As the state grapples with what many call a heroin epidemic, a growing number of correctional facilities are starting to treat addicted inmates with medication in an effort to prevent fatal overdoses.
While many jails and prisons only offer counseling and support groups for drug-addicted inmates, a growing number are treating inmates with drugs such as methadone, an opioid-based substance that eases withdrawal symptoms, or Vivitrol, a nonopioid, injectable medication that blocks the effects of both alcohol and heroin.
Among those offering medication are Anne Arundel, Harford and Washington counties. And a new federally funded study at the Baltimore City Detention Center will look at how hundreds of incarcerated addicts respond to methadone.
The state health and public safety departments, in a report issued last fall, have recommended that more corrections administrators consider the use of medicated-assisted addiction treatment, which has proven more efffective than counseling alone.
They have collected data that shows drug-addicted inmates are especially susceptible to overdoses in the first week after their release — the risk is more than eight times higher — compared with three months to a year after their release. That's largely because an inmate's tolerance to drugs drops significantly during their time behind bars.
"We strongly recommend that people be treated for their illness even while they are incarcerated, and medication-assisted treatment is the gold standard for treatment" of opioid addiction, said Kathleen Rebbert-Franklin, deputy director of population-based behavioral health at the state Department of Health and Mental Hygiene.
The report does not address how much the treatment would cost.
In Harford County, a new program will provide injections of Vivitrol to detention center inmates who are addicted to opiates or alcohol. Washington County also operates a Vivitrol program.
The goal is to help addicts stay clean when they get out of jail so they can find treatment for their substance-abuse problem, said Dr. Julie Stancliff, a psychiatrist with the Harford County Health Department, which is working with the detention center.
Although authorities acknowledge that some addicted inmates get their hands on smuggled substances, many addicts' tolerance drops while they're behind bars because they have no access to drugs.
"A lot of them leave the jail and their first intention is to go back to taking drugs or back to [drinking] alcohol," Stancliff said. "They come out, they feel like they can use the same amount as they used to, and they end up dying."
Two people in Harford County received Vivitrol shots this week just after being released from jail, Stancliff said. She has also treated about a dozen noninmate patients at the county Health Department with Vivitrol.
"They're very engaged in the recovery process," she said. "There's no temptation to divert the medicine, and there's no temptation to abuse the medicine."
An advantage of the injection is that, unlike pills, it can't be diverted and abused among inmatesthe facility, she said.
Diversion of medicines used to treat addiction is a concern for jail administrators, said Sharon Tyler of the Maryland Correctional Administrators Association.
Buprenorphine, known by the brand name Suboxone, also is used to treat opiate addiction and is "one of the biggest contraband items we now have coming into the local facilities," said Tyler, a program manager with the Baltimore County Department of Corrections.
Dr. Robert P. Schwartz, medical director at the Friends Research Institute, is leading the study involving methadone treatment at the Baltimore City Detention Center, which is funded by the National Institute on Drug Abuse.
He said many people enter jail with an addiction, yet many have never been in treatment.
In jail, "you can get people's attention and try to motivate them to get help," Schwartz said.
Since 2012, Anne Arundel County has run a methadone-based addiction treatment programcalled Road to Recovery, a partnership between the health department and the Ordnance Road Correctional Center in Glen Burnie. More than 400 inmates have gone through the program.
Road to Recovery, which also provides counseling and recovery coaching, was initially only available for inmates who were already on methadone-maintenance when they entered the facility, officials say. But it has been expanded so that other drug-addicated inmates can join.
When inmates are released, they are connected with outpatient treatment services in the community. The goal is to stabilize them and stop them from seeking illegal drugs when they get out.
Owen McEvoy, spokesman for Anne Arundel County Executive Steve Schuh — who recently announced plans to declare a state of emergency over heroin abuse — said the program is part of a county philosophy that combating the drug problem is not a job solely for law enforcement.
"You have to attack it from every angle, and one of those angles is treatment," McEvoy said. "The detention center provides us a unique opportunity to give people the help they need."
Lisa Lowe, director of the Heroin Action Coalition of Maryland, said she worries the state has focused too much on methadone treatment. While Lowe said everyone should "choose their own path" to recovery, she's heard methadone referred to as "liquid jail," with patients becoming dependent on their dosage schedules.
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"They're kind of trapped," she said. "They can't leave their methadone clinic."
But advocates say methadone can be effective.
Scott Nolen, director of the drug addiction treatment program at Open Society Institute-Baltimore, a non-profit organization whose goals include increasing access to substance-abuse treatment, said correctional facilities also provide an opportunity because the inmates are typically already undergoing various evaluations, such as determining if they are a threat to the community upon release.
"Why not do a more comprehensive evaluation to see what are the needs this person has, because maybe if you address this substance-abuse issue, they're no longer a risk," Nolen said. "It's a win for the system, and it's a win for the individual."