“Is this really happening?”
A handful of callers posed that question in recent weeks to Essex County Sheriff Kevin F. Coppinger, who said he was surprised to hear from them, all people who had warrants out for their arrest.
When told that yes, it’s really happening — medications to treat opioid addiction will be provided in jail — the callers agreed to turn themselves in, Coppinger said.
Along with six other Massachusetts counties, the Essex County House of Correction launched a pilot program Sunday to provide buprenorphine (often known as Suboxone) and methadone to newly arriving inmates who are already taking the medications under a doctor’s supervision. The drugs ease cravings, prevent overdoses, and help keep people in treatment.
At most prisons and jails, addicted inmates are forced into painful withdrawal when incarcerated.
“There’s a great sense of relief on behalf of our offenders,” said Hampden County Sheriff Nick Cocchi. “What we’ve heard is, ‘Thank you for acknowledging and continuing the treatment.’ ”
Providing medications doesn’t merely keep inmates comfortable — it will dramatically reduce their risk of dying, as people who leave jail with their tolerance reduced often fatally overdose.
The seven counties — Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, and Suffolk — are participating in a pilot program created by a 2018 state law, launched this week, and celebrated Thursday on the State House’s Grand Staircase.
Six other counties are watching to see how it works out, and one (Dukes) does not have a correctional facility.
With tiny sheriff stars sparkling on their dark lapels, the sheriffs stood in formation on the marble steps, as Middlesex County’s Peter J. Koutoujian, president of the Massachusetts Sheriffs’ Association, announced “one of the most ambitious undertakings in the history of correctional health.”
“Today’s medication-assisted treatment pilot isn’t meant only to disrupt the status quo,” Koutoujian said. “We’re looking to rewrite the books on corrections.”
Advocates have long argued that the chapter on addicted inmates needs a total rewrite. Correctional officials here and elsewhere, including many of the Massachusetts sheriffs, have long resisted the idea of providing buprenorphine or methadone. Nearly all counties in the state have been offering departing inmates shots of Vivitrol, a drug that blocks the opioid high for three or four weeks. But officials balked at methadone and buprenorphine because they are opioids.
Many adhered to the “outdated view that medication-assisted treatment is just a bunch of drugs that can be abused,” said James Pingeon, litigation director for Prisoners’ Legal Services of Massachusetts. And indeed, illicit buprenorphine is one of the most common forms of contraband in prisons and jails.
Officials also had worries about the costs and logistics of running addiction-treatment programs behind bars.
But attitudes are changing, nudged forward by legislation and litigation. Correctional officials in Massachusetts lost two suits over the issue within the past year.
The pilot program “is really is moving the needle forward in how we think about substance use disorder,” said state Senator Cindy F. Friedman, a champion of the legislation, who spoke at the State House event. Using drugs to treat drug addiction is “counterintuitive,” she acknowledged, and requires focusing on the science about what works.
The legislation allocates $10 million for the program.
Each county had to find the best way to meet the tough federal regulations surrounding methadone. For example, Essex County spent $600,000 converting its print shop into a methadone dispensary, and hired an outside company to come in and provide the doses. Suffolk County transports its methadone patients to a nearby methadone clinic. Franklin County became licensed to become its own methadone clinic.
The jails are preparing for the second phase of their pilot — starting inmates on medication 30 days before release, when recommended by an addiction specialist.
Although all are working to ease inmates’ transition to society, Koutoujian and others raised concerns about whether community providers have the capacity to care for them. Someone who leaves on methadone but can’t find a methadone provider near home will not fare well, Koutoujian said.
With a $10 million federal grant, researchers from the University of Massachusetts will track and evaluate the program. The seven sheriffs’ efforts are expected to provide a roadmap for other counties, and Koutoujian said he expects six other sheriffs to eventually join in.
As for the state’s prisons, where people serve longer sentences, they began offering one medication, buprenorphine, in April, but have not yet worked out the logistics of providing methadone.