Can time behind bars save your life?

Editor’s Note: This op-ed/editorial was written by Peter J. Koutoujian, Sheriff of Middlesex County, Massachusetts. This piece is part of our Special Series on Addiction Treatment within Correctional Facilities. We’re grateful to Sheriff Koutoujian for sharing his perspectives.

For those suffering from addiction sentenced to a period of incarceration in the Middlesex House of Correction we work every day to answer that question in the affirmative.

Right now we are witnessing a frightening number of deaths due to opioid overdoses across the Commonwealth of Massachusetts. Heroin and other opioids are mercilessly taking the lives of users while leaving loved ones left to grieve and ask why.

Policy makers and those in government – myself included – are searching for answers As the former chair of the Commonwealth’s first OxyContin Commission in 2005, I heard the stories of how an increasing prescription drug abuse problem was feeding an equally expanding heroin problem. Almost a decade later as Sheriff, nearly 50 percent of inmates participating in our most intensive drug treatment program in 2014 reported heroin/opioid dependency as their most pressing drug problem. This is a significant percentage of our population that quite honestly represents the more fortunate – those who are getting the help they so desperately need – even if comes at the cost of incarceration.

Every day at the Middlesex Sheriff’s Office we use the unique window of opportunity we have with those struggling with addiction by utilizing a host of programs and tools to assist in their recovery. We’ve invested more to expand our drug treatment programs to offer inmates services, including our Accountability Recovery Community (A.R.C.).

An intensive 90-day program, A.R.C. participants reside in our 126-bed Residential Substance Abuse Treatment (RSAT) housing unit where they can dedicate each minute to their recovery. In 2014, we were designated as a National Mentor Site by the U.S. Department of Justice’s Bureau of Justice Assistance for this program and hosted 30 professionals from across the country for training this past May.

Those inmates who participate in the A.R.C. program are encouraged to tackle their addiction head on through an evidence-based curriculum. They focus first on their own recovery and second on supporting the recovery of those in the program with them. Additionally a priority is placed on getting participants to think about the impact their addiction has had on those around them including spouses, children and friends. And finally, participants are challenged to reimage themselves and stop thinking of themselves in negative terms. We don’t want them to think of themselves as addicts, but rather as fathers, sons and friends and set long-term goals for success.

At the Middlesex Sheriff’s Office we take a holistic approach by addressing drug addiction from every angle. But what is going to make an individual successful when they leave our custody depends on their will and the resources available to treat their addiction. That is why continuity of health care is critical.

We can be as aggressive as we want when it comes to treating addiction on the inside, but there must be an infrastructure available once these individuals return home. Provisions included in the Affordable Care Act allow for expanded treatment for drug addiction as well as medications, such as Vivitrol, to treat this disease. Vivitrol, a long lasting form of Naltrexone, is a non-opiate based medication that differs from Suboxone in that it carries no street value and is administered by a physician. The effects of one injection can reduce cravings for 30 days and many health insurance plans now cover the cost. That is why ensuring individuals have medical coverage is key to recovery.

Drug addiction devastates the lives of those who suffer from it, as well as their families and loved ones. By working smartly and creatively, our goal is to use incarceration as a way to help save lives.

My ultimate goal, however – and one shared by my fellow founding members of Law Enforcement Leaders to Reduce Crime and Incarceration – is to divert as many of those facing low-level drug offenses away from jail and towards treatment and support services in the community.

 

Peter J Koutoujian

Sheriff of Middlesex County, Mass.

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Comments

[Kay John Borzsony]

