The Green resumes its coverage of new programs meant to reduce Delaware’s overdose rate.
We previously reported on ChristianaCare’s Community SOS program.
This week, Delaware Public Media’s Nick Ciolino goes inside Delaware’s prison system - where the state recently rolled out an expanded program using medications like methadone and buprenorphine to treat offenders with substance abuse disorder.
Delaware’s Department of Correction announced in June it is expanding Medication Assisted Treatment to all of its level five facilities.
The DOC previously only offered MAT to pregnant women and would also use medicine to assist offenders going through opioid withdrawal. But for the past few months now, methadone, buprenorphine and Vivitrol have been available to inmates with substance abuse disorder throughout their stay in any Delaware state prison.
This comes in response to the First State’s rising overdose rate, which has reached sixth in the nation, according to the Centers for Disease Control and Prevention.
“I would expect that our program in the prisons will eventually catch up to where the rate is and start to bring the overdose death down,” said Dr. Marc Richman, Delaware’s former Chief for the Bureau of Correctional Healthcare Services who stepped down at the start of the month.
Richman says since the expansion of the program, the number of inmates being treated with MAT has gone up from about .5% to a little more than 2% of the overall prison population and he says the DOC is adding about 15 new patients each week.
States like Rhode Island and Vermont have started similar programs with significant success. The statewide overdose rate in Rhode Island started to decline for the first time in years in 2017 after the start of the program.
Richman says it stands to reason Delaware will also be able to lower its rate as it increases the use of MAT in its prison system.
“Rhode Island is at about 15% of their average daily population and Vermont is up to 50 to 60% of their average daily population of folks on MAT. So we have a way to go,” he said. “I don’t know where we’re going to end up, but certainly we expect it to be more than where we are right now as we continue to identify people.”
To make those identifications, Richman says each offender receives a mental health screening upon admission to determine whether or not they are a candidate for Medication Assisted Treatment.
“Ask that point blank question, ‘are you using?’ Because if you’re not honest with us, you’re going to get sick, and we want to be able to help you so you don’t get sick,” said Richman.
Once a patient is identified as a candidate for MAT they are asked if they would like to receive medication and which of the three options they are willing to continue to take. The MAT program is often coupled with mental health counselling as well.
James Goddard is the Health Service Administrator at Baylor Women’s Prison in New Castle. He says the program’s roll out went smoothly, as the prison was already offering MAT to pregnant women.
“The only change was we were providing it to everybody rather than just the pregnant offenders. We already have processes in place for the nurses on intake to refer the patients to leadership so we could reach out to the clinic,” said Goddard. “So a little more work for us, but not an issue.”
30 of the 350 inmates at Baylor are participating in the MAT program. Security staff is provided with a list of those patients and the times they are meant to receive treatment. Security then escorts the offenders from their cell to line up in front of a medical window and receive the medication.
“It’s a collaboration between medical and security to ensure that the offender has taken the medication,” said Baylor’s Warden Brian Emig, “Oral medications they ensure a mouth check is done to include lifting the tongue. That way nothing is being cheeked or moved throughout the facility and passed on to other offenders.”
The Department of Correction is currently getting its methadone, Vivitrol and buprenorphine from its contracted medical provider Connections, but the state is seeking federal approval to designate its state prisons as medication dosing sites. This would allow the prisons to store the medications under lock and key on site.
Delaware is one of the few states that combine its jail and prison system. This means some offenders are admitted and released very quickly. James Goddard says having the medication on site would make the process much more efficient and reduce waste.
“There would be a lot less waste,” he said. “As of now the medication is brought from off site and by the time they even get here the patient could be released so at that point it’s a waste of a medication.”
And the time of release is the time of high risk for an overdose. A recent state-run analysis of Delaware overdose deaths in 2017 found 35% had interacted with the Department of Correction in the year prior to their death.
“Unfortunately a lot of people die of what are called hot shots back in the community, meaning that their body has become acclimated to being not on the opioids, then they go back out into the community and use the same amount that they used before they came in and overdose fairly quickly,” said Dr. Richman. “So we want to try to avoid that.”
Delaware’s statewide reentry team is in charge of connecting offenders to an MAT provider in the community and will even offer a ride to the provider when the offender is released.
Richman says the state is working to bolster those efforts with a pilot program at the Howard R. Young Correctional Institute in Wilmington. He says a grant from Delaware’s Division of Substance Abuse and Mental Health is funding opioid use case managers at that facility.
“We essentially have staff in the booking and receiving areas and areas where detainees are housed,” said Richman. “And we’re looking for folks with opioid use disorder and linking them immediately upon release to a community-based provider.”
Richman says more than 70 individuals have been connected to MAT through this program so far and the hope is to expand it statewide.
A Department of Correction spokesperson told Delaware Public Media the cost of administering MAT statewide in level five prisons is currently being paid for from the DOC budget and from the prison medical provider Connections.
The costs are expected to go up as more inmates take advantage of the program and those costs will be reported to Delaware’s General Assembly. Richman says the cost is worth it.
“By all accounts it has been very successful,” said Richman. “Occasionally we get some anecdotal stories of former inmates saying basically it saved their lives, because instead of going back to the streets and looking for their first score, they’re trying to stay healthy. So every life saved is worth it.”
One offender recently released from Baylor and connected to a community MAT provider is Geralyn Holmes. Holmes is a single mother of two and works as an administrator in an HR department. She says she was hospitalized after suffering domestic abuse and received a prescription for opioids which she began to abuse and became addicted.
“Not with the right direction from the prescribing doctor started to over-abuse the prescription which led to looking for opioids outside of what was prescribed to me,” said Holmes.
Holmes was charged for felony possession of cocaine in 2017 which she says she was selling. She was receiving buprenorphine through Mid-Atlantic Behavioral Health when she was forced to spend seven days at Baylor this September for violating probation. Holmes says she was able to continue treatment for her addiction while incarcerated.
“To see people that come in there withdrawing in there in the position that they’re in and then able to get their maintenance while they’re in there, it’s a 100% 360 degree turn. It gives a different outlook on life, hopefully, when returning back to the real world,” she said.
Holmes says Connections staff offered to help set up appointments with Mid-Atlantic Behavioral to resume her MAT in the community. She’s now continuing her treatment and says she hopes to one day start a nonprofit to help felons like her find work.
James Elder, formerly DOC’s Bureau Chief of Community Corrections, stepped in at the start of the month to replace Richman as the Bureau of Healthcare Chief – which is now expanded to include Substance Use Disorder and Mental Health Services.