A recent study identified bridge doses of medication for those involved in medication-assisted treatment programs for opioid use disorder, as well as better communication and phone access, as three areas of improvement needed for Massachusetts county jails as incarcerated individuals transition back into the community.
“The information is really important,” Ed Hayes, director of treatment at the Franklin County Sheriff’s Office in Greenfield, said of the study and its recommended areas of improvement. “There tends to be a vacuum of research with the work of criminal justice. … By partnering with researchers, we’re able to advance the field.”
According to the study, completed by researchers at Tufts University School of Medicine, the University of Massachusetts Amherst and University of Massachusetts Chan Medical School-Baystate, people released from jail or prison are 120 times more likely to overdose on opioids than the general population in Massachusetts.
“It’s not just an abstract problem,” Hayes said. “These are real people and we are still in the throes of the opioid epidemic. The COVID pandemic has made things much worse for the world of recovery. Now is the time, more than ever, where we need this research ... to help us understand effective ways to address this.”
The team interviewed 36 medical, supervisory and administrative staff from 18 opioid use disorder medication-assisted treatment programs that serve jail-referred patients. Among those interviewed, 14 worked within local jails as outside contractors on behalf of a community-based agency providing addiction treatment services.
“Continued treatment reduces the risk of death and leads to improved health and social outcomes,” Liz Evans, professor of public health at UMass Amherst and co-principal investigator of the study, said in a statement. “Many people with opioid use disorder engage with the justice system, making it a critical place to offer evidence-based treatment. As people are released from jail, their ability to continue life-saving treatment largely depends on innovative collaborations that have been established between community treatment providers and jails.”
In 2018, Massachusetts lawmakers mandated expanded access to medication-assisted treatments like buprenorphin. The Franklin County Jail and House of Correction led the way in 2018 with its treatment program, with the Hampshire County Jail and House of Correction following not long after.
The effort, part of a larger five-year project called the Massachusetts Justice Community Opioid Innovation Network (JCOIN) that received funding for research in 2019, provides incarcerated individuals with medications for opioid use disorder, including methadone, buprenorphine and naltrexone. The project aims to evaluate the outcomes of people with opioid use disorder who have gone through the prison system, as well as evaluate the costs of offering these types of treatment.
“A lot of times when we’re thinking about the standard of care for patients — if we’re working with a middle-class patient at a medical clinic, we’re often looking at research in the past five or 10 years,” Hayes explained. “When we’re talking about treatment for those who are involved in the carceral system, we’re often looking at research from 40 years ago.”
Hayes, who said the Franklin County Sheriff’s Office is on the steering committee for the JCOIN project, said the research aims to analyze the replicability of programs in place at Greenfield’s Franklin County Jail and House of Correction.
“We’ve had a strong partnership with … our local Hampshire County Sheriff’s Office,” Hayes noted. “We worked closely together and they were able to take a lot of the work we did, not reinvent the wheel, and replicate what we’re doing.”
Hampshire County Sheriff Patrick Cahillane said while data to demonstrate the success of the medication-assisted recovery program is hard to come by, it’s evident that people who remain in touch with staff “tend to do better, because they know somebody here they can reach back out to.”
He said people leaving the Hampshire County Jail and House of Correction are provided with bridge doses and are offered wrap-around re-entry services, whether it’s a recovery coach or a case manager. People can also sign up for free cellphone access.
“I think the key is, and what people should understand, is the goal of medication-assisted treatment programs is to help those individuals going back to the community avoid overdoses and overdose deaths,” he said. “That’s what helps us continue to have a safe community.”
Still, he said, there are other elements that contribute to a person’s success during the jail-to-community transition. The lack of housing, he noted, was among them.
“We know there’s a lack of jobs … that can be easily filled by people leaving custody without background checks,” Cahillane continued. “Money and food resources are all things that individuals coming out of correctional facilities and have a substance use disorder have to be concerned about. … If we get them to the point where they are successful on the outside, than you reduce the problem of re-incarceration.”
Reporter Mary Byrne can be reached at mbyrne@recorder.com or 413-930-4429. Twitter: @MaryEByrne.