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Author Topic: methadone in jail !!!! what a novel idea  (Read 5977 times)

Offline clinton (OP)

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methadone in jail !!!! what a novel idea
« on: November 08, 2015, 06:06:11 AM »
http://www.corrections.com/news/article/41352-methadone-in-a-jail-

The question was raised recently about how to handle inmates who prior to jail, were enrolled in a methadone or Suboxone program to treat narcotic addiction. Should they continue the methadone or Suboxone in jail? Or should they instead be enrolled in the jail opioid detoxification program (we use clonodine at my jails) and withdrawn?

This is a problem I suspect prisons do not have to deal with. But it is a common, every day, problem for jails in cities where such methadone programs exist. In Boise, there are two such programs. They do good and valuable work for the community. I am a fan.

But whether to continue methadone treatments in jail is a clinical decision that is a balancing act between two conflicting principles:
The best interest of the patient. It is not in the best interest of the patient to stop treatment for heroin addiction and, as a result, have the patient relapse into heroin use. It is also not in the patient’s best interest to put them through a partial opioid detoxification program only to have them immediately restart methadone the day they get out of jail. On the other hand, for some inmates, continuing methadone therapy in jail simply means perpetuating their addiction, not helping them to recover.
The safety and security of the jail. Any time you allow a schedule 2 narcotic inside the walls of the jail, you have potentially compromised safety and security. Other inmates (some of them also narcotic addicts) will find out about the methadone use and may threaten the inmate getting the methadone. They will complain that they were not also allowed access to methadone. Also, the more controlled substances you allow in the jail, the more chance that some day some turns up missing, triggering a big and nasty investigation. I’ve seen both happen.
There is no one right answer for all patients. Like many other medical interventions, the trick is to weigh the expected benefits of continuing methadone treatment against the potential harms, both to the patient and security of the facility, of allowing the methadone therapy to continue.

Two Conflicting Cases

There are clearly some cases where the proper decision is to allow the methadone therapy to continue. Take, for example, the case of a heroin addict who has been clean for 8 months while participating in methadone treatment and has to serve 6 days in jail for a charge that is not related to substance abuse–let’s say petit theft. Let’s also say this patient has made all the arrangements with their methadone clinic to continue therapy for the six days while in jail. It simply does not make medical sense to put this guy on clonodine for six days and then have him return to methadone the day he gets out of jail.

On the other hand, there are clearly some cases where the proper decision would be to immediately discontinue methadone and treat the patient for withdrawal. An example here would be the patient who has been obtaining methadone from several sources and is in jail for felony trafficking charges.

Since there are clear cases on both sides of the question, for me the goal is to define the circumstances under which I will allow methadone into my jail. This basically involves writing a policy on the subject, hopefully with the help of both jail administration and with input from the area methadone programs, as well. My policy on methadone (and Suboxone) maintenance therapy in jail contains three main rules.

Three Rules for Allowing Methadone in Jail
I myself cannot prescribe methadone for the treatment of narcotic addiction. It is illegal. In order to prescribe methadone for such patients, I and the jail would have to apply for and be accredited to become a Methadone Treatment Center by the DEA. The DEA is a stickler for this rule. I personally know of two local physicians who were disciplined by the DEA for prescribing narcotics for addiction without the proper accreditation. (I can, on the other hand, legally prescribe methadone for an ankle sprain if I want. What can you do?)

There are some jails that have applied for methadone treatment program status. More power to them. I have not, nor will I do so. In my opinion, the headaches of such a program in my jails would far outweigh the benefits. (But if your jail has applied to be a methadone treatment program, I would like to hear about it! Comment or email me!)

