CINCINNATI The main idea of a program, introduced here last week,to provide medication for inmates who experience opioid withdrawal is to keepthem from dying.
Hamilton County jail in Cincinnati became first in Ohio to launch a program with its health-care provider that manages inmates in opioid withdrawal with buprenorphine, Hamilton County Sheriff Jim Neal said Wednesday.
Symptoms from heroin, fentanyl and prescription-painkillerwithdrawal can include severe diarrhea and vomiting, which could lead to dehydration, electrolyte imbalanceand, ultimately, death.And during a nationwide opioid epidemic, jails are used to seeing hundreds of people coming in with these symptoms.
“It’s an indirect path, (but) people are at risk of dying,” said Chief Executive Brad McLaneof NaphCare, an private health-care company based in Birmingham, Ala., that serves about 30,000 patients in 27 jails and prisons nationwide.Buprenorphine helps quell the symptoms and provide a safer withdrawal.
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The jail in Cincinnati is the 10th for which NaphCare provides a buprenorphine-aided withdrawal program, McLane said.NaphCare introduced its program through a pilot a little more than a year ago at the Washington County jail in Hillsboro, Oregon.
Since then, the health-care provider for correctional institutions has established the program inKings County and Santa Ana jails in California; Hillsborough County jail in Tampa, Florida; Middlesex County jail in New Jersey; Washoe County jailin Reno, Nevada; Pierce County and Skagit County jails in Washington; and the SouthCorrectionalEntity misdemeanor jail in Des Moines, Washington.
NaphCare isn’t the only jail health-care provideroffering treatments to block opioid withdrawal symptoms or help inmates get off opioids for good, but the therapy is not widely available:
Rhode Island began a state Department of Corrections program in mid-2016 that made three medications available to treat opioid addiction and almost immediately found that fewer deaths were occurring after an inmate was released, according to the April issue of JAMA Psychiatry.
Snohomish County Jail in Everett, Washington, started a pilot program in January using suboxone, KING-TV, Seattle reported.
Jefferson County Jail in Golden, Colorado, began in April to use naltrexone,a drug that works in the brain to keep opiates from working andhelps stop cravings, for its addicted inmates, KUSA-TV, Denver reported.
About a week ago, NaphCare workers introduced the treatment in the Hamilton County jail, providing it in anunder-the-tongue dissolving film to experiencing opioidwithdrawal. The patients must be closely watched to ensure the medication is taken properly, McLane said.
“You need to have a nurse or corrections officer watch the patient, or there’s a risk that they will cheek it and divert it,” he said
That’s because buprenorphine is also an opioid.
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If used as medical practitioners direct, it does not cause euphoriaand helps quell cravings for opioids. But it can be used improperly to get the effects of other opioids.
The use of the medicationisalso compassionate, McLane said.
“There's no need for people to suffer through (withdrawal) symptoms. It's unnecessary.”
Brad McLane, NaphCare
“There’s no need for people to suffer through (withdrawal) symptoms,” he said. “It’s unnecessary.”
TheNaphCare CEOhopes to get similar programs established throughout the jails his company serves, he said.
In Ohio, Hamilton County inmates are the only ones getting the treatment in jail so far, and NaphCare had to go through the Ohio Medical and Pharmacy boards to do so, McLane said.
The use of the medication to treat withdrawalisn’t new in other settings.
“Buprenorphine has been used to treat opioid withdrawal for more than 20 years, using the gradual taper,” said Dr. Adam Bisaga,an addiction research scientist who is a professor of psychiatryat Columbia University Medical Center.
In Middlesex County Jail in North Brunswick Township, N.J.,NaphCare is providing some inmates with maintenance doses of buprenorphine as part of an addiction treatment program, McLane said.
That maintenance medication is considered one of the best options for addicts to be weaned from opioids, according to a paper published in the October 2012 edition of Journal of Addictive Diseases.
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But offering that service takes additional certification of medical staff, and prescribers have limits on how many patients they can care for with buprenorphine, McLane said.
“It’s challengingto do that (treatment) in the jail setting” with a quickly changing inmate population, he said. Andcurrent regulations do not allow opioid addicts to receive long-term buprenorphine treatment inside Ohio jails.
Buprenorphine patients at Hamilton County jail will be tapered from the drug, McLane said. The intent is to guide theminto community-based addiction treatment when they’re released.
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Connecting released inmates to evidence-based treatment programs is essential, Bisaga at Columbia University said. Buprenorphine withdrawal treatment should be undertaken only if a plan is in place for giving inmates naltrexoneor keeping them on buprenorphine.
“There is a significant risk for overdose upon release from incarceration,” saidLindsey Vuolo, associate director of health law and policy at the New York nonprofit Center on Addiction. “Initiating and maintaining an individual on a medication such as buprenorphine can significantly decrease the risk for a fatal overdose.”
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