Opioid use disorder treatment in jails making strides in North Carolina

By Rachel Crumpler

Elijah Bazemore believes there needs to be a paradigm shift in the way detention facilities — jails and prisons — are managed.

“What we’re doing is putting a person back into the community the same way they came in — broken and torn up,” said Bazemore, who recently retired as a major from the Durham County Sheriff’s Office after more than 30 years. 

“We should be in a position to try to help that person be a better person when they are released out of the facility. That’s going to reduce recidivism,” he said. “We should be working to eliminate our jobs by helping people.” 

Establishing programs that provide medications for opioid use disorder in jails is part of that paradigm shift, he said.

Momentum is building for this type of treatment in jails due to recent guidance from the U.S. Department of Justice that states it is a violation of the Americans with Disabilities Act if correctional facilities do not continue an individual on the medications they were receiving to treat their addiction in the community prior to incarceration.

There are three medications approved by the U.S. Food and Drug Administration to treat opioid use disorder — methadone, buprenorphine and naltrexone — that are often paired with counseling. Treatment that includes these medications is considered best practice for people with opioid use disorder. They suppress withdrawal symptoms, reduce drug cravings and decrease the risk of overdose death.

Approximately three-fourths of jails in North Carolina are not yet providing this gold standard treatment and now need to consider how to put the logistics in place to provide the treatment to incarcerated folks. Failure to do so could open a jail to liability and lawsuits for violating the Americans with Disabilities Act. 

“We’re in the midst of this culture standard of care shift, real-time, and we’re all working to evolve with that,” Sarah Gayton, Buncombe County Detention Facility’s community integration and addiction treatment services director, said in an August webinar series called “MAT in Jails: Legal, Medical, Community, and Security Considerations.” MAT or medication-assisted treatment refers to the three medications used for opioid use disorder.

Getting buy-in

In part, implementation of addiction treatment in jails has been slow due to persisting stigma. Gayton said in an interview with NC Health News that there’s still a “huge lack of understanding” about addiction and treatment both inside and outside of jail, so education is “incredibly important” in explaining opioid use disorder and the need for these medications.

To get the buy-in needed to launch a program, Bazemore, who is now a consultant with Vital Strategies specializing in jail-based opioid use disorder treatment, suggests assembling a group of all relevant parties, including detention staff, medical staff, county commissioners, community treatment centers and peer support specialists.

“You cannot move the needle if you don’t have all those people together,” said Bazemore, who helped launch the program providing medications for opioid use disorder at the Durham County Detention Facility in 2019.

These discussions can help identify motivations as well as points of resistance that need to be overcome in order to form an implementation plan that works best for each county jail. 

“Every person brings something different regarding their motivation and their vantage point to the situation,” Gayton said. “For some, the focus is lives lost. For some, it’s the child welfare — the kids that are impacted within that system. For some, it’s straight economic costs. For others, it’s crime rates.” 

Gayton said one of the best ways to alleviate stigma is hearing from real people who have benefited from addiction treatment.

“If you just get to know individuals who have walked through this process, they will be your biggest salesmen for the why and they will bring an absolute unshakable conviction of the need to move forward when you get to see their successes when they have treatment support,” Gayton said during the webinar.

A success story

That’s where Samantha Brawley came in, sharing her own story in her previous role as a peer support specialist in the Buncombe jail’s addiction program with both detention staff and people going through the program. Her personal experience illustrates just how effective these medications can be. 

Brawley said she had tried everything for her opioid use disorder: faith-based programs, Narcotics Anonymous and Alcoholics Anonymous meetings, in-patient treatment centers. 

None of it worked. 

She described herself as a “chronic relapser” whose cravings always led her back to drug use. She thought she would never get well, that is until she started taking medication for her opioid use disorder six years ago. The medication, along with a lot of hard work, has kept her from returning to drug use.

“Without it, I’d be on edge and have a lot of cravings,” she said. “I’m not myself. I’m agitated and aggravated. It’s a brain disease. The medication is healing my brain and that’s the goal — to make people well. We should just normalize it.”

But Brawley didn’t start the medication for opioid use disorder until well after serving several stints in jail. It wasn’t offered or available to her then. She’s glad that’s starting to change. 

“I just kind of think back to how much it’s always been needed,” Brawley said. “Thank goodness, we’re kind of finally at this point.”

Options for starting to provide MAT

There are two options to provide medication to treat opioid use disorder to individuals in jail. The easiest option is for a jail to partner with an Opioid Treatment Program (OTP), which is a certified and accredited outpatient entity that provides these medications, which are classified as controlled substances. Due to federal regulations, methadone for the treatment of opioid use disorder can only be obtained through a licensed OTP.

North Carolina has at least 85 Opioid Treatment Programs spread across the state, though one is not located in every county. 

Partnerships can operate differently based on what jail administrators and Opioid Treatment Program staff decide is the most workable and efficient process. 

For example, staff from one of the certified facilities can bring medication to the jail and administer it to a patient themselves or leave doses to be given by jail workers. 

Another more laborious process would involve jail staff transporting an incarcerated individual to an Opioid Treatment Program to receive the medication. Until a few months ago, that’s what staff at Forsyth County Detention Center were doing to maintain individuals on medication for opioid use disorder, said Crystal VanBencoten, a registered nurse and director of jail operations with NaphCare, the health care provider at the facility.

However, when the detention center had three people at once who needed to continue on the medication, it became too taxing to coordinate daily transport to the local methadone clinic. To make the process more efficient, the jail partnered with the local treatment program to have the medication delivered. 

This marked the first time methadone would be brought inside the facility, and Detention Services Bureau Commander Major Robert Whitaker was initially apprehensive. He feared there could be issues if the medication was diverted to someone besides the patient. Forsyth County, like many other jails providing medications for opioid use disorder, opted for liquid methadone, instead of the pill form that could be easily hoarded, to lessen diversion risks. 

“Keeping them in a program that they were already successful in is important to continue,” VanBencoten said. “That’s the way we’ve looked at it.”

The second option for providing these medications in jails is for a detention center to become a licensed Opioid Treatment Program. However, it is an expensive and time-consuming process to become licensed, said Jana Burson, an addiction medicine doctor at an outpatient opioid addiction treatment facility in North Wilkesboro, during the August webinar. It is likely only practical for large facilities, she added.