Hampshire Hope: Jails take huge step toward rehab
Hampshire County Jail and House of Correction. GAzette file photo
By MELINDA CADYand ELIZABETH EVANS
The Hampshire Jail and House of Correction took a huge step forward in October when it opened a fully functioning clinic within the jail to provide medication for opioid use disorder. In light of the nation's opioid epidemic and the involvement of people with opioid use disorders in the criminal justice system, this represents a sea change in the work of a correctional facility.
It has become clear that to reduce recidivism for people struggling with opioid addiction while incarcerated, their disease must receive treatment — and medication for opioid use disorder is the gold standard of care.
Since December 2018, the Hampshire House of Correction has been providing medication for opioid use disorder by contracting with outside clinics. The journey to becoming an independent opioid treatment program has been a long one — but well worth the effort — dating back more than two years.
Under the leadership of Hampshire Sheriff Patrick Cahillane, jail staff applied to the Massachusetts Department of Public Health in May 2019 for funding to expand capacity to treat with medication people who are incarcerated with opioid use disorders. Providing medication-assisted treatment in a jail requires careful planning — and the effort in Hampshire County was guided by staff at the Franklin House of Correction, which has provided such treatment since 2016. They were generous with their time and expertise.
By September 2019, initial certification was awarded by the federal Drug Enforcement Agency and the state Drug Control Program, after these agencies determined the plan met their standards for safe, controlled medication-assisted treatment. Hampshire jail medical, treatment and security staff underwent training on how to safely prescribe and administer the medications, monitor dosing and oversee behavioral health interventions.
Around this time, a decision was made to pursue full licensure as an independent opioid treatment program, rather than contracting with an outside provider.
In January of 2021, an application to operate an independent treatment program was submitted to the Massachusetts DPH Bureau of Substance Abuse Services, and by end of the summer, that application approved; and the required certifications by the federal Substance Abuse Mental Health Services Administration and recertification by the DEA and DCP were received.
Assistant Deputy Superintendent and opioid treatment program Director Melinda Cady secured the services of Dr. Katherine Krauskopf (medical director of outpatient services at Mira Vista in Holyoke) as the House of Correction's opioid treatment medical director and Heather Roose, PA (also of Mira Vista), to assist.
In early October of 2021, the Hampshire House of Correction joined the Franklin House of Correction as one of two fully operational and independent opioid treatment programs in the state — and still among only a handful nationwide. This means the Hampshire House of Correction's treatment program is fully staffed and supported by Hampshire Sheriff's Office employees.
Currently 36 people are enrolled in facility's medication-assisted treatment program, with the number of participants steadily growing. The clinic provides medical assessment and ongoing monitoring, dispenses the medications and offers individual, group and reentry counseling services daily.
Clinic staff also provide aftercare services, initiated while participants are incarcerated so as to have no gaps in treatment. Jail staff help set up appointments with local clinics, day-of-release transportation to these clinics, and ongoing aftercare counseling provided at the Northampton Recovery Center two evenings a week to help smooth the transition from jail to the community.
As the Hampshire jail's medication-assisted treatment clinic came to fruition, researchers from the University of Massachusetts and Baystate Health System were gearing up to study the outcomes of such treatment within jail settings.
Despite a growing body of evidence suggesting that medication-assisted treatment for people who are incarcerated holds great potential to improve outcomes after release, these evidence-based treatments are not currently the standard of care in U.S. jails and prisons.
The Franklin House of Correction began offering medication-assisted treatment in 2016, and at the time of the study, the Hampshire jail was not yet offering that treatment option; the UMass-Baystate research team realized they had a unique opportunity to test the hypothesis that medication-assisted treatment within a jail setting improves recidivism rates and other outcomes.
They set out to conduct a natural experiment with these two county jails located within 23 miles of each other with very similar populations — and for a period of time — different treatment offered to inmates with opioid use disorders.
This study aimed to be one of the first to evaluate the impact of medication-assisted treatment specifically on recidivism, defined as additional probation violations, reincarcerations, or court charges after release.
Researchers studied the outcomes of 469 adults with opioid use disorders, 197 of whom had been incarcerated in Franklin County where they received medication-assisted treatment and 272 in Hampshire County, where they did not receive medication-assisted treatment.
The results were compelling: The study found a 32% reduction in recidivism rates for those treated with medications compared to those without such treatment.
Though this study involved a relatively small sample, results show convincingly that on top of already-demonstrated positive health effects, providing medication-assisted treatment in jail reduces recidivism, offering a chance to break cycles of arrest, reconviction and reincarceration that occur in the absence of adequate help and resources.
That should be a game-changer for jails across the state and around the country.
Melinda Cady, assistant deputy superintendent and opioid treatment program director at the Hampshire House of Correction, and Elizabeth Evans, Ph.D., a UMass researcher and professor of public health, are part of the Hampshire HOPE opioid prevention coalition based in the Northampton Health Department. Members of the coalition contribute to this column about local responses to the opioid epidemic.