Since I cannot legally prescribe methadone for these patients, the first rule of a jail methadone policy is that an accredited methadone program has to prescribe and deliver the medication. The two programs in my city will do this as long as the patient pays, in advance, a $25.00 a day fee. If the inmate cannot pay, the methadone program will not deliver the methadone. Since I cannot legally prescribe it, we are done–the patient gets no methadone. I will do what I can for them, using clonodine.
The second rule for a jail methadone policy is that it cannot go on forever. Since clonodine treatment for methadone withdrawal takes about two weeks, I use 2-3 weeks as an arbitrary cut-off time for ongoing methadone treatment in the jail. If an inmate is going to be in jail for longer than that, she will be withdrawn. However, I sometimes have another option besides clonodine for such patients. If the inmate can afford the $25.00 a day delivery fee, the methadone programs I work with will deliver a rapid taper of methadone, usually decreasing the total dose by 5 mg a day. I then may still supplement with clonodine after that.
The third rule is that the methadone has to be meticulously accounted for and meticulously stored. Only medical employees should accept the methadone from the program. Deputies should not be involved in this process, except as escorts. The transfers must be accounted for on paper, similar to “chain-of-evidence” documentation. The jail must have a double-locked, secure area for storage of schedule 2 narcotics, as required by the DEA. Many smaller jails simply cannot adhere to this level of narcotic security and so cannot participate in such a methadone maintenance program.
I have discussed here maintaining methadone maintenance for patients taking methadone for narcotic treatment. What about patients taking methadone for chronic pain? My rules for them are similar but not identical. More about them in a future post.

Under what circumstances will you allow methadone maintenance therapy into your facility? Please comment!

Corrections.com author, Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of practice experience before moving full time into the practice of Correctional Medicine. He is the Chief Medical Officer of Centurion. He is also the author of the "Jail Medicine" blog
In the vein...

Offline clinton (OP)

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Re: methadone in jail !!!! what a novel idea
« Reply #1 on: November 08, 2015, 06:09:33 AM »
He is actually pretty open minded considering the fact that most prison officials answer is always Hell No!
In the vein...

Offline Lolleedee

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Re: methadone in jail !!!! what a novel idea
« Reply #2 on: November 08, 2015, 06:28:31 AM »
Everyone has to come to a general concensus...either addiction is a disease or it's not.  If it is a disease you should have a right to be treated with methadone/or suboxone..the fact that you are in jail shouldn't matter.

This is the only medication that they would stop if you were in jail and it is due to stigma and misinformation.  There is NO benefit to stopping treatment during a stint in jail.  For christ's sake, methadone is on the WHO's (world health organization) list of essential medicines!  I think withholding it (or charging a rediculous $25.00 a day) is a crime!

If we heard about jails refusing to give inmates insulin or high blood pressure meds, there would be a march on Wahington demanding healthcare for the jailed population.  People should be just as upset about them not receiving their methadone/suboxone.

Also, I think anyone who has ever been on methadone can agree that detoxing with only clonidine is a big, fat joke.  As is a rpid 5 mg. a day detox! I find THAT to be cruel and unusual punishment!

Also, the only thing that will be accomplished by stopping treatment is an almost guarenteed relapse and overdose once they are released.

Methadone programs can be successful in jails and prisons...just ask Riker's Island in NY!
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Re: methadone in jail !!!! what a novel idea
« Reply #3 on: November 08, 2015, 06:47:09 AM »
Many jails and prisons don't offer adequate medical care. I'm part of a class action suit against armor correctional Healthcare right now. They are one of the top 3 companies who provide outsourced Healthcare to inmates in the country.

They bill a rounded number for every inmate in each institution if youvery got more problems than the rest your cutting into their bottom line.
« Last Edit: November 08, 2015, 06:52:48 AM by corlene »

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Re: methadone in jail !!!! what a novel idea
« Reply #4 on: November 08, 2015, 02:07:08 PM »
About 4 or 5 months back I got picked up on a warrant I had and was being taken to the jail.  Was in the back of the cop car and everything, the cop asked if I was an addict or anything, I told him I was on methadone and he radioed in to the jail and told them.  The jail came back and told him to let me go because they weren't taking in any addicts or people on methadone.

He drove me all the way back to my car and everything and let me go.  So fucking lucky...

Pretty sure it's because the jail I was being taken to had, somewhat recently, been involved in lawsuits involving deaths attributed to withdrawal and stuff.

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Re: methadone in jail !!!! what a novel idea
« Reply #5 on: November 08, 2015, 05:48:30 PM »
I don't know the details, but you can get methadone in jails here in Canada.  You can maintain on it for years and years apparently.  You used to also be able to collect a reduced welfare cheque while incarcerated.  I believe that you had to prove you have no money or family to help.  That is now finished as of a few years ago.

