Corrections Takes Steps to Help Curb State’s Opioid Epidemic
November 13, 2018
TUMWATER – Aliza Mooney knows the pain and anguish of watching a loved one struggle with opioid addiction.
At 15, her daughter began using marijuana. Within a year, Mooney’s daughter was using intravenous drugs and spent her 16th birthday at the Echo Glen Juvenile Rehabilitation Center in King County, Wash., only to relapse three days after returning home.
“We went through the cycle again,” Mooney said through tears. “We got through Christmas and New Year’s (Day) clean, but on January 7, I got a knock at the door. She was found unconscious at a home. We spent 12 hours watching my baby on life support before we made the decision to let her go.”
Deaths like Mooney’s daughters are unfortunately not uncommon. Opioids were responsible for 693 overdoses in the state of Washington in 2017, according to the state Department of Health. Nationally, opioid overdoses accounted for 2/3 of the 72,000 drug overdose deaths last year. Furthermore, research published this year in the American Journal of Public Health found that people releasing from prison are 40 times more likely to die from an opioid overdose than the general population.
Mooney shared her daughter’s story during a panel discussion at the September 27, 2018 Continuing Medical Education conference at the state Legislative Building in Olympia. Stafford Creek Corrections Center Medical Director Ryan Herrington and state Department of Corrections’ (DOC) Health Services Opioid Grants Manager Tami Kampbell discussed ways the department is helping to curb the state’s opioid epidemic by offering various services and treatment to incarcerated individuals and people on community supervision who struggle with an opioid use disorder.
Medication Assisted Treatment
One example of this is through Medication Assisted Treatment, or MAT. MAT is the use of FDA-approved medications, in a combination with counseling and behavioral therapies to provide a “whole-patient” approach to the treatment of substance use disorders.
MAT involves using medications such as methadone, buprenorphine (also known as Suboxone), and naltrexone (also known as Vivitrol) for the treatment of opioid use disorders. Research has shown that MAT can reduce relapses, increase retention in treatment, and reduce overdose risk. It can also help reduce rates of other health issues that can come from drug use such as Hepatitis C and HIV.
Unlike methadone treatment, which must be performed in a highly-structured clinic setting, buprenorphine products can be prescribed or dispensed in physician offices, making treatment more accessible, Herrington said.
To administer MAT, health care professionals must receive extensive training and earn a waiver from the Substance Abuse and Mental Health Services Administration.
Six DOC prisons, Monroe Correctional Complex, Washington State Penitentiary, Stafford Creek Corrections Center, Washington Corrections Center, and Washington Corrections Center for Women, have health care staff who have earned the waivers to allow them to administer MAT. A total of 50 health care staff have earned the waivers so far, according to Herrington.
“I am just delighted that 50 of you are now waivered,” Herrington said. “The fact that you found time to do this is tremendous for the state.”
Treatment Outside Prison
The department is helping people who continue with MAT outside prison. If someone on community custody is arrested for committing a community custody violation and their community corrections officer discovers they are receiving MAT, the person is transported to one of the six facilities to continue being prescribed Suboxone, instead of going to a county jail, where MAT is often not available, Kampbell said.
Health services officials report 127 unduplicated community custody violators have continued with services since the program started in January of 2018, Kampbell said.
The grant funded the development and operation of two programs: Care for Offenders with Opioid Use Disorders Releasing from Prison (COORP) and Reentry Post Release Program. COORP includes outreach to incarcerated individuals releasing from any prison or work release and offers referrals to MAT community providers in their county of release. If someone is interested in these services, Kampbell coordinates a conference call among the incarcerated person, his or her assigned staff and local community providers prior to release. During the phone call, an appointment is scheduled with the incarcerated person to meet with the community provider within 24 hours of their release from prison.
In the Reentry Post Release Program, department staff perform outreach to those who violated conditions of their community supervision serving time in county jails at Nisqually, Yakima, Kent regional justice center, and the South Correctional Entity (SCORE) jail in Des Moines. DOC staff provide a brief risk screening and offer referrals for MAT and other treatment services.
Nasal Naloxone Kits
Under both programs, individuals are now offered education on Nasal Naloxone and given a kit upon release. Participation in both programs is voluntary.
So far, the grant has supplied more than 1,200 overdose prevention kits to staff in prison, work release, community corrections offices, Correctional Industries, and the department’s headquarters in Tumwater to use as first responders. The kits contain Nasal Naloxone (Narcan), which can be administered immediately and reverse an opioid overdose by blocking the brain’s opioid receptors. Staff have received training on the use of the Narcan kits. Kampbell says since the kits were distributed earlier this summer, there have been four reported “saves” by staff that administered the nasal naloxone to individuals during an opioid overdose.
Assistant Secretary of the Health Services Division Kevin Bovenkamp said with the rising number of people who come to prison with opioid use disorders, using tools like Narcan and getting trained to administer MAT is rapidly becoming a requirement for correctional workers.
“There’s no magic pill that cures addiction,” Bovenkamp said. “Medication Assisted Treatment is going to be part of your job. I want you to know I appreciate what you do.”
Kampbell and Herrington also spoke about the recent creation of an Opioid Epidemic Steering Committee. The committee is comprised of staff within many divisions within the agency. It provides direction, coordination, and communication on all the efforts addressing the opioid epidemic. It also seeks to create a streamlined process for identifying individuals who have an opioid use disorder. According to data from the U.S. Department of Justice, approximately half of state and federal prisoners nationwide meet criteria for substance abuse disorder. In Washington state, 38 percent of women and 21 percent of incarcerated women screened as needing a substance abuse assessment reported heroin and other opiates as their primary drug of dependence.
Several department medical professionals attended the conference and gave presentations on various other topics including:
- Dr. Laura Strick, Vaccinations: When to Order and Management of Cirrhosis
- Dr. Bart Abplanalp, Mental Health Decompensation and What to Do About it
- Dr. Steven Hammond, Hormonal Treatment of Gender Dysmorphia/Gender Transition
- Dr. William Hayes and Kami Barbo, management analyst at Maple Lane School CIPS Tips and Tricks
- Dr. Ken Moore, Pulmonary Function Testing and Analysis
- Brent Carney and Jamie Dolan: Individual and Population Nutrition in DOC
In her first presentation, Strick gave strategies on becoming familiar with vaccines, when to use them and where to find educational information about vaccines. Her other presentation gave tips on recognizing symptoms of decompensated cirrhosis and how to make diagnoses.
Abplanalp’s shared tips on how non-mental health workers can recognize early signs of mental illness and what they can do to help the individual.
Hammond gave an overview of gender dysmorphia and transgender identification and provided a knowledge base of how to understand and apply DOC protocol for evaluation and management of hormonal treatment of gender dysmorphia/transgender identification.
Hayes and Barbo talked about ways to improve interaction with the DOC pharmacy system, and invited suggestions for meaningful improvement in prescriber use of the DOC pharmacy system.
Moore taught attendees the differences between simple spirometry (which can be done on-site) and complete pulmonary function testing (which must be done in a hospital). He also discussed safety measures required for testing, reasons for testing, and showed examples of test results.
Carney, a dietary program manager, and Correctional Industries Director Jamie Dolan gave overviews of therapeutic diets and healthy snacks within the DOC, nutrition standards used to develop DOC menus and the governor’s Executive Order 13-06, which outlines requirements of access to healthy foods in state facilities.