N.Y. counties preparing mandatory in-jail medication treatment programs
Staffing provides the biggest obstacle for both COs and nurses, but officials say they are working on it
By Julie Abbass
Watertown Daily Times
LOWVILLE, N.Y. — North country counties are in various stages of the planning and implementation process necessary to be law-compliant by October for offering medication-assisted treatment for jail inmates with substance use disorders.
Amendments to state correction and mental hygiene laws signed by Gov. Kathleen C. Hochul in October, require prisons and county jails statewide to provide addiction treatment that includes Food and Drug Administration-approved medications whenever possible.
The medications — along with peer support, individual and group counseling, discharge planning and assistance-finding services for more successful community integration, affordable housing and employment resources — will be part of a customized plan created for each person participating in the program.
Lewis County Community Services Director Patricia M. Fralick gave a presentation to the county Health and Human Services Committee on Tuesday explaining the law and the steps the county needs to take to begin offering the treatment services by the Oct. 7 deadline.
To date, Mrs. Fralick said she and the jail staff have primarily been researching how jails in other counties will be implementing the program and gathering information from the state Department of Corrections and Community Supervision and various treatment agencies.
She said the medication distribution will be "a very staff-, labor-intensive process" because it will require a physician or nurse practitioner licensed to distribute methadone for about two hours daily for the medication distributions and someone to sit with anyone who may be issued another treatment drug that is administered via a film with the medication that can take 15 to 30 minutes to dissolve in a person's mouth.
Unlike in Jefferson and St. Lawrence counties, there are no approved methadone providers already providing the service in Lewis County, making it necessary to find a company or agency able to get the approvals to bring in the medication services from outside the county.
Mrs. Fralick said there are already three agencies that supply counseling or addiction support services at the jail but the implementation of this program will restructure those services for program participants. In-jail peer support still needs to be organized.
There is about $101,000 in state funding that can be used for the treatment program, she said, though that is not likely to cover all of the costs, including for the medications, medical professionals and, potentially, additional corrections officer hours to screen new inmates 24 hours a day.
County Manager Ryan M. Piche added that there is no way to bill insurance of any kind for the medication or services.
"My goal today is to be able to put out an RFP (request for proposals) to see who we'll be working with and then start to unfold the details with the vendor because there's a lot of details to consider ... and then figure out the rest," Mrs. Fralick said.
The committee forwarded the request for proposals to the full county board of legislators for a vote in July.
In Jefferson County, parts of the program are already running, while others, like arranging for in-jail peer support, are still in the works.
"It's been a long road here, but I think we almost have everything in place," said Timothy J. Ruetten, community services director for the Jefferson County. "It's a heavy lift because really, it's creating a mini substance use disorder clinic within the jail's walls. That's something that's been foreign in this region."
The Watertown-based substance abuse disorder treatment provider, Credo, will be administering the medication. Other than the peer support addition, counseling services were already in place as in Lewis County.
"I think there will be a learning curve (for corrections and treatment officers)," Mr. Ruetten said. "The communications have been so extraordinary I think they've worked through a lot of it already. I think it's a win for the community members that need our help and a win for the jail, too."
Mr. Ruetten said the treatment provided under the new law should not be considered "special" or "better" treatment for inmates because it is the same treatment available "for anyone in our community." He added it is "a medical treatment or a medical condition," like any other.
Sheena T. Smith, addiction services program director for St. Lawrence County, said that her department has been "working in cooperation with the county correctional facility to develop the plan, but we are still working on finalizing it."
Medication treatment for opioid addiction is already available through a county clinic so those services will be extended to the jail.
Staffing provides the biggest obstacle, she said, for both nurses and correctional officers, but they are working on it.
Overall planning is further complicated by "not knowing how long a person will be inside," according to Ms. Smith, being that they could get transferred to a state facility, get released early, be released on bail or do something in jail that requires them to stay longer.
"We have to think through the big web of all kinds of different avenues to make sure the inmates, or participants, aren't left without all of the services they need. There's a lot of factors to consider," she said.
Counseling services in the jail have been primarily virtual since the start of the COVID-19 pandemic, but that presents a number of logistical challenges too.
"We're trying to find a happy medium so that people can have the support they need," Ms. Smith said. "It's not going to be a walk in the park, but at least it will be for the greater good."
Although Mrs. Fralick spoke specifically about the usefulness of the program for opioid addiction treatment in her presentation, the law itself includes general language involving medication-involved treatment for any substance addiction.
In addition to three opioid treatment drugs — buprenorphine, naltrexone under the brand name Vivitrol, and methadone — the FDA has also approved medications to help with alcohol addiction, one of which is also naltrexone/Vivitrol. The other two are disulfiram, also known as Antabuse, and acamprosate, formerly sold under the brand name Campral.
The law outlines the program's basic steps. All inmates will be screened for substance use disorder. Those who qualify for the medication-assisted treatment or were getting treatment medication before their incarceration must be offered the opportunity to participate. But it is not mandatory and the inmate can change their mind at any point while they are incarcerated.
County jails are also required to have a withdrawal management plan for alcohol, benzodiazepine, heroin and other opioids, which can also include medications.
Mrs. Fralick said the new amendments were put in place because numerous studies over the past 10 years have found that about 75% of opioid-addicted people who do not receive medication treatment relapse into drug use within months of reentering their communities, and are about 20 to 40 times more likely to overdose than addicted people in the general population.
Between 40% and 50% of people with opioid use disorder get arrested again within a year of their release from jail or prison, according to a 2019 study.
The effectiveness of the program will be monitored and reported annually through data analysis, including changes in the behavior of incarcerated people, rates of relapses, overdoses and recidivism.
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