By MATT BLOIS
The Brentwood health care company Corizon hopes to make medication assisted treatment more easily available for people addicted to opioids in jails and prisons.
Corizon is a private company that provides health care to more than 300 prisons and jails in 22 states. With more than 220,000 patients, the company is one of the country’s largest health care providers for jails and prisons.
Overdose deaths involving opioids in Tennessee increased by nearly 70 percent between 2013 and 2017, but prisoners tend to have higher rates of drug use. According to a U.S. Department of Justice report, about a quarter of all inmate in state prison reported using heroin at some point in their life.
During the past year, Corizon has been testing out a medication assisted treatment program using buprenorphine in the Philadelphia prison system to solve that problem. Now, they hope to bring the program to other locations.
Doctors providing medication-assisted treatment for addiction give patients a drug — such as methadone, buprenorphine or naltrexone — to reduce drug cravings and withdrawal symptoms.
Corizon Chief Medical Officer Pete Powell called addiction a national crisis, and said treating people addicted to opioids in jail is an important step to overcoming the problem.
“Many of those patients, the reason they’re incarcerated in the first place is the drugs themselves,” he said. “If we can get rid of that addiction, we’ve improved life for our patient, but also the community.”
Kelly Moore — a professor of psychology at East Tennessee State who has researched medication assisted treatment in jail — called this type of treatment the gold standard.
In a recent paper, Moore reviewed dozens of studies, and found that inmates going through medication assisted treatment were more likely to enroll in treatment after release and less likely to use drugs. However, she said it’s relatively rare in jails and prisons.
“Most correctional facilities just do forced withdrawal. If someone comes in with an opioid problem, they just withdraw from opioids during incarceration,” she said. “The standard substance abuse treatments that are offered in jails or prisons are usually some form of group or individual counseling, or self help.”
The federal agency tasked with fighting substance abuse only released guidelines about medication assisted treatment in jail in March 2019.
Without those clear guidelines, Powell said Corizon had to figure out how to best implement this type of treatment in prison. He broke down the process into three steps: intake, treatment and transition.
When an inmate comes into jail, doctors screen the patient. They have to identify people already on medication-assisted treatment and people who could benefit from it.
Once an inmate is in jail or prison, doctors can prescribe medication to treat the addiction, but it’s not always clear how long the patient will be there.
“You have some people who go to jail for 24 hours because they drank too much, but you may have some people in jail six months,” he said. “We have to have a program that encompasses both sides.”
The biggest challenge is the transition from treatment in jail to treatment outside of jail. Powell said Corizon starts planning the transition as soon as inmates arrive, connecting them with treatment programs and pharmacies in the community.
The inmates leave jail with a pack of buprenorphine pills that should last a month, which is supposed to give them time to find a treatment program.
One obstacle to expanding medication-assisted treatment could be the availability of treatment programs outside of jail. If inmates can’t find treatment after release they’ll likely have a hard time staying sober.
“Not every town, not every city has a great treatment program,” Powell said.
In addition, Powell said it can be hard to find doctors to operate medication assisted treatment programs because it requires a special license.
Corizon is hoping to make medication assisted treatment more readily available, but that likely depends on the resources available to jails and prisons. Corizon is a for-profit company and it’s state or local governments that ultimately pay for the treatment.
The Philadelphia Deparment of Prisons Chief of Medical Operations Bruce Herdman, said the the program in Philadelphia cost about $850,000 per year for about 3,000 inmates. That’s a big initial investment, but he said the city will probably save money because fewer people will return to drugs after leaving prison.
“In the immediate time frame it doesn’t save any money,” he said. “If we can get people treated effectively once they leave, as well as here, it will save a lot of money and save a lot of lives.”
Ultimately, Herdman said prison and jail operators might not have a choice. A series of court cases have determined that governments need to provide prisoners with health care that meets community standards.
“What’s happening is medication-assisted treatment is becoming the community standard around the country because it has been proven to work,” Herdman said. “I think jurisdictions aren’t going to have an option. They’re either going to do it or they’re going to get sued.”