdosing when they get out,” said Costley, now director of the De Novo treatment program in Salt Lake City.
Costley and other drug treatment experts say they are encouraged by scientific advances in the fight against addiction. They say a growing body of evidence shows methadone and newer drugs can reduce addiction, cut repeat crimes by released inmates and prevent overdoses.
This year, deaths attributed to apparent medical causes in Northern Utah jails have drawn attention to jail health care operations, including how jails handle addicts in withdrawal.
Costley said the jail in Ogden was not welcoming to methadone or Suboxone treatment for addicted inmates when he dealt with the institution for several years until 2012.
“Even after we confirmed that our patients were legitimately prescribed these medications, even after we explained the risks to our patients of sudden withdrawal and even after our patients were in extreme discomfort,” Costley said.
“Their position seemed to be that suffering withdrawals was a legitimate part of our patients' punishment,” he said. “This was in spite of our offer to bring in the medication at our cost.”
SECURITY AND LOGISTICAL CONCERNS
But medical supervisors at the Davis and Weber county jails present detailed arguments against widespread adoption of narcotic-based addiction treatment inside jail walls.
“Both Suboxone and methadone are highly abused medications, and anyone that is on them are at risk for not only abusing those medications themselves but are at risk for being bribed, coerced, or threatened by other inmates to cheek or sell those highly abusable medications to others that they are not ordered for,” said James Ondricek, Davis County Jail medical supervisor.
Ondricek, a registered nurse, said substitute opioids are a crutch not needed in a jail.
“While an inmate is in the jail they are not able to abuse other prescription meds or illegal substances anyway, and the whole point of using methadone or Suboxone as a deterrent to protect the inmate from abusing drugs is a moot point while in the jail,” he said. “They will eventually leave the jail clean and sober without having to rely on a substitute opioid medication to keep them clean and sober.”
The jail already helps inmates in withdrawal, without giving them narcotics, he said.
“The only downside of not allowing methadone or Suboxone to inmates in the jail is because they will go through withdrawals in the jail, and we can treat those withdrawal symptoms in here just like we do for any other inmate that needs it,” Ondricek said.
Kay Haw, nursing administrator at the Weber jail, said jail personnel are not licensed to dispense narcotics, so methadone and Suboxone are not given.
One exception is pregnant women, Haw said, but an outside clinic must come in to administer the medications. The Davis jail also now allows methadone and Suboxone for pregnant women under similar restrictions, Ondricek said. Inmates sentenced to weekends only are allowed the medications and are housed in the medical unit.
Costley said state and federal substance abuse agencies have “more and more indicated that longer-term maintenance therapy on methadone and Suboxone is the gold standard for opioid addiction treatment.”
Clandestinely diverting those drugs is easily preventable in jail, Costley said.
“Methadone is very hard to cheek or divert, because it can be given in a liquid form, and Suboxone comes in strips that dissolve under the tongue,” he said.
An addicted person might seem OK for two or three days after entering jail, “but by the time they get out they’re in severe withdrawals, and they might get something off the streets, commit another crime,” Costley said. “After being without, their tolerance may be down, they’re at risk of overdose. Some people have died.”
“All we’re saying is at least, for a few days, let us take the inmates medicine so when they’re released they’re not in bad shape, and with decreasing doses they can come down over time rather than cold-turkey.”
A NON-NARCOTIC SOLUTION?
The emergence of a non-narcotic drug called Vivitrol has given substance abuse workers another tool to help addicted jail inmates without causing security concerns for jails.
“The Vivitrol basically makes it so they don’t have a craving, or as big of a high” from narcotics, said Jed Burton, WHS clinical director.
A Vivitrol injection lasts 30 days, but the cost for one shot — $1,480 — has kept it from wide adoption. The new jail program is funded by a grant Midtown received from the U.S. Health and Human Services Department.
Haw said the Vivitrol injections are allowed in the Weber jail only via court order by a drug court judge.
Burton said Vivitrol in liquid form costs only 75 cents per daily dose, but with a daily regimen it’s easy for an addicted person to fail to persevere through treatment.
“Vivitrol seems to be a safer alternative to methadone because it completely blocks the receptors that give the high from opiates,” Burton said. “Vivitrol is also a monthly injection, with methadone being dosed daily.”
Plus, there’s no fear of Vivitrol being diverted into a jail inmate black market, because unlike methadone or Suboxone, it has no narcotic ingredient.
“I can’t imagine anyone would want to abuse it,” Burton said.
Kevin Eastman, Weber Human Services director, said the program will give addicted inmates a chance of being out of withdrawal when they leave jail — a major step toward “ending the prehistoric way we are treating people.”
Salt Lake County has been running a Vivitrol program for almost a year, said Janida Emerson, associate director of the Behavioral Health Services Division. She said 141 people are being treated, either in the jail or in connection with a drug court or other criminal justice program.
“We’re in uncharted territory, but the jail has been a great partner with this,” she said.
Jeff Marrott, spokesman for the state Division of Mental Health and Substance Abuse, said he thinks it’s only a matter of time before effective drug addiction treatment is offered ubiquitously in Utah jails.
“The science of addiction is growing quickly,” Marrott said. “It’s beginning to bear fruit in the courts and corrections.”
Drug courts and regular courts have begun accepting the newly recommended treatment protocols, Marrott said, “but some of the sheriffs and jail commanders are still hesitant to fully embrace this.”
Costley said some past treatment programs for people in the justice system were executed badly and amounted to “bad medicine.” He praised the state substance abuse agency for its recent work in the area.
“It is much, much more effective to be retaining them in treatment, stabilizing their lives, at some point withdrawing, not engaging in addictive behaviors, and now holding down good jobs and doing well,” he said.
PREJUDICE AGAINST ADDICTS OR HARD REALITIES OF JAILS?
Costley said prejudices against addicted people and types of treatment should be eliminated through education “and awareness and support from people who really know what they are doing at the county level and the criminal justice system.”
But Ondricek said people outside the system are ignoring the realities of security, logistics and staffing at jails.
“We are not a licensed drug treatment facility, and we are not licensed by the state to prescribe (methadone and Suboxone) and therefore, we would have to rely on outside prescribers to order meds for inmates in the jail,” he said.
“We do not want inmates’ personal doctors prescribing meds for them while they are in jail,” Ondricek said. “Those prescribers do not understand how a jail functions, and we cannot operate with literally dozens of physicians ordering any medications they want in the jail. While in the jail, only our physician can order medications for any inmate.”
Herrera’s death may be a flashpoint in the debate. Her sister, Holly Macias, and a family attorney, Michael Studebaker, say the Weber jail was negligent in her medical care.
“She was a full-blown heroin junkie, and she would have been the first to tell them that she was deathly afraid of becoming sick,” Macias said. “The cops think that just because people are in jail they don’t matter.”