Updated: Jul 20
A great substance abuse treatment program can be made excellent through progress, innovation and collaboration.
Opioid overdose deaths in Massachusetts rose nearly 9% in 2021 marking the highest total number of deaths recorded. These numbers are despite increased funding for programs related to prevention and treatment, increased access to treatment programs and pandemic related changes that allow for more access to medications for the treatment of substance abuse.
The opioid epidemic has now entered a new phase where the majority of deaths are now directly linked to fentanyl. Fentanyl is now becoming the drug of choice for many opiate users and fentanyl has now made its way into other drugs. Recent reports note cases of fentanyl overdose in users of cocaine and marijuana which have been laced with fentanyl. In 2018 MA DPH released a clinical advisory recommending the use of life saving drug overdose medication Narcan to be administered in all suspected non-opioid drug overdoses because of the high likelihood of opioid presence in all drugs. More troubling are recent reports that fentanyl is being packaged to look like benign over the counter and prescription drugs.
As a correctional nurse with 10 years of day to day and face to face interactions with justice involved individuals in the throes of addiction, Caitlin sees not a single day go by where someone isn’t detoxing from opiates, being monitored for detox because of an abuse history, being treated for their addiction or requesting to be treated for their addiction. It is the most common issue correctional healthcare deals with today. Full stop.
The correctional funding report released by the Commonwealth earlier this year notes that nearly 80% of the individuals cared for by the Hampshire County Sheriff’s Office are diagnosed with a substance use disorder. Correctional facilities like the Hampshire Sheriff’s Office are front line agencies in the opioid epidemic. As such, there is significant opportunity for positive impact.
The Hampshire Sheriff’s Office is a licensed Opioid Treatment Program (OTP), a program Caitlin was on the ground level of helping to establish in her years at the facility. That program is grant funded. The current program design requires streamlining in order to make better use of those funds. Examples include:
Dedicated nursing staff who complete TCUs, GPRA, discharge planning, appointment scheduling and MDToolbox medication orders so that no one falls through the cracks if released from court unexpectedly or is bailed.
A part time statistician to complete all data reporting requirements for the grant, the DPH and research associates monitoring our program. Monies for this are available in the grant and allows for nursing staff to do the work of care and treatment rather than clerical.
Increased communication between medical/MOUD dedicated nursing staff and the Records Department, court system and District Attorney’s Office so that re-entry services are robust and well planned in advance.
MOUD medical staff will become part of the monthly re-entry round table community meeting when they resume post-COVID. They are not currently a part of the discussion.
Begin use of rapid urine toxicology screening cards which eliminate the need for security staff to be involved in treatment decision making, as they presently are, and return them to their security role. These will be used on intake for detox monitoring safety as well as MOUD program compliance requirements. Grant funding is available for testing supplies.
The OTP will need to be brought under the umbrella of the Medical Department so care is integrated rather than parallel.
Medical, Mental Health and OTP should be in lock step with goals and communication. Presently, the systems are largely separate without a firm understanding of what each is doing. This can be accomplished with regular meetings, open communication and information sharing. Care should be integrated, not parallel, in order to increase success.
Harm reduction should always be the primary focus. Medication and treatment working in concert are the ultimate goal, but the opioid epidemic is so prevalent and so dangerous, and the average justice involved individual at the Hampshire County Sheriff’s Office remains at the institution very short term, that the focus should be on access to treatment in any form the individual is open to accepting in order to save lives.
The Hampshire County Sheriff’s Office is undoubtedly at the forefront of substance abuse treatment at Massachusetts correctional facilities. There are a number of very hard working staff at the facility spearheading this program, many of whom Caitlin worked shoulder to shoulder with on this program. Good programs can always be made great with progress and innovation. These suggestions can help move this program into its next phase of success.