Mass. prisons start offering medication to treat addiction

Chesterfield County, Virginia implemented a multi-faceted response to the opioid crisis, including a jail-based recovery program, Helping Addicts Recover Progressively (HARP), that brings people in recovery to the local jail to talk about addiction and treatment resources. Combined with other efforts, overdose deaths have dropped by half in a single year, and around 4,000 people have participated in HARP.

Research has found that providing medications for opioid use disorder can help prevent overdoses after release from prison. The state’s Department of Adult Correction recently launched a pilot program to test this theory. 229 of the 287 participants received treatment, several of whom said the access to the medications helped save their lives.

To combat opioid overdose deaths among incarcerated people, the California prison system in January 2020 launched a treatment program that combines medication-assisted treatment with professional and peer counseling. The program uses the three most effective medications to reduce opioid dependency. The one-year program features intense counseling, individual and group, based on a workbook that takes gender and trauma-related causes for drug abuse into account. Preliminary data show a decrease in deaths at San Quentin prison. More than 15,000 people have enrolled in the program.

The Montana prison system operates a pair of men's and women's treatment facilities that provide an intensive, nine-month treatment program for methamphetamine and opioid abuse that has shown high rates of success. Residents are seen not simply as prisoners or people with addiction, but as people needing empathy and life lessons in accountability and honesty. Therapy groups allow patients to share their stories of trauma. Various studies have shown the treatment centers have successfully graduated 75-95% of their patients.

Six programs throughout the state, including the SUN Project and Project CARA, are working to provide support to pregnant mothers navigating a substance use disorder. With support from the North Carolina Perinatal Substance Use Disorder Network, the programs share best practices for treating perinatal substance use and expand access to treatment. Project CARA alone serves more than 200 patients each year.

Health engagement hubs like Washington state’s Buprenorphine Pathways connect people with prescriptions for methadone and buprenorphine to help treat addiction. In addition to medication and a syringe-exchange program, the hub also connects patients to social services, taking a more holistic approach to addiction treatment.

Los Angeles County’s Homeless Outreach & Mobile Engagement (HOME) program uses street psychiatry to get psychiatric medication to people experiencing homelessness in an effort to get them a step closer to housing. The HOME team has 223 full-time staff members and served 1,919 people last year, 22% of whom ended the year housed.

CalAIM’s contingency management program gives people gift cards for not using drugs. For every negative drug test, patients receive gift cards, and the payouts increase after each test. Patients who test negative every time over six months can earn up to $599. The treatment style is based on the concept of reinforcement as an effective motivator. Studies suggest the excitement of getting a gift card mimics the dopamine rush from using drugs.

Project CARA (Care that Advocates Respect/Resilience/Recovery for All) supports pregnant and parenting people with substance use disorders, providing healthcare, addiction resources and obstetrics care in one spot. The program's hub-and-spokes model makes care more accessible, especially for those in remote areas. Data from the Project also indicates that participants of the program are more likely to attend prenatal and postpartum appointments than those outside of the program.

The Olympia Bupe Clinic's walk-in model for treating opioid addiction allows patients to receive medication-assisted treatment with buprenorphine on their first visit without barriers or extensive wait times. This low-barrier approach eliminates the hurdles people often face when seeking treatment. The Clinic also hires staff with lived experience with addiction to build trust and community with patients.