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The Journal Gazette

  • Chad Ryan | The Journal Gazette Allen County judge Wendy Davis

Monday, October 24, 2016 3:36 pm

Getting detox started in jail

Jamie Duffy | The Journal Gazette

Changes may be coming in the way Allen County treats its drug-addicted offenders.

For years, opioid abusers have been arrested, gone through a painful detox in the Allen County Jail and been released on probation, only to wind up back in jail for another detox bout.

Some offenders are channeled by the prosecutor’s office into the Allen County Drug Court overseen by Allen Superior Court Judge Fran Gull. The rest wind up in Criminal Court overseen by Allen Superior Court Judge Wendy Davis. The decision about which court the offenders end up in is up to the prosecutor’s office.

This perpetual cycle of capture, detox, release and re-arrest has led some health professionals, probate officers, criminal judges and law enforcement officials to propose a new approach that reduces recidivism, saves taxpayer money and helps the addicted get back on their feet.

Called Medication-Assisted Treatment, or MAT, it usually starts 10 to 14 days from the first day of detox.

Fort Wayne proponents such as Davis and Dr. Deborah McMahan, Allen County health commissioner, want to see MAT start in the jail, which would require an assessment and most likely an injection of the drug Vivitrol before the addict leaves jail. Vivitrol, usually given monthly, reduces the desperate craving for drugs.

The drugs are paired with "wraparound services" that would help offenders find housing – away from so-called drug houses and heroin hotels – health insurance, food and counseling.

MAT also includes counseling and behavioral therapies, providing a whole-patient treatment, according to the Legal Action Center, a strong MAT proponent based in Washington, D.C., and New York City.

For opioid addicts, MAT uses medications that stabilize brain chemistry, block the euphoric effects of opioids, relieve physiological cravings and normalize body functions. Numerous studies show that MAT reduces drug use, disease rates among drug users and criminal activity among opioid-addicted people, according to a report from the Legal Action Center.

"Most of them (addicts) are desperate," Davis says. "They want off drugs. They’ll beg me to get clean."

Steve Stone, public information officer for the Allen County Sheriff’s Department, estimated that detoxing typically takes 12 hours. Davis, however, said addicts who show up at her court after two or three days of detox are still jerking and can’t sit straight.

"It’s hard to have a meaningful hearing when the defendant has only been detoxing 24 hours, two days. They’re still coming off the drug," Davis said.

The Leadership Council for the Regional Mental Health Coalition, covering northeast Indiana, includes health, law enforcement, religious, governmental and nonprofit leaders. Since its first meeting in August, it has been encouraging Allen County Sheriff David Gladieux to adopt MAT for the Allen County jail.

Gladieux said his part in the process is allowing the first step to take place while the drug offender is incarcerated. He said he is ready to go forward with the program "as long as all of the stakeholders can agree on how that’s going to play out." He added that it is important that the person be completely detoxed.

"There’s a waiting period. My understanding is that towards the end of their stay at the jail, one of the last steps is they receive that shot. We’re specifically talking about Vivitrol."

The benefits as he understands it are less recidivism and fewer drug offenders on the streets.

"We’ve got to do something. We’ve got to get some programs started," Gladieux said.

It takes awhile to get all the pieces in place, Davis said, including a provider for Vivitrol, which she said is more effective than methadone.

Drug overdose deaths reached an all-time high in Allen County of 77 people in 2015, according to information supplied by McMahan. From 2008 through 2015, overdose deaths in Allen County increased 93 percent.

Davis currently orders drug addicts to Park Center or Bowen Center for an assessment and, she hopes, a shot of Vivitrol, after she sees them in court on a probation violation. If MAT were instituted, the Vivitrol shot would start in jail at the end of incarceration, Davis said.

The Legal Action Center said other research demonstrates that those in MAT programs experience dramatic improvements while in treatment and for several years following, including decreases in drug use, drug dealing, and other criminal behavior as well as increases in employment and marriage.

One study found that those receiving MAT as part of their treatment were 75 percent less likely to die because of their drug addiction than those not receiving it.

Paul Wilson, executive director of Park Center, a MAT supporter, said with MAT, if someone on probation "comes up dirty," or tests positive for drugs, the offender is returned to jail for detox for about 10 days. If MAT is started at the end of incarceration, then, after the first shot of Vivitrol, the patient would be linked with an outpatient prescriber treatment program to continue those shots, perhaps on a monthly basis.

A new private provider for the jail, Quality Correctional Care, has been involved with MAT programs in other counties and is considering this approach, both Wilson and Davis said.

In Indiana, MAT is taking hold at county jails and is already in use in Madison and Scott counties, Davis said.

Madison County Sheriff Scott Mellinger said results from the use of Vivitrol are encouraging. Of the 28 inmates who were offered the drug in the summer when the program started, only five have slipped. The shot is offered at the jail while navigators get the inmates signed up for Medicaid, which picks up 95 percent of the costs for the drug thereafter. The second shot is administered 30 days later.

In Ohio, where the program has been around longer, the success rate is about 65 percent, Mellinger said.

Madison County was in the top five counties in Indiana for the last two years as far as heroin use, arrests and overdoses. The level of hepatitis C picked up from using dirty syringes, Mellinger said, "was really off the charts."

Mellinger and a county judge met at a conference this year with the Vivitrol pharmaceutical representative who proposed the program, Mellinger added.

The cost savings to taxpayers could be significant. Keeping addicts out of jail means that for every dollar invested in treatment, taxpayers avoid $3.36 in criminal justice costs, said Jeff Yoder, executive director of the Allen County Drug Court Program’s Criminal Division Service.

"If you also include savings from reduced victimization and health care utilization, it goes all the way up to $27 for every dollar invested," he said.

The drug court program is already seeing success with the clients on Vivitrol, Yoder said, adding that the treatment was fairly new.

The drug court’s caseload includes 190 clients. If those 190 people were to be incarcerated, it would cost Allen County $30 a day per offender, for an additional $163,000 a month, Yoder said.

And the number of active clients has increased 68 percent over the last six years, said Yoder, adding that it goes in waves.

"Clearly heroin and prescribed opiates, that’s the main battle we have right now. Synthetic marijuana and K-2 spice, that’s an issue, but all of these drugs have really taken a back seat to this heroin," Yoder said.

Most addicts in drug court fall in the 20- to 27-year-old range, he said.

"Heroin really goes across socioeconomic lines. It’s every demographic factor you can imagine. Addiction to heroin knows no boundaries or social strata."