Louisville selected for program to expand medication-assisted treatment for opioid addiction in jails

Photo via Metro Department of Corrections website

Louisville is one of 15 local jurisdictions to be selected to participate in a national program that could expand the use of medication-assisted treatment for Metro Department of Corrections inmates with an opioid use disorder.

According to a news release from Mayor Fischer’s office, the Planning Initiative to Build Bridges Between Jail and Community-Based Treatment for Opioid Use Disorder program will “provide expert guidance on how to overcome barriers to providing opioid treatment, including staff training and guidance for jail officials in creating treatment guidelines, managing administration of the medications, and educating jail staff about addiction.”

Though medication-assisted treatments like methadone and buprenorphine — often known by the brand name Suboxone — are increasingly viewed by professionals as the most effective evidence-based treatment for chronic addiction to opioids, less than 1% of jails in the country offer such medication.

Most inmates with opioid use disorder, whose numbers continue to grow, instead go through detoxification, lowering their tolerance levels upon release and putting them at more risk of an overdose if they relapse.

While Metro Corrections has offered limited forms of medication-assisted treatment in recent years, in only very limited circumstances will it allow inmates with opioid use disorder to begin or continue treatment using methadone and buprenorphine — though the news release and a subsequent statement from the department suggested that this may change.

Metro Corrections began a voluntary program in 2016 for such inmates to receive injections of  Vivitrol, the brand name of a medication that contains naltrexone, which blocks opioid receptors in the brain for one month at a time.

In 2017, the jail began transporting pregnant women to the health department’s methadone clinic for treatment, and last year, clinic employees began coming to the jail to administer those methadone doses.

However, no other inmates at the jail received either methadone or buprenorphine, even if they are already receiving medication-assisted treatment for opioid use disorder with those drugs at the time they are incarcerated, officials said.

But according to recent federal court decisions, jails may soon be prohibited from denying such inmates the ability to continue treatment using methadone and buprenorphine while incarcerated, as judges have found this to be a violation of an individual’s constitutional rights and the Americans With Disabilities Act.

In the news release announcing Louisville selection in the program — a joint initiative of the U.S. Department of Justice and nonprofit Arnold Ventures — Metro Corrections Director Mark Bolton stated that the next logical step “is to expand treatment for opiate use disorder for individuals who remain in custody.”

“We have the commitment to help this population and now with support of our federal, state and local justice partners, we will have additional resources to help people confined in the jail more effectively combat substance use,” stated Bolton.

While the news release mentioned that only 30 of the 3,200 jails in the country allow methadone and buprenorphine to be administered to inmates, it did not specifically state that Metro Corrections would now allow this type of medication-assisted treatment at the city beyond pregnant women.

Asked if the department’s participation in the medication-assisted treatment (MAT) program would bring the expansion of treatment to Louisville inmates involving the administration of methadone and buprenorphine, Corrections spokesman Steve Durham would not confirm this — but left the door open.

“This is a planning initiative to learn from experts in the field about expanding our current MAT from jail to community,” Durham stated to Insider Louisville. “Metro Corrections plans to conduct an in-depth review of current best practice MAT options and make decisions about what will give us the best return, based on resources, for the impacted population.”

As an example of the review that Metro Corrections will conduct, Durham noted that “we will be looking closely at jails where persons entering custody already on prescribed methadone or buprenorphine are medically managed through withdrawal by tapering individuals off a maintenance medication; jails where individuals are maintained on prescribed medication until they leave the jail; as well as jails that initiate MAT upon admission through a screening and assessment. All Metro Corrections efforts will be woven into a community transition pathway.”

According to figures provided by Durham, the department has administered over 300 injections of Vivitrol to inmates since it began the program offering this form of medication-assisted treatment in partnership with Wellpath. In 2018, 34 pregnant inmates were administered methadone through the health department, with 21 percent of those women continuing treatment with the city’s methadone clinic following their release.

Louisville’s jail is often called the region’s “largest detox facility” by city leaders, as the opioid crisis has dramatically increased in recent years and driven a corresponding spike in the number of inmates incarcerated.