North Country county jails discuss impact of Opioid Treatment Law

Oct. 18—PLATTSBURGH — At Clinton, Essex and Franklin County jails, the implementation of New York's Opioid Treatment Law has received mixed results and feelings so far.

"It's not a one size fits all," Clinton County Sheriff David Favro said about the legislation. "My concern is that laws like this are just created for an issue: 'We have a cause out there, OK, here's the law that's gonna fix the cause.' It's not. It's not fixing it. Not from my perspective."

"And if you were to ask any of my officers, I think they would all tell you, independently, that I don't see where this is fixing anything. (Instead), we've created problems."

Under the state law, which went into effect last year and now requires all jails to provide medication for opioid use disorder (MOUD) — most commonly suboxone, methadone and buprenorphine — every inmate who comes through any New York jail has to go through a screening process and evaluation so they can take advantage of the medication-assisted-treatment (MAT) services and programs being offered if necessary.

The tri-county jails have all adhered to the new law with varying degrees of success.

ESSEX COUNTY

While the financial aspect of implementing MOUD has fallen on the shoulders of the jails instead of the state, Essex County Sheriff David Reynolds says his jail was fortunate to get some funding in advance of the legislation passing.

"We read the tea leaves and saw that it was coming," Reynolds said, referring to the passage of the Opioid Treatment Law last year.

"So we were able to start the process a couple years ago, and started slowly with suboxone. But now, obviously, with the new legislation, we have to provide all forms of MAT medication, which we do."

Being in a rural county of only 38,000 people, though, has its challenges when it comes to accessing some of the necessary opioid medications.

Reynolds said the nearest methadone clinic is in Plattsburgh. To the south, the nearest is in Glens Falls.

"There's nothing convenient for us," Reynolds said.

"To provide methadone, when there are no methadone clinics around, becomes difficult."

Reynolds said the jail ultimately incurs costs for the "majority" of the medication expenses for all non-federal inmates. Additionally, for Essex County to offer methadone, they also had to incur other expenses like a specialty safe to store the limited supply they are allowed to have at the facility.

"That's New York state, that's how they operate with everything," he said. "They say 'you have to do this,' but then they don't give you the money to accomplish it."

Still, Reynolds said the implementation of MOUD at the jail seems to have been well received so far, despite inmates attempting to divert the medication.

"I think it's been supported from the top, so it's just the normal day to day thing we do now," he said.

"(But) it is time consuming to administer the medications ... It takes officers and our medical staff time to do the program. So, from years ago, our medical, handing out meds and doing all that, was kind of quick. Now, it's a long drawn out process, because there's an observation period with everybody to make sure they're not diverting their medication, which happens all the time."

Dan Egglefield, a nurse at the Essex County Jail, says the program has been beneficial to the jail. Though, he did not believe the implementation of MOUD and MAT programs was a good idea at first.

"But now that we've had the program here, I do believe it's a benefit, not only for the medical department, but for the individuals coming into the jail," he said.

"We've seen a lot less withdrawal, which definitely helps with recovery. and then the other thing that we have seen, and granted ... the numbers aren't solid yet, but those who we've started on the program, we have seen them coming back into the facility less. So those are all positive things."

To be admitted into the MAT program upon booking, Egglefield explained that an inmate has already been in a program elsewhere, or the team of medical professionals determined after the screening and evaluation process that it was necessary.

An inmate can also request to be admitted to the program.

"We make a team effort with myself, mental health, St. Joseph's, and the provider on whether or not they meet the criteria, but in today's society, most people who come into the jail meet the criteria, unfortunately," he said.

"Which is a change of pace from the 13 years I have been here. When I first started, it was mostly alcohol — that was our biggest concern and benzodiazepines. and now it's opiates and methamphetamine."

"We have transition counselors that work with anybody that's in the MAT program," Reynolds said.

"St. Joseph's comes in and they have individual sessions with the inmates and group sessions. So it's not just throwing medication at them and trying to fix the problem. It's really trying to get to the root of the problem: helping with addiction issues."

FRANKLIN COUNTY

Franklin County Sheriff Jay Cook directed questions for this story to Franklin County Jail's MAT Program Coordinator, Scott Hudson, and nurse administrator Wade Sullivan.

Franklin County Jail's MAT program runs similar to the operation in Essex County.

"Every person that comes into the facility, we document whether they have current prescriptions for opioid treatment or SUD (Substance Use Disorders). If they're getting treatment for SUD on the outside, we have a person from St. Joseph's that does assessments on everybody that comes into the jail," Hudson said

"And then we have a team that meets together made up of medical, St. Joseph's and security and we make the determination, as far as whether they continue on it or we induct people into the MAT program."

Hudson and Sullivan said any treatment is ultimately decided by the doctor.

"We do the leg work through the assessments. They fill out a TCU5 (Texas Christian University drug screen 5)...you can do an assessment where they put down their prior drug use, their cravings, things like that. and basically we go off of that to help make the determination," Hudson said.

"Some people want to come in and ask for suboxone for the wrong reason like for pain, which is not what suboxone is used for or buprenorphine. So we do all the legwork, give the facts to the doctor and he ultimately makes the decision as far as who gets on the MAT program."

CLINTON COUNTY

In Favro's opinion, he says it's too easy for an inmate to get admitted into the MAT program, and once they're in, there is no clear and obvious exit plan.

Currently, about one-third of Clinton County Jail's population is taking some form of MOUD.

"It's ridiculous," he said.

Being required to offer MOUD, he added, has since led to instances where inmates who were previously in treatment programs and who have been clean for a while, are seemingly "forced into a corner" to take the medication because the medical professionals are obligated by the state to offer it to them.

"Then they get started up again," Favro said. "And then you have to give them some when they leave. We're not doing anything to fix the problems. We are in this type of society right now where we just want to be nice, we want to do the right thing, but the right thing short-term is the wrong thing for the future in this particular instance, because we're not really helping these people out."

This has caused a ripple effect across the jail.

Favro said some inmates — who don't necessarily need the medication but qualify for it — take it, "cheek it" (hiding MOUD, typically suboxone, in their mouth), then attempt to sell it to others for money or commissary or they snort it later to "make their stay easier."

In turn, the jail population that does need MOUD has been negatively affected.

"You have those that are trying to take advantage of them, manipulate them," Favro said.

"Mandating it for everybody across the board like that isn't really an accurate way to go and certainly isn't a help to society as a whole ... as opposed to this being an opportunity to straighten them out, get them some education, try and help them."

"Jails are continuing to be used as treatment facilities, and it's just not a good environment for that," he continued.

"I think New York really needs to take a look at possibly opening some treatment facilities. If that's what their intentions are ... because you've got many, many people who are incarcerated, who have substance abuse problems, who are in jail because they were stealing, because they were selling, because they were distributing. It's a bad environment to offer more medication."

Having to fund the services associated with the Opioid Treatment Law is another challenge.

"Unfortunately, the implementation of this — like many other regulations in New York state — didn't come with an awful lot of resources to be able to accomplish it," Favro said.

"It has been a financial burden. It has been a staffing burden. It has created multiple problems. We've had fights in the jail, over this stuff, that were created because we're providing it. I don't see the large benefits outweighing the problems it has caused."

Email: cnewton@pressrepublican.com

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