Preventing Opioid Withdrawal Deaths in County Jails

In July 2018, we told you about Arapahoe County's new program to prevent opioid withdrawal jail deaths by way of medication-assisted treatment such as methadone to help addicts safely kick their habit while behind bars.

Now the state is expanding this effort by way of nearly $1.9 million in grants awarded by the Colorado Department of Human Services, Office of Behavioral Health to seventeen counties, including Arapahoe.

Marc Condojani, the state's director of adult treatment and recovery, confirms that the project has been influenced by the broader opioid crisis in Colorado. But he also underscores the special challenges related to inmates suffering from addiction. "We know the risk of overdose is greatest when there's a period of abstinence, whether or not it's enforced. A study out of North Carolina shows the rate of overdose death for people who've been incarcerated is forty times higher than the average."

For this reason, Arapahoe and an increasing number of agencies are providing opioid-addicted inmates who've completed their sentence with Narcan, a substance that is capable of saving them if they overdose following their release. But equally worrisome are in-custody deaths of individuals going through withdrawal — something that's both undeniably tragic and potentially expensive for municipalities where they occur.

Note that a lawsuit over the heroin withdrawal death of Tyler Tabor in Adams County jail circa May 2015 was settled for an eye-popping $3.9 million this past year. In addition, Jefferson County paid $2.5 million circa 2016 in a case brought by the family of Jennifer Lobato, who died in jail the previous year from opioid withdrawal. And while a still-active complaint filed by the estate of Jeffrey Scott Lillis against Arapahoe County notes that his 2014 jail death involved sepsis and bacterial pneumonia, he was a heroin addict who had been forced off the substance while in custody prior to other issues presenting themselves.

Condojani stresses that the most important goal of medication-assisted treatment, shorthanded as MAT, is to save lives. But he acknowledges that "we're administering a federal grant and a lot of state dollars. So this also lowers risks in terms of county governments and county sheriffs."

Here's the grant breakdown:

Arapahoe $150,000
Boulder $150,000
Conejos $60,000
Denver $150,000
Douglas $150,000
Eagle $60,000
El Paso $150,000
Fremont $150,000
Garfield $100,000
Gilpin $60,000
Jefferson $60,000
La Plata $60,000
Larimer $150,000
Mesa $150,000
Moffat $60,000
Pueblo $150,000
Summit $60,000

Five of the counties — Boulder, Denver, Douglas, Jefferson and Pueblo — had previously received funding directly from the Office of Behavioral Health for MAT programs, with nearly 500 people receiving such treatment since 2017. But federal bucks were off-limits until recently.

"One of the challenges of doing this has been that the funding is often restricted," Condojani admits. "Different types of federal funds are often restricted for use on people who are incarcerated. But in this round of the state's opioid response, the grant from SAMHSA [Substance Abuse and Mental Health Services Administration] lifted the prohibition. That allowed us to use money to treat people who are incarcerated."

The MAT program is intended to help facilities get addicted county-jail inmates on the path to recovery, but Condojani emphasizes that one size doesn't fit all. "Each county jail in Colorado is configured differently. They're different sizes, they're in different areas and environments, and they have different medical infrastructure to meet people's needs. So we're taking the approach of something being better than nothing."

For instance, he continues, "there are three FDA-approved medications to help people end their dependency on opioids: methadone, Suboxone and naltrexone. But some jails may only be comfortable with one or two of those. Methadone can only be used in coordination with a licensed opioid treatment program, and some counties don't have programs like that within fifty miles of them, which may lead them to Suboxone and naltrexone."

As for the latter, "it's typically administered as a shot pre-release, because they're rather expensive, and after that, standard procedure is to make sure there's a good, warm hand-off spot in the community for follow-up care. But some communities don't have those facilities, either."

In recognition of these treatment gaps, Condojani says, "we've been working to build community capacity. A new treatment program has opened up in Lamar, which is great, because southeast Colorado has been hit really hard by this crisis. And in September, we'll be deploying six mobile MAT health-care units — RVs that will drive around and provide people with everything other than methadone, because there's a federal prohibition for that in a mobile facility. We've selected a vendor for each of the mobile units, which are being built and will hopefully be delivered soon. We should be able to fund them on the road to rural communities with grants for at least a year or two. And if they're meeting their goals, we'll continue to fund them."

Regarding patient costs, "the good news is, all of these MAT programs are covered by Medicaid or commercial insurance," he reveals. "And for the 5 percent of Colorado's population that's uninsured, we'll use our funding to cover it."

Helping to get addicted inmates clean should pay dividends down the line, Condojani believes — and he has high hopes the mission will be successful. "As devastating as the opioid crisis has been, there are thousands of people living in recovery, living productive lives right now. So we need to keep the message alive that recovery is very possible and treatment is becoming increasingly available — and it's very effective."