County jail approved to become a methadone clinic

Dr. Ruth Potee is medical director of the Franklin County House of Correction in Greenfield, which received a license to become a methadone clinic.Steven G. Smith for the Boston Globe

A jail in a rural corner of Massachusetts has received a license to become a methadone clinic, boosting its efforts to treat opioid addiction among inmates and potentially blazing a trail for other correctional institutions.

Officials at the Franklin County House of Correction in Greenfield said their facility is the first in the state and among the first in the country to choose this arduous approach to providing methadone, a key medication for treating opioid addiction. The few jails and prisons that provide methadone typically contract with community providers rather than becoming methadone clinics themselves.

“I honestly see sheriffs as part of the solution when it comes to treating people with addiction and mental illness,” said Franklin County Sheriff Christopher J. Donelan, noting that both conditions are common among inmates. He said he hopes Franklin County’s experiences can make it easier for others to do the same.

But no question, it was hard, said Dr. Ruth A. Potee, the jail’s medical director, because methadone clinics are heavily regulated by the federal government. The “Kafkaesque” licensing process took 54 weeks, involving reams of documents passed among two federal agencies and the state Department of Public Health.

“It’s an absurdity. In today’s world, with today’s epidemic, access to methadone should be easy,” said Potee, who said she wept when she learned last week the license had finally been approved. “We have regulations that are nearly 50 years old that have not been touched.”

What happens in prisons and jails matters a great deal in any effort to combat the opioid crisis.

A high proportion of people addicted to opioids end up in jail, and an estimated two-thirds of inmates have some kind of substance use disorder. But most prisons and jails do not provide the medications that ease cravings and maintain tolerance to opioids — buprenorphine and methadone. As a result, people leaving prison and jail are at extremely high risk of fatal overdose.

The Franklin County facility has been an exception; it has offered buprenorphine since 2016, and struggled to find ways to offer methadone.

Now, other facilities in Massachusetts and elsewhere are starting to address the needs of addicted inmates, as public concern over opioid deaths, legal challenges, and legislation have overcome correctional officials’ longstanding resistance to providing the medications.

Under a pilot established by a 2018 state law, Franklin and six other counties in Massachusetts will start offering medications to treat opioid addiction to their inmates on Sept. 1. The county facilities hold people awaiting trial or serving brief sentences.

As mandated by the same law, the state’s prisons, where people serve longer sentences, began offering one medication, buprenorphine, in April, but have not yet worked out the logistics of providing methadone.

Inmates at New York City’s Rikers Island jail have been receiving methadone since 1987. Dr. Jonathan Giftos, who directs substance use treatment for the city’s Correctional Health Services, said the city’s public hospital system holds the license to provide methadone.

“Franklin County deserves a lot of credit,” he said, but noted that there may be other similar programs quietly operating elsewhere — no one is tracking how various prison and jails are responding to the opioid crisis.

But it’s unmistakable, Giftos said, that interest is growing in providing treatment to addicted inmates. These days he gets phone calls and e-mails several times a week from prisons and jails around the country asking advice on starting medication treatment behind bars.

“It’s heartening that jails and prisons are starting to see the light on this issue,” said Sally Friedman, legal director for the New York-based Legal Action Center, a nonprofit that fights discrimination against people with addiction. “A lot more need to step up to the plate.”

So far, all the lawsuits challenging prisons and jails on their policies of denying access to anti-addiction medications — including two in Massachusetts — have ended in orders or settlements that required providing the medication to the plaintiff, Friedman said. Most of these wins applied only to one individual — but they signaled that correctional facilities are unlikely to win future litigation.

The Franklin County House of Correction chose to become licensed as its own methadone clinic because it already had the capacity to provide the medication and counseling, Potee said.

Providing methadone on its own is also cheaper than contracting it out, she said. The drug is extremely inexpensive. The biggest cost was the $10,000 the county had to spent to install a safe with cameras trained on it, as required by federal regulations.

About 40 to 50 percent of inmates at the House of Correction, which typically holds 250 to 300 people, suffer from opioid use disorder, Potee said. About 30 to 40 people are on buprenorphine. She estimates about 10 or fewer will be taking methadone on any given day.

The license arrived in the mail on Monday, Potee said.

“It was the hardest thing I’ve ever done,” she said. “I went to Yale Medical School. I have three children. I’ve run marathons. This was the hardest thing I’ve ever done.”

But she felt it was important to prove it could be done, to encourage others.

A jail in Philadelphia wrote to her for advice. Potee created a seven-page document listing the steps required to become a methadone clinic, with links and a flow chart. “Within a day, I heard back: ‘We can’t do that. It’s too hard,’ ” she said.

The six other counties participating in the pilot also did their share of heavy lifting to get their treatment programs started. For example, both Middlesex and Essex counties are spending hundreds of thousands of dollars on physical plant renovations to create in-house dispensaries for methadone and buprenorphine. Both have hired outside contractors to run the treatment program.

Under the pilot, the houses of correction will provide the medications to inmates who arrive already taking one of them with a legitimate prescription and to inmates 30 days before release. But Franklin County will start medication at any time during an inmate’s stay.

“Everyone’s on board, on time,” said Middlesex County Sheriff Peter J. Koutoujian, who is president of the Massachusetts Sheriffs Association. “Sheriffs have had dozens of meetings throughout the past year, together discussing plans. Everyone indicated they’re ready to go on Sept. 1.”

Koutoujian said he, too, gets inquiries from around the country asking about the Massachusetts effort. “A lot of folks are watching what we’re doing,” he said.