The opioid epidemic has made jail the treatment of last resort
Note: This article, written by Melinda Cady, originally appeared in a Hampshire Gazette column on February 27, 2017.
The opioid problem is not new to those of us who work in the Hampshire Sheriff’s office. However, as with other sectors in our state and nation in recent years, we, too, are experiencing it as an epidemic. Heroin abuse is soaring. Far beyond taking a toll, it’s taking lives.
This is why our office is part of Hampshire HOPE, the county’s opioid abuse prevention coalition. At Hampshire HOPE meetings, we share experiences, talk about the needs of people struggling with life-threatening substance use disorders and brainstorm about how to help them. With so many community agencies at the table, we aim to find solutions that make a difference.
One new intervention launched at the Hampshire House of Correction is our substance abuse roundtable. These meetings support people as they prepare to make the transition from jail back into their communities. House of Correction staff, sitting together with providers from Community Support Options, Tapestry and On Call, spend a couple of hours on the first Monday of every month with men who will be leaving custody over the next 30 days. (Women from this county are incarcerated in the Western Massachusetts Regional Women’s Correctional Center in Chicopee, which is why this column refers only to men.)
During these sessions, we talk frankly about after-care needs specific to men dealing with substance misuse and addiction and how to set people up with mental health support or medically assisted treatment.
Our mission: drive home the message who the support is, where it is, how to use it.
The sad truth is that the Hampshire Jail and House of Correction is essentially the detox of last resort. Uncharacteristic of most, we always have open beds.
As the director of treatment and reentry, clinical supervisor and licensed drug and alcohol clinician, I know, as do my colleagues and Sheriff Patrick Cahillane, that limited access to treatment in society contributes to the number of people coming through our doors. We have firsthand experience with the devastation substance abuse imparts upon individuals, families and our communities. It’s directly tied to crime and public safety. No, most don’t end up here for possession; rather most are here because of crimes they committed while under the influence or to sustain a habit.
Individuals entering our facility overwhelmingly test positive for drug use upon admission. This is why we must educate and provide treatment for substance misuse. While we are a correctional facility, we operate like a modified therapeutic community. We follow a medical protocol for men who enter while actively detoxing from a substance. We offer a variety of group and individual treatment programs. That includes after-care planning, crucial for post-incarceration success because it means setting up services for individuals. I can’t stress enough how important that is.
At our roundtables, we gather in the visiting room to work out final details that we believe will put newly released people in the best possible position to succeed. We talk frankly about substance use once they are out and overdose risks. We give them release packets, which are clear plastic pencil cases loaded with information. These packets include telephone numbers and addresses for peer support, detoxes, halfway houses, shelters, meals, recovery meetings, hotlines and other contacts. We tell our inmates: “Take them, keep them, use them.”
Although this is not entirely new information — we offer information about substance abuse after-care services upon their arrival at the jail — we go over it again one last time. We want them to understand that there is help in the community when they leave.
We educate them about the Good Samaritan Law, in case they or a companion overdoses. This law protects people from arrest if they summon help for an overdose.
Also at these planning meetings, mental health clinicians explain the services available, including intensive outpatient programs, early recovery groups, individual and family counseling and peer support. The clinician might even take care of the intake on the spot.
Meanwhile, staff from On Call, which offers medically assisted treatment (known as MAT) for those addicted to opiates, describes how that works. If a man decides he wants the opiate-blocker Vivitrol and is deemed an eligible candidate for that treatment, he may leave our facility having received his initial shot. We then generally drive the participant over to On Call for his first appointment, where staff there takes over.
Staff from Tapestry demonstrate how to identify an overdose and train people on how to administer Narcan. Overdose is a real possibility, for those newly released from jail, and it is one we must address candidly. After being incarcerated and generally free from drugs when released, an individual’s tolerance has changed, putting him at great risk of overdose. We encourage people in recovery to carry Narcan, the overdose-reversal drug, as that could save a life. If a person leaving our facility wants it, we’ll place a dose in his release packet.
It’s been my experience during 25 years working in this field, that something significant changes for many people just before they are released from incarceration. Anxieties rise. A person who thought he “was all set” realizes he feels vulnerable. Doubts about recovery pop up. This is why we plan carefully as the men are about to leave, and tell them: “We want to arm you with information. Overdose is real. You have a community here supporting you with resources available. Use them.”
Melinda Cady is the assistant deputy superintendent at the Hampshire Sheriff’s Office and a member of the executive board for Hampshire HOPE. Hampshire HOPE is the county’s opioid prevention coalition that is operated out of the Northampton Health Department and funded with federal dollars.
She is one of several individuals who contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.