After the Webinar: The Provision of Methadone for Opioid Use Disorder within a County Jail. Q&A with the Presenters

Webinar presenters Dr. Alexandra Duncan and Dr. Grant Phillips answered a number of your questions after their presentation, The Provision of Methadone for Opioid Use Disorder within a County Jail. Here are just a few of their responses.

 

Audience Question:  Alex, what percentage of jails and prisons are doing programs like what Grant’s jail is doing? 

Dr. Alexandra Duncan: That’s a great question. Unfortunately, that’s a hard question to know an answer to. There are several researchers around the country doing surveys now, as well as the Bureau of Justice Statistics is also doing a survey, so that way, we can better have the answer to that question. Right now, we do know out of the 3000 or so jails, we’re seeing not a substantial percentage that are offering all three medications, and hopefully, more research to come to be able to have a definite answer to that question.

 

 

Audience Question: So, it sounds like certainly data is certainly lacking. In your experience and I’m sure you’ve dealt with folks all across the country, what is your experience telling you in terms of why jails may or may not be adopting? Was the polling question accurate and that really is around funding? 

Dr. Alexandra Duncan:  Yes, a lot of the sheriffs and wardens I talk to are challenged with funding and also challenged with ensuring they have the right staff, that correctional officers are aware of how the medications work, and that there are appropriate security controls. So, there are a host of different challenges our jails are facing and the poll question reflected that.

 

 

Audience Question: Are you seeing attitudes changing in terms of the old-school attitude of, oh, just toughen up buttercup. Are they really seeing that this is a health issue, it’s not a choice of willpower? 

Dr. Alexandra Duncan: Absolutely, attitudes are definitely changing. Even in the last few years, I’ve seen wardens who previously said, no, I’m not really comfortable with buprenorphine or methadone in my facility have definitely changed and are now offering those services.

 

 

Audience Question: Grant, you talked about the changes that you’ve seen over the duration of the opioid epidemic. Where do you think things need to go,  or what continued changes need to happen especially in jails and prisons, to continue to address the epidemic? 

Dr. Grant Phillips: Yeah, that’s a good question. Of course, I’m looking at what I know, which is Maricopa County Jails, and I think that reflects a lot of what’s happening nationwide. I think, continuing to work with outside partners and expand services, one of the things that I mentioned was the peer navigators through the SOR (State Opioid Response) Grant or the STR navigators. Getting outside people who have ‘lived experience’ with addiction, with opioid use disorder, to connect with our patients when they’re in custody has been very successful. However, it’s also a challenge. These individuals are available, however, some of them have been justice-involved in the past, and getting them badge access into the jail and getting them connected with patients can be a challenge. Interestingly, COVID-19 has brought out some silver linings, and one is that, now, instead of coming into the jail, these individuals, the peer navigators, have access to our patients through secure, HIPAA compliant video visits, where they can connect with patients and they still have access to our electronic health record and can document and then make that connection, so that our medical providers can prescribe medications for the patients. That’s one facet of it.

 

 

Audience Question: Fantastic, and you used a term that I just want to make sure everybody knows. Probably, most people know but I just would like for some clarification. Can you explain the term peer navigators, please?

Dr. Grant Phillips: Right, so a peer navigator is a mental health counselor who, for their degree of licensure, I actually would have to defer to my mental health colleagues on it. A lot of these individuals, they will work for community agencies that provide substance use disorder services. When I say they have ‘lived experience’, many of them have dealt with addiction themselves and have been able to overcome it and treat it, and then can help each other or help others in the community.

 

 

Audience Question: Grant, is it safe to say that many rural areas in the Midwest, like states like Ohio, have been particularly hit hard by this epidemic? Or is it far more widespread than that at this point? 

Dr. Grant Phillips: Yeah. So, speaking about Ohio, I know I don’t have experience working in that area. I have colleagues who work in that area and work in correctional health. It is one of the hardest-hit parts of the United States. Opioid use disorder is certainly a widespread problem, but I know that Ohio and other states in that area have been hit hard.

 

 

Audience Question: How about you, Alexandra? Are you seeing this? Is it really a rural challenge? is it pretty much everywhere at this point?

