Ending Addiction

Like many of his fellow inspectors across the state, Mike Desco spent much of his time focused on keeping substances like Suboxone out of prison.

So when it was announced in 2019 that the department would launch a Medication-Assisted Treatment program in its prisons that included the controlled use of buprenorphine, also known Suboxone, Desco’s colleagues at Central Michigan Correctional Facility expected him to balk at the idea.

Instead, they were surprised by his response.

“I really didn’t think it was a bad idea,” said Desco, now an acting assistant deputy warden. “If we can take away the illegal Suboxone issues and treat them with a qualified mental health professional and get them the treatment they need, it will make facilities run a lot more smoothly. It gives us another tool to use.”

Physician Janak Bhavsar, Psychologist Manager Linda Bresette, Nurse Practitioner Ronald Drinkert and Assistant Deputy Warden James Malloy review Medication-Assisted Treatment information to prepare for implementation of the program at Charles E. Egeler Reception and Guidance Center in Jackson.

Medication-Assisted Treatment, or MAT, is a treatment approach that will combine the use of prescribed medications, cognitive behavioral therapy and recovery support to help prisoners identified as having an opioid-use disorder overcome their addiction.

Central Michigan Correctional Facility, Carson City Correctional Facility, and Charles E. Egeler Reception and Guidance Center will be the first facilities to pilot Medication-Assisted Treatment with implementation expected in March. Women’s Huron Valley Correctional Facility will be added as a fourth site after the initial rollout of the pilot, which is expected to be expanded statewide in mid-2020.

A growing health crisis

Opioid use disorders have been recognized by the medical community as a serious chronic health issue impacting millions of people nationwide.

Implementing MAT is an important step in efforts to combat the state’s opioid epidemic.

In 2018 alone, Michigan had more than 2,000 opioid-related overdose deaths and more than 7,000 Michigan residents lost their lives in the last five years to the opioid epidemic.

It’s why Gov. Gretchen Whitmer in November announced a goal to cut opioid-related overdose deaths by half in five years.

“This epidemic touches all areas of our state and is one of the greatest health crises of our lifetimes,” Whitmer said as the state announced a slate of steps to combat the opioid epidemic, including the launch of MAT at correctional facilities. The implementation of MAT was also done at the direction of Director Heidi Washington and included in the department’s new Strategic Plan, released in 2019.

MDOC Bureau of Health Care Services Administrator Marti Kay Sherry discusses Medication-Assisted Treatment in Michigan correctional facilities during a November press conference with Gov. Gretchen Whitmer announcing steps the state will take to fight the opioid epidemic.

In addition, Gov. Whitmer declared February 24–29 Opioid Use Disorder Awareness Week to continue to elevate the conversation around the opioid epidemic and efforts to fight it.

Growing opioid use in Michigan communities is also being seen at correctional facilities, where more than 20 percent of incarcerated individuals have been identified as having an opioid-use disorder. Those leaving prison are 40 to 120 times more likely to die of an overdose within two weeks of release.

Access to MAT can help prevent overdose deaths and improve outcomes for prisoners who had struggled with substance use.

Prisoners are eligible to participate in MAT if they have been identified as having a substance use or opioid use disorder, have symptoms of opioid withdrawal or recently experienced an opioid overdose.

Treatment medications are expected to include buprenorphine, naltrexone and methadone. Assessment and treatment will start when offenders come to prison and will continue through parole, under clinically-based treatment plans. The MDOC plans to add 30 qualified mental health professional positions to support MAT, and also received funding from Bloomberg Philanthropies to facilitate the implementation of the treatment program.

“If we’re treating this specific condition according to the standard of care, it’s going to make it more likely they will stay on a positive and productive track,” said Ronald Drinkert, a nurse practitioner at Charles E. Egeler Reception and Guidance Center, or RGC, which is a pilot site. “Things that are new and not how we’ve always done it can be scary. It doesn’t mean it’s not something that’s going to be more useful and helpful.”

Gaining momentum

While system-wide availability of MAT for opioid use disorders is new to the Michigan Department of Corrections, it’s an approach that has already been successful in other states.

