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RI program to treat opioid addiction called a national model

An addiction-treatment program that has reduced overdose deaths among individuals incarcerated at the Adult Correctional Institutions could prove a national model

By G. Wayne Miller
The Providence Journal, R.I.

CRANSTON, R.I. — An addiction-treatment program that has significantly reduced overdose deaths among individuals who have been incarcerated at the Adult Correctional Institutions could prove a national model, say researchers behind a study published Wednesday in Journal of the American Medical Association Psychiatry.

Begun in 2016, the program, said to be the first of its kind in the nation, screens all inmates in Rhode Island for opioid use and provides treatment for those in need. With this approach, the study’s authors write, a 61-percent decrease in deaths among individuals after their incarceration was recorded.

That decrease was a factor “in an overall 12 percent reduction in overdose deaths in the state’s general population,” according to Brown University, where study lead author Traci Green is associate professor of emergency medicine and epidemiology at Warren Alpert Medical School. Green is also senior research scientist at Rhode Island Hospital.

“People have been searching for some way to stop overdose deaths,” said Green. “Here we have a program that’s shown to work, and it’s absolutely replicable in other places. Not only do we see that a statewide program treating people using medications for addiction treatment is possible and reduces deaths, but also this approach intervenes in the opioid epidemic at its most lethal and socially disrupting point — incarceration — to give hope and heal communities.”

Said study co-author Dr. Josiah “Jody” Rich, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at The Miriam Hospital in Providence: “This program reaches an extremely vulnerable population at an extremely vulnerable time with the best treatment available for opioid use disorder. With this study, we wanted to see if that intervention could impact statewide overdose mortality, and the answer is a resounding yes.”

According to the JAMA Psychiatry paper, “Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System,” the program screens ACI inmates — many of whom are incarcerated only briefly after arrest — for addiction, and offers methadone, buprenorphine and naltrexone treatment, provided by Cranston-based CODAC Behavioral Healthcare. A key element is continuing the treatment after release.

Using the measure of “recently incarcerated people” — within the previous year — the study authors reported a decrease of 17 overdose deaths, from 26 in the first half of 2016 to nine in the first half of 2017. This, the scientists said, was “a major contributor” in Rhode Island’s general-population decline in such deaths, from 179 to 157 in the period. Such findings are a sign of hope in an epidemic overwhelming America.

“While comprehensive treatment for opiate use disorders has not been the traditional role of correctional facilities, we have shown that it is feasible,” said Dr. Jennifer Clarke, an associate professor of medicine at Brown who heads medical programs at the state Department of Corrections. “Providing treatment saves lives and helps people become productive members of society [and] positively engages them with their communities and families, which makes for healthier and safer communities.”

The so-called MAT program (medications for addiction treatment) that Clarke directs addresses not only opioid cravings, but withdrawal. Traditionally, addicted individuals put behind bars are forced to undergo withdrawal without medical intervention.

During a conference call, Rich spoke to that, using “punishment” to describe the standard approach across America.

“They literally feel like they’re dying,” Rich said. “They will do desperate things to avoid that feeling.”

And incarceration without treatment and a post-release plan, he said, is foolhardy, a disservice not only to individuals but to families and society.

“We can lock people up, take away their children — punish, punish, punish — and they will continue to use drugs,” Rich said.

The new program in partnership with CODAC includes assistance with post-release housing, insurance and other necessities of life — and that, too, is rare in the U.S. criminal-justice system.

On the conference call, Rich asserted that the success of the ACI program has implications for agencies and institutions “beyond” prison and jail, here in Rhode Island and globally: courts, police, probation and parole systems, and “also the entire medical system,” including hospitals, mental-health providers and others.

The findings were to be announced Wednesday morning at a meeting of Gov. Gina Raimondo’s Rhode Island Overdose Prevention and Intervention Task Force. In 2016, Raimondo included $2 million in funding for the new ACI program and her proposed 2019 budget seeks funds to continue it.

“Our number-one goal in fighting the opioid overdose crisis is simple: save lives,” Raimondo said. “But to do that, we have to use every tool in our toolbox. Our data told us that too many Rhode Islanders leave prison and overdose. So, we took action, and created this program with the Department of Corrections. Now, we are beginning to see results. We still have a lot of work to do, but this study lets us know that we are starting to move in the right direction.”

In addition to Green, Clarke and Rich, study authors include Brandon D.L. Marshall with Brown’s School of Public Health; state Health Department head Dr. Nicole Alexander-Scott; Rebecca Boss, head of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals; and Lauren Brinkley-Rubinstein of the University of North Carolina.

Green, who also hold positions with Boston University’s schools of medicine and public health, has emerged as a national leader in drug-abuse and addiction research. Her study of use of an inexpensive test strip to identify the presence of potentially fatal fentanyl in other drugs made headlines last week.

©2018 The Providence Journal (Providence, R.I.)