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ACLU probes opioid treatment in Ohio jails

WARREN — If you or someone you know was or is in an Ohio jail or prison with an opioid use disorder and is or was impacted by the the unavailability of medication assisted treatment, the ACLU of Ohio wants to hear about it.

“Although Ohio is among the states hardest hit by the nationwide opioid epidemic — with the incarcerated population particularly at risk — numerous county jail authorities are failing to provide even the most basic medical care needed to blunt this ongoing crisis. This denial of treatment to people suffering from opioid use disorder is making it far more likely that Ohioans will remain captive to this disease — and even die of a drug overdose,” states a December blog post written by David Carey and Joseph Longley of the American Civil Liberties Union in Ohio.

Approximately half of Ohio jails are denying all forms of medication-assisted treatment to prisoners who are in need of it, ACLU Ohio found after a review of public records for jails across the state.

“And of the jails that provide it, many have only extremely restrictive, limited programs that fail to address the problem. The ACLU of Ohio is continuing to study county jails closely and is considering legal options to expand access to this life-saving medicine for people impacted by the opioid epidemic,” Carey and Longley wrote.

Medication-assisted treatment for people who have opioid use disorders is “standard medical care” and should be available in a jail as other medications are, the blog states. Many people in county jails haven’t been convicted of a crime.

“MAT now constitutes the therapy of choice — indeed, the standard of care — for the treatment of opioid use disorders,” notes Dr. Skip Leeds, a clinical specialist in chronic pain management at Wright State University’s Boonshoft School of Medicine. “To interrupt or deny this life-saving intervention to a patient in need, simply because that patient has been arrested or incarcerated, is unconscionable.”

One study ACLU Ohio researched found a 74 percent decrease in all-cause mortality among currently incarcerated people receiving MAT and an 85 percent dip in all-cause mortality among people recently released from incarceration. And another study showed that formerly incarcerated people are 56 times more likely to die of an overdose than the general population, while yet another study showed that they were 129 times more likely to experience a fatal overdose.

“Similar policies to Ohio’s have come under attack across the country. Lawsuits in Kansas, Maine, Massachusetts, and Washington have resulted in granting prisoners access to MAT. Further, legislation has been enacted in Colorado, Maryland, Massachusetts, and Vermont that has increased access to MAT for people suffering from opioid use disorder (OUD) in jails and prisons. It is long past time for Ohio to follow suit,” Carey and Longley wrote.

LOCAL PROGRAMS

It appears many of the MAT programs now available at local facilities concentrate on in-facility counseling and upon-release vivitrol shots.

Julie Loomis, assistant warden and public information officer at Trumbull Correctional Institution, said its MAT program now is for inmates soon-to-be released, though more ideas are being considered.

Some 300 of the nation’s roughly 3,200 or jails and 1,900 prisons now offer some form of addiction medication to select inmates, according U.S. Department of Justice.

Only about 30 facilities widely offer the two other more-proven federally approved medications for opioid addiction treatment — methadone and buprenorphine, said Andrew Klein, a criminal justice analyst, in 2018.

Corrections officials have been slow to embrace addiction medications. But reluctance is starting to fade with newer medications and more scientific evidence, said Elizabeth Gondles, of the American Correctional Association, a trade organization that accredits jails and prisons.

“We understand this is a public health crisis,” she said. “We know what we need to do. We just need the resources.”

The legal system could end up forcing the industry’s hand. The American Civil Liberties Union recently sued correctional institutions in Maine and Washington state, arguing they’re violating the Americans with Disabilities Act by not providing the medications, and the U.S. Department of Justice has been investigating Massachusetts along similar lines.

Carey said ACLU Ohio is looking for people who may have been denied treatment while locked up in Ohio.

“We are extremely concerned by our findings and we are exploring our legal options to expand access to the medication. We are in the phase of trying to make contact with people throughout the state who are a victim of being denied health care,” Carey said.

People who think they may have been affected can contact the ACLU Ohio through the legal intake form available at https://action.aclu.org/legal-intake/ohio-legal-intake.

TRUMBULL JAIL

In 2018, Trumbull County had the seventh-highest number of overdose deaths out of Ohio’s 88 counties, according to the Ohio Department of Health.

In the Trumbull County Jail, women who are pregnant when they were locked up and already were on methadone can continue to receive methadone while incarcerated, said Maj. Dan Mason, jail administrator. But the jail doesn’t distribute medications such as methadone, suboxone and vivitrol throughout a person’s incarceration. If there is a court order for an inmate to receive a medication, however, he or she will receive it and once a person nears release, he or she can obtain a vivitrol shot — which can help block the cravings for opioids — up to three months before release.

“The Trumbull County Mental Health and Recovery Board received a State Opiate Response grant to provide medication assisted treatment in the Trumbull County jail,” said April Caraway, executive director of the board. “We have a contract with Meridian, one of our provider agencies, to provide the treatment services. A peer support worker and counselor work with the inmates and jail staff to help the inmates work on their addiction issues while in the jail and work with the jail staff who provide the vivitrol shots. Meridian staff then do the assessments while the client is still incarcerated and schedule follow up appointments for treatment and continuation of MAT once they are released.”

Mason said the jail would love to have the funds to provide more therapies and medications to the inmates that need them. But, he asks, who foots the bill?

“We are losing our tax base with a shrinking population. We do need more treatments, and there are more issues than opioids that we can’t treat. Mental health, psychological problems, emotional problems. If these issues were solved on the outside, then we wouldn’t have half the population in the jail with these issues,” he said. “The costs for treatments are astronomical. We have limited funds to spread out to take care of the services we need to take care of and there is nothing left.”

He asked: “… where does the money come from? From the state? From the ACLU? Where can we cut from?”

Caraway said she believes there is a need for more medication-assisted treatment in jail.

While some people there have private insurance, anyone with Medicaid loses his / her insurance while incarcerated, even before he or she is convicted. Jails are responsible for paying the costs of medications the jail medical program chooses to make available.

MAHONING COUNTY

In 2018, Mahoning County had the 22nd-highest number of overdose deaths out of Ohio’s 88 counties, according to the Ohio Department of Health.

Commander Ken Kountz, Mahoning County jail admiistrator, said the policy is similar to what happens in the Trumbull jail.

If someone was receiving methadone on the outside, they can continue to receive it while incarcerated, though it is distributed outside the facility. And vivitrol shots are available offsite shortly before a person is released. Prescriptions for suboxone are not available to inmates, Kountz said. The jail also offers support groups and counseling for people with addiction issues.

Brenda Heidinger, associate director of the Mahoning County Mental Health and Recovery Board, said if a client requests vivitrol, a court order can help guarantee he or she receives it — if a judge is willing to sign the order.

Counselors work with inmates and put together individualized plans for their release — like MAT or therapy, Heidinger said.

“We are lucky to have a sheriff that allows us in the jail to provide treatment. Sheriff (Jerry) Green has been very receptive to allow us to come in and provide services. It makes a big difference,” Heidinger said.

The Associated Press contributed to this report.

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