I remember reading that one of the top drugs prescribed in jails here is Viagra.  In would assume for the conjugal trailers, but maybe not.  I guess some cutie dropping the soap just isn't enough for some guys.

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Re: methadone in jail !!!! what a novel idea
« Reply #6 on: November 10, 2015, 02:15:28 PM »
i think you can get this or Bupe in jail here in Australia.

that's a huge relief but i'm not intending to ever go to jail so i am always on my best behaviour !
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Offline quzyke

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Re: methadone in jail !!!! what a novel idea
« Reply #7 on: November 11, 2015, 08:56:59 AM »
I'm so glad that in Belgium they continue your methadone treatment. Can't imagine the horror of losing your done after years on a high dose... Snoops's jail cold turkey story from back on Opio comes to mind...

They even start some people on subs or methadone here, especially addicts in prison for drug-money related crimes like theft.

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Re: methadone in jail !!!! what a novel idea
« Reply #8 on: November 11, 2015, 11:37:58 AM »
Yeah I would have LOVED to have been started on methadone while I was in jail! The perfect drug for the environment you're in.
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Re: methadone in jail !!!! what a novel idea
« Reply #9 on: November 11, 2015, 12:15:53 PM »
My local county will continue for done or bupe treatment as long as you are currently enrolled in a clinic.

I got fucked and had to go CT even though i proved that i was on done from my PM doc. It has to be for drug dependence not pain or any other reason which i find to be bull.

Why does it matter why I'm on it, the withdrawal is going to be the ëxact same.

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Re: methadone in jail !!!! what a novel idea
« Reply #10 on: November 11, 2015, 12:35:25 PM »
I always felt worse for some of the old heads when I was in jail. A lot of time they had never came off of their prescription drugs and a lot of them take benzos and opiates. I thought one guy was going to die the first time I went to jail. He was in his 80s and he had to walk around with a towel around his neck all day to stay warm I thought he was going to die from hypothermia. I still don't understand the use of A/C in the winter.

The last jail I went to was so much better I am glad that I was detoxing there and didn't get shipped out till after it had already been 3 weeks. They let you turn on the heat, you had your own cell. They let me get extra blankets and use the extra "mattress" that was in my cell.

There was a lady guard who worked there that I didn't like but most the other guards were okay minus the racism. She was always getting everyone in trouble and trying to get everyone to snitch or make you wait with her so everyone thought you were talking. She would take my blood pressure 4 times in a row to get it under 130/90 so that she didn't have to give me a clonidine. Her daughter was a junkie I think she was taking some of it out on me.

They recently did a study on people who are in the clinic who get incarcerated. They say on average 10% of the clinic will get incarcerated each year. A high percentage that I don't remember did not return to the clinic after getting out resulting in a high rate of overdoses. It is sad that they just want you to suffer and always have to be dicks about it. I always hear them say this is jail don't get arrested if you don't want to be sick. I saw a sign in the docs office in the last jail I was in that said "no one sleeps in jail" I thought the sign was perfect.

It is sad to watch so many people go untreated in jail someone from my clinic died in the jail when I was there last time. Due to dehydration from withdrawal. They basically left her to die even after most the inmates were screaming to get her help. I have seen people with broken bones in there that don't get anything because there policy is no pain meds or benzos. The only controlled meds they give are anti-psychotics.

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Re: methadone in jail !!!! what a novel idea
« Reply #11 on: November 11, 2015, 03:57:51 PM »
I saw a sign in the docs office in the last jail I was in that said "no one sleeps in jail" I thought the sign was perfect.

Shit in all the jails around here, they'll give you Benadryl or Vistaril just to help you sleep. I even got Seroquel 100mg/hs, just for sleep, scripted to me while I was in the Alexandria jail. That was like 5 years ago, though, and I don't think they give Seroquel anymore in correctional facilities due to the lawsuits re metabolic syndrome (diabetes, gyno, extreme weight gain, high cholesterol and triglycerides, and attendant increased MI and CVA risk).
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Re: methadone in jail !!!! what a novel idea
« Reply #12 on: November 11, 2015, 09:34:31 PM »
Yeah I would have LOVED to have been started on methadone while I was in jail! The perfect drug for the environment you're in.

Yeah, I'd probably just get on a massive dose and sleep all day/night.

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