As a long-time, recovering opioid addict, I must admit to feeling nothing but distress at reading about your “behind-the-bars” treatment program, and my instinct as to why this methodology does not sit right with me was stimulated not so much by what was stated in the description, but rather much more by what was implied, as well as what was, most crucially, left unsaid.
While I am not questioning the sincerity of your motives, i.e. it seems clear enough to me that you desire a positive outcome for those inmates undergoing this treatment program, I do seriously question the inherent biases which are revealed by your definition of a positive treatment outcome as it relates to treating opioid addiction: Although never explicitly stated, the obvious (and only) definition of treatment success that can be gleaned from reading the description appears to be total abstinence from any controlled substances.
To quote from your article,
“We can be as aggressive as we want when it comes to treating addiction on the inside, but there must be an infrastructure available once these individuals return home. Provisions included in the Affordable Care Act allow for expanded treatment for drug addiction as well as medications, such as Vivitrol, to treat this disease. Vivitrol, a long lasting form of Naltrexone, is a non-opiate based medication that differs from Suboxone in that it carries no street value and is administered by a physician. The effects of one injection can reduce cravings for 30 days and many health insurance plans now cover the cost. That is why ensuring individuals have medical coverage is key to recovery.”
Vivitrol, a.k.a. depot-naltrexone, has been nothing less than a massive, disastrously consequential failure whenever it has been utilized in newly “detoxified” opioid addicts, and what is most stunning to me is that these dismal results have been documented by multiple researchers, writing in numerous peer-reviewed journals, for almost as long as naltrexone has been available. In point of fact, the #1 FDA approved use for naltrexone, in any form, is as an adjunct treatment to decrease cravings in alcoholics. This makes logical (and evidence-based) sense, since naltrexone has been proven in multiple studies to accomplish this in alcoholics who wish to abstain or reduce their drinking. Alcoholic brains have not been “re-wire” in the way that opioid addicted brains have, and this is why naltrexone is effective in this, and only this group.
The effect of naltrexone on abstinent opioid addicts, myself included, is literally aversive, which makes sense when one considers that opioid antagonists are not in any way “selective,” meaning that they not only block exogenously administered opioids (such as heroin, morphine, etc.,) but (and this is what makes them ineffective to treat addicts) they also block our own, internal, endogenously produced opioid peptides, like beta-endorphin and enkephalin. Considering how crucial endogenous opioids like the aforementioned are to maintaining a normal, healthy sense of well-being, it cannot come as much of a surprise that naltrexone has proved to be such a failure when utilized to maintain abstinence in opioid addicts. Both from personal as well as anecdotal testimony, naltrexone is to the opioid addict what Kryptonite is to Superman: newly “detoxified” addicts will do everything possible to avoid ingesting this drug, and the depressed and anhedonic state produced by it are so aversive that addicts have been known to literally cut out their newly placed naltrexone implants, so as to produce such suffering and human misery, in the aggregate, that I am truly left scratching my head as to how this program was ever medically approved.
The hard and uncomfortable reality is that no matter how controversial and politically unpopular as it still is, methadone maintenance treatment (MMT)(and, for a smaller sub-group, Suboxone maintenance) has, by orders of magnitude, been the most successful method for re-integrating opioid addicts back into normal, healthy, drug-free and productive lives. Again, don’t take my word for it, but rather consider that no-less than the American Society for Addiction Medicine (A.S.A.M.) has come to consider MMT the “gold standard” in the treatment of opioid addiction. Perhaps this is because, as every opioid addict comes to find out the hard way, abstinence as a treatment end-point is utterly unrealistically achievable, and it is not without reason that MMT has become a life-saving treatment for an addict group that otherwise has no truly effective options. Yes, we’re all familiar with the “former heroin addict” who has been abstinent for 20 years, but these individuals are so exceptional that it begs the question of whether they were ever truly addicted in the first place. I am much more familiar with those addicts who have been shamed and blamed into abstinence-or-else, and unfortunately, far too many of them are now dead.
I should know; at age 47, I have been stabilized on MMT for 15 years, during which time I was able to get married, go back to college and eventually nursing school, and am now pursuing a career as a full-time, free-lance writer. The sad fact remains, however, that in this age of 24/7/365 multimedia news ‘availability,’ success stories like mine are essentially never covered, because (I suspect) that a story like mine is just not as salacious and headline-grabbing as one that, though the absolute exception in reality, serves to shock and horrify readers by re-affirming old prejudices and stereotypes about methadone. After all, sensationalism sells.
As a concluding thought, I beg of everyone reading this to go outside of their comfort zone, step outside of the current flawed paradigm regarding opioid addiction, and re-evaluate the way opioid addiction is treated. One thing that we know for sure is that once the brain has been “re-wired,” so to speak, from opioid addiction, abstinence is not only unrealistic, but in the most consequential sense, more often than not, ultimately a death sentence for the addict who has been afforded no other options.