Dr. Alexandra Duncan: Opioid-use disorder and overdose deaths are everywhere. Doctor Phillips showed us a couple of maps of overdose death rates. In the maps, you can see in several states, in the mid-west region and the Appalachian region have high overdose death rates. However, we want to make sure people are aware that overdose deaths can happen in any community, regardless of urban, rural, income level, race, ethnicity.

 

 

Audience Question: When you talk about MAT, should additional psychological support also be offered? So, for example, Narcotics Anonymous, individual counseling, should they go hand in hand? 

Dr. Grant Phillips: Sure, I can take that one. So yeah, I mean, the more resources that can be put towards these individuals, the better. Either through individual behavioral therapy or group counseling sessions. The challenge often is funding, is staffing, it’s even finding space, right? If you talk about a Narcotics Anonymous group that needs to meet, well, there’s got to be a place for those individuals to sit in a room. Now social distance with masks to conduct those kinds of things is a challenge. You know, finding innovative ways to do these kinds of things or at least, educating patients about these options, so that when they do leave jail, they’re connected to resources, and they have the immediate means to obtain those resources.

 

 

Audience Question: Are there interventions that can target methamphetamine abuse in addition to opioid abuse? 

Dr. Grant Phillips: That’s a challenge. Interestingly, in all the focus that we’ve put into Opioid Use Disorder over the last several years, in talking to patients who strictly have a methamphetamine use problem, they kind of feel left out. I think they feel left out from the standpoint that you know, of course, a lot of funding is put into Opioid Use Disorder, and there are specific medications to treat opioid use disorder, and there are no specific medications used to treat methamphetamine use. However, the behavioral and counseling therapies apply and should be tailored to everyone with substance use disorder.

 

 

Audience Question: Dr. Phillips, you mentioned that the LOS was less than 30 days for those in MAT. What is the daily cost of a SUD bed in your jail? 

Dr. Grant Phillips: I knew there’d be a stumper. I don’t have an answer to that one. The length of stay, just to clarify that length of stay applies to all inmates coming into jail. It averages less than 30 days. However, that range is from, you know, several hours all the way up to 6 or 7 years. So, it’s a very wide range. We tend to focus our services through peer support, peer navigation, as well as discharge planning on those individuals who have a set release date and who are generally minimum or medium custody, who we know, are going to be getting out of jail fairly soon. I know I’m diverting a little bit. To know the actual cost of an individual patient, yeah, I’d have to do some looking into that.

 

 

Audience Question: Where does the funding come from? What is the solution? If funding is such that is a challenge for these, for these agencies, what do they do? Where does your funding come from, Grant? Is it mosaic, county funding, federal, state? Is it grant funding from certain foundations? Then, Alexandra, if you can expand that to a brighter wider discussion of what agencies should be doing. So, Grant, I’ll start with you. 

Dr. Grant Phillips: Okay, so, yeah, I’m speaking from my experience in my own facility.  I am aware of facilities that use grant funding and we do use grant funding strictly for our Narcan, our harm reduction program, giving the Narcan individuals before they leave jail. When it comes to medication-assisted treatment, since we mainly focus on methadone – methadone is a low cost. We’ve incorporated the actual policies and procedures, the administration of methadone, into the daily workload of our staff. When it comes down to, you know, counseling, and this is really where those outside partnerships come in because we couldn’t hire 10 more mental health counselors that focus strictly on substance use disorder. So, getting the peer navigators and the outside agencies that do have funding to come in and provide resources and collaborate with us have been the biggest game-changer.

 

 

Audience Question: How about Alex, what are you seeing across the US? 

Dr. Alexandra Duncan: Yeah, so a lot of jails are using their county-based funding to offer these services. Many are also trying to get federal funding to trickle down to them, some of those state opioid response dollars or the state targeted response dollars to trickle down to the county correctional facilities. People are also applying for grants. Several federal agencies have great opportunities. The most common opportunities I see people apply for are through the Bureau of Justice Assistance.  Those grant dollars are awarded through a competitive application and that’s something that jails can look into.  I mentioned as part of my presentation that policymakers are also a resource and can be an advocate. So, talking to multiple stakeholders in your jurisdiction, including policymakers can be a way to get some appropriated funding that will hopefully trickle down to jails to offer these services.

 

Click Here to Watch a Recording of  The Provision of Methadone for Opioid Use Disorder within a County Jail.

 

 

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