TRAVERSE CITY — Inmates addicted to opioids are less likely to relapse, contract an infectious disease, die from suicide or overdose if they receive medically assisted treatment, yet attitudes and funding challenges have largely kept MAT out of area jails.
“It would, number one, decrease Grand Traverse County Jail’s liability with suicide attempts,” said Pam Lynch, volunteer with Harm Reduction Michigan.
“People who are medically stable are not going to be as suicidal as those who are in withdrawal.”
There have been 51 suicide attempts, and two confirmed suicides, at the Grand Traverse County Jail between 2011 and 2018, the Record-Eagle has previously reported.
That data is available Sheriff Tom Bensley said, because the jail voluntarily tracks suicide attempts.
Medically assisted treatment, or MAT, is the use of medications such as buprenorphine (brand name “Suboxone”) or methadone to treat opioid addiction.
Methadone and Suboxone are schedule II controlled substances, dispensed as frequently as daily, under a doctor’s supervision and through a certified opioid treatment program.
When administered properly they reduce opioid craving and withdrawal, while not giving the user a “high,” said Lynch.
National Institutes of Health studies have shown MAT to be more effective than behavioral therapy alone.
Inmates in Grand Traverse, Kalkaska and Antrim county jails do not have access to MAT; inmates in Leelanau County Jail have access to a new nurse practitioner who may soon be providing MAT; inmates in the Benzie County Jail do have access, as of Oct. 1.
Funds to operate a MAT program would have to come from county budgets or grants; the Medicaid Inmate Exclusion Policy largely prohibits using federal funds for services provided to inmates of a public institution.
Grand Traverse County Jail has a contract with Wellpath, a Nashville, Tenn.-based corporation responsible for more than 300,000 incarcerated patients in 34 states. It is the largest correctional healthcare company in the nation.
When questioned recently by county commissioners, Wellpath representative Elaine Kaiser said MAT was offered in some of the jails the company contracts with. There may be an additional fee for the service, she said.
“If the jail wants that, that has to be something we’ll talk to the jail about,” she said. “It doesn’t make sense to give this medication, to prepare them (inmates) to leave, and not have some organization that will support them on the outside.”
The closest methadone clinics for follow-up treatment after incarceration are in Gaylord, Mt. Pleasant and Muskegon.
Benzie County Sheriff Ted Schendel agreed that support upon release was needed. Yet said he was feeling optimistic about Benzie’s new jail healthcare contract, which went into effect Oct. 1 and includes MAT.
“We’re so close to Traverse City, and I see the problems because we’ve had them here, too,” Schendel said. “But the big companies providing healthcare to inmates, that’s just not working anymore. You need to have a local touch to it.”
For 2017, 2018, and part of 2019, Benzie County used Advanced Correctional Healthcare, of Peoria, IL, a company second only to Wellpath in size, but now contracts with a local doctor.
“Advanced saved us money the first year, and then the second year they just took everyone to the emergency room,” Schendel said. “They’d take someone to the ER for a broken toenail. That adds up fast, so I knew we had to do something else.”
Schendel said he’d heard from his counterparts in Manistee and Mason counties about Dr. Michelle Custer, of All Access Care in Ludington. He did some research and learned Dr. Custer had “a special passion” for caring for people with addictions.
“Healthcare costs have taken a huge leap in the wrong direction because so many of our inmates have mental health or substance abuse issues or both,” Schendel said. “She has been able to cut costs, we have nurses here seven days a week, and she can be here, too, when we need her.”
Prior to 2010, Grand Traverse County Jail hired its own nurses and medical staff to provide basic medical services to inmates — not MAT — but Bensley told county commissioners that had become problematic.
“We had a terrible time trying to staff the nursing positions,” Bensley said, at the Oct. 2 commission meeting. “Additionally, the liability involved with running our own medical program. People may not want to hear this, but it’s a jail. We’re not a hospital, we’re not a mental health facility.”
Medical Director for the Grand Traverse County Jail is Dr. Ann Kuenker, board certified in family practice.
According to information available online, Kuenker divides her time between the Elk Rapids Skin and Laser Clinic, where she specializes in treating obesity using the Ideal Protein diet and an UltraSlim-brand laser to dissolve fat and tighten skin. And, the Vein Center, in Traverse City, where doctors treat varicose and spider veins.
Kuenker did not return repeated calls for comment.
At a meeting of the Human Rights Commission earlier this month, Bensley said he was aware of the new contract in Benzie County, but was not sure that kind of service could work in a larger community like Grand Traverse County.
“That sounds well and good, but do they have 145, or do they have 20?” he said, referring to jail inmate numbers.
In downstate’s St. Clair County, jail program manager Deb O’Brien is six months into a pilot program to provide MAT to a dozen inmates at a time.
She said the program offers methadone, Suboxone and Vivitrol, is facilitated through Sacred Heart Rehabilitation and funded through Region 10 Prepaid Inpatient Health Plan.
“I think its here to stay,” O’Brien said of the pilot program. “It’s not a perfect solution — for example we have problems with transportation to treatment once inmates are released, but when they leave they do already have some recovery.”
Grand Traverse, Kalkaska, and Antrim counties are not the only places which lack MAT for jail inmates, according to experts who say law enforcement have very real concerns about misuse and have been slow to accept it as a legitimate medical response to addiction.
O’Brien said their treatment plan calls for providing inmates medication at 10:30 p.m. daily, when other inmates are locked down for the night, and requiring those who receive MAT to wait 30 minutes before returning to their cells.
“Philosophically, certain sheriffs have the attitude, why prescribe one drug to take the place of another?” said Dr. Sheryl Kubiak, Dean of Wayne State University’s Center for Behavioral Health and Justice. “But that’s not best practices.”
Kubiak works with 16 downstate Michigan counties, plus Charlevoix and Berrien in the Upper Peninsula, to address the challenges of incarcerating people with mental illness and a co-occurring opioid use disorder.
Earlier this month, experts from another outside entity, Vital Strategies, the New York nonprofit implementing Bloomberg Philanthropies’ $10 million opioid crisis grant, visited Petoskey to discuss MAT with judges.
Emmet County Sheriff Pete Wallin said Emmet County jail inmates have no access to methadone or Suboxone but do have access to other unnamed medications for addiction.
Vital Strategies is also offering a free MAT webinar to all Michigan county sheriffs on Nov. 6.
“There’s still a lack of understanding that this is a medical issue,” said Daliah Heller, a director with Vital Strategies. “But a key component to reducing overdose deaths is to have this in jails.”
“If you are a jail program that does does not provide methadone or buprenorphine (Suboxone) then you do not understand opioid use disorder and you are setting yourself up for failure,” she said.
Kubiak said she’d received “indirect” inquiries from outside the sheriff’s department asking about getting MAT in the Grand Traverse County jail. She declined to name the source of those inquiries, but said she understands the challenges.
“MAT helps people get drugs — medicine — that aren’t going to kill them” she said. “Whether it can work in any particular county? That all depends on the players and the history.”