The New York City Department of Correction has provided MAT since 1987. States including Rhode Island, California, Vermont, New Jersey, Pennsylvania and Washington have also launched MAT programs and are seeing positive results.

After Rhode Island implemented MAT for both its jail and prison systems, overdose deaths after release fell by 61 percent. In California, prison rule violation reports fell by 58 percent for prisoners participating in MAT.

States using MAT have also reported fewer cases of contraband introduction, less illicit substance abuse, fewer incidents of violence, a decrease in HIV and hepatitis C transmission and better outcomes for offenders post-release.

“Medication-Assisted Treatment, along with additional substance abuse treatment services, increases the likelihood of long-term recovery, reducing the chance of recidivism,” said Marti Kay Sherry, administrator for the MDOC’s Bureau of Health Care Services.

Overcoming objections

Though there is support in the medical community for MAT and research has showed its success, resistance to it and questions about it are not uncommon, especially in correctional settings.

Beth Boyd, Substance Abuse Services manager for the MDOC, said it is important to keep in mind that addiction changes a person’s brain in a harmful way. Long-term opioid use even alters brain chemistry and leads to uncontrollable cravings and intense feelings of despair. Medications used in MAT move the healing process forward.

“These medications help heal the brain, help the person engage in treatment and help them live their life in a productive way as they work through therapy and have more and more clean time,” Boyd said.

Buprenorphine, or Suboxone, also has a ceiling effect that prevents users from continually experiencing highs from it, she said. Those with opioid-use disorders who take suboxone don’t experience any high from it, but withdrawal symptoms are decreased.

RGC Assistant Deputy Warden James Malloy said he was initially apprehensive about MAT, but learning more about it helped him see the benefits.

“The more we look at it as a prescription like any other we give out to take care of a particular disorder, the better off we will be,” he said. “We want to give everyone an opportunity. At the end of the day, we just want a safer Michigan and less people coming to prison.”

MDOC Chief Medical Officer, Dr. Carmen McIntyre Leon speaks to department medical providers during a training session on MAT.

Acting Assistant Deputy Warden Desco said when colleagues approach him about MAT, expecting to hear his reservations, it has instead given him an opportunity to share the benefits of the treatment approach.

When the discussion ends, his colleagues often walk away with a more supportive view of MAT.

“Right now we’re seeing prisoners testing positive and getting misconducts,” Desco said. “These guys are telling us ‘I know it’s wrong, but I can’t get off this.’ It’s sad and I’m glad this will give us another solution for taking care of them.”

Janak Bhavsar, a physician at RGC, said continued discussion and a collaborative effort between medical and mental health providers and custody staff will be important to the success of MAT.

“Talking to medical providers, no one is saying ‘why are we still doing this?’” Bhavsar said. “Our focus is how are we going to do it, so we can do it the right way.”

Additional training for staff will also be important and plans to train staff statewide are in the works.

“People think this is replacing one addiction with another addiction, but they don’t understand the science behind it,” said Linda Bresette, a psychologist manager at RGC. “That’s why training is so important. I think people who are involved in any addiction are miserable in their addiction. We’re providing them with a safe space for treatment.”

Drinkert said MAT fits the department’s mission to protect the community, while helping prisoners change their lives.

“The mindset that prison is punitive doesn’t go anymore,” Drinkert said. “There are others who genuinely need help and this is one way we can do that.”

Want to learn more about Medication-Assisted Treatment?

Click the links below to hear Bureau of Health Care Services Administrator Marti Kay Sherry, Substance Abuse Services Manager Beth Boyd and Chief Medical Officer, Dr. Carmen McIntyre Leon, talk about MAT on the Field Days Podcast.

Understanding the science of addiction

Understanding addiction is the first step in tackling the nation’s opioid crisis. At a recent Medication-Assisted Treatment training session for MDOC health care providers, nationally recognized addiction expert Dr. R. Corey Waller spoke on substance abuse and the neuroscience of addiction. Check out Dr. Waller’s Addiction Neuroscience 101 here:

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