Jail program helps addicts get clean
OPIOID EPIDEMIC
CIRCLEVILLE — Justin Bell uses the shoulder of his jailhouse scrubs to wipe away his tears as he swears that, this time, things really will be different.
A drug user since the age of 12, Bell has been in the Pickaway County Jail nine times since 2009. With treatment, he once was clean of heroin and stayed out of jail for more than four years.
But then he relapsed. On Jan. 23, right after dropping off his fiancee and their 7-month-old twin sons at home, he overdosed in his SUV in the parking lot of an auto-parts store.
At his jail booking that afternoon, he carried just 115 pounds on his 5-foot, 10-inch frame. The needles had pocked and bruised his skin, the drugs had rotted his teeth. At 25, he had been cheating death daily but had never before considered that time could soon run out. Then came the overdose.
“It’s not just me anymore, man. I have a family. That day, I thought someone else was going to have to raise my kids,” said Bell, who is scheduled for release July 6. “It scared the hell out of me.”
Once past the violent drug withdrawal, he asked for help.
Sheriff’s Lt. Gabe Carpenter promised to get it for him.
As administrator of the Pickaway County Jail, Carpenter oversees a program started last year that gets inmates into a medicationassisted treatment program for opiate addiction immediately upon release. Carpenter and his team ensure the inmates’ state-funded Medicaid or private insurance is in order and that a post-release sobriety plan is in place. On the day of release, corrections officers take the drug users to a clinic — a judge signs the order to actually release the inmates from custody at that location — where they receive their first dose of Vivitrol, a medication that blocks the craving for opiates.
Sometimes, Carpenter even drives them there himself.
The goal is to give the inmates their best chance at sobriety, but also to keep them from returning to jail. So far, Sheriff Robert Radcliff is pleased. Of 25 inmates released through the program since it began in March 2016, 12 have returned.
That might not sound like much, Radcliff said, but because it’s common for addicted inmates to return to jail within days or weeks of release, the Vivitrol program is clearly making a difference. Of the 12 who returned, only one returned to jail within a month, and several were out for nearly six months or longer.
“We know relapse happens,” Carpenter said. “But the longer we can keep them out and clean, the better off their chances are the next time they try. It’s a process.”
The first two weeks after incarceration are a critical time when people in recovery are at their highest risk of overdose. Their bodies have lost their tolerance for opioids and if they give in to the urge to use, it can easily be deadly.
“After detox, the patient is basically practicing new skills, navigating life’s challenges and trying to get settled, but they can’t cope the way they used to — with drugs,” said Kylie LeMaster, a behavioral health clinician at the Hopewell Health Center in Chillicothe, which runs the Vivitrol program that Pickaway County uses. “It can be a struggle.”
Closing that time gap between jail release and getting into outside treatment was the impetus behind Pickaway County’s program. The Ohio Department of Rehabilitation and Correction, in partnership with the Ohio Department of Medicaid and other agencies, has phased in a successful program that makes certain eligible inmates are insured and connected with wellness, mental-health and addiction resources upon release.
Other counties have taken notice.
In Ross County, Sheriff George Lavender now has two case managers working in his jail. Since December, inmates there have received their first Vivitrol injection a few days before their release.
It takes a team approach to screen the 2,000-plus inmates who are in the Franklin County jail on any given day to determine who would benefit from a Vivitrol program and to get them started, said Maj. Mychal Turner, who oversees the county’s Jackson Pike jail. He said recovery-services organizations under contract and the county’s drug court help get qualified inmates their injections, as does the Veterans Administration.
In Pickaway County, Carpenter is a former police officer and municipal court probation officer who had worked for the sheriff’s office early in his career. He returned in 2015 to run Radcliff’s 110-bed jail and immediately looked for ways to help the inmates be successful after release. He said the philosophy of county corrections is changing.
“It used to be bricks and mortar. Sheriffs would build jails as big as they could and then they’d fill them,” Carpenter said. “Now, it’s about helping people to stay out of jail. We’re social workers as much as we are corrections officers.”
Radcliff and Carpenter called on Ohio Attorney General Mike DeWine’s heroin unit/outreach team to brainstorm for new ways to do things. Eventually, those sessions led Carpenter to Joy Ewing, director of Pickaway County Job & Family Services. She said she could help.
Medication-assisted treatment to help kick drug addictions — Suboxone/ buprenorphine, methadone and Vivitrol — are more common than ever. Vivitrol, which is specific to opiate addiction while not being addictive itself, is much sought-after. But it is expensive: each monthly injection can cost $1,300 or more.
Ewing said she was the first Job & Family Services director in the state to send someone regularly into a county jail to enroll Medicaid-eligible inmates so they would have the insurance upon release to cover the cost of the Vivitrol immediately. (Medicaid won’t pay while someone is in custody)
Job & Family Services Program Manager Joe Brust visits the jail in Circleville weekly to meet with new inmates and get their paperwork in order.
“We’re seeing people in this community lose their lives. They come in here to jail and get clean, but then they left and couldn’t immediately get any help,” Ewing said. “We all have a responsibility to save lives. Trying to fix this was a no-brainer.”
The state’s total cost for medication-assisted treatment is increasing dramatically. In 2014, Medicaid spent $72.9 million for treatment, with $52.9 million of that for Suboxone/ buprenorphine, $16.6 million for methadone and $3.4 million for Vivitrol. Last year, the overall number increased to $112.4 million, including $61 million for Suboxone/ buprenorphine, $27 million for Vivitrol and $15.4 million for methadone.
In his years of addiction, Bell has tried both inpatient and outpatient treatment, but he has never used medication to help him stay clean. He is hopeful the Vivitrol will work.
He met with Brust in a jail visitation area on Tuesday to get his Medicaid paperwork in line.
Afterward, Carpenter listened as Bell ticked off all that had gone wrong in his life. He watched as Bell cried while saying how much he loves his fiancee, how the unwavering support of his sister means everything, and how badly he wants to be a dad and not just a father.
Carpenter said he has been at this long enough to know when someone’s desire to change comes from their heart. And he likes what he sees in Bell this time around.
“That’s the whole goal of this program, to provide you with the resources you need to get better,” he told Bell. “You can’t fix anything else in your life until you fix you.”
The two shook hands, and Bell headed off to finish his chores in the jailhouse laundry room, another day closer to yet another chance.