MOUD program helping Michigan jails provide SUD treatment to inmates

By

Shane Ersland

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Law enforcement officers are using a medications for opioid use disorder (MOUD) program in Michigan correctional facilities to help inmates get the substance use disorder (SUD) care they need to reintegrate into society. They discussed their progress at the 2024 Michigan State of Reform Health Policy Conference.

Health Management Associates (HMA) Principal Rich VandenHeuvel said 85 percent of inmates in the U.S. prison population either have a substance use disorder or were incarcerated for a crime involving drugs or drug use. 

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“If you remember no other statistic, remember this, and why we concentrate on corrections in terms of treating substance use disorder,” VandenHeuvel said. “I’m not an epidemiologist, but that seems like a logical place to concentrate treatment with a statistic that high. Unfortunately, in our world, the biggest behavioral health system in every state is its jail and correctional system. Those are just the facts. I’m not saying that’s a good thing. It’s also an opportunity to intercede with evidence-based treatment.”  

The Michigan Department of Health and Human Services (DHHS) awarded a three-year contract to HMA to serve as the project administrator for a technical assistance program for up to 24 county jails seeking to implement or expand MOUD programs in February. Jared Welehodsky, state assistant administrator for DHHS, said Michigan has seen a big increase in overdose disparities among Black residents since 2017.

“And that’s where we’re focused, is ensuring we are reaching the most high-need populations in the state. We have a comprehensive strategy that’s focused on prevention, treatment, harm reduction, (and) recovery. We really wanted to make sure people who are using drugs are using as (safely) as they can. And we’ve been working to promote access to treatment. We’ve been able to expand the number of treatment providers in the state. We’re also focused on treating people in long-term recovery.”

— Welehodsky

The MOUD project is funded through opioid settlement dollars and is designed to address significant overdose risks in incarcerated populations during and following incarceration by increasing access to MOUD programs. Participating counties will receive grants up to $25,000 to cover associated costs, VandenHeuvel said.

“We provide training,” VandenHeuvel said. “We coach (and) support (jails). We don’t deliver the treatment. We help the jails and facilities provide evidence-based standards of care. The hard part is the culture change (and) addressing stigma. Clinically, we’re only talking about three medications. This is a need in every county in the country because we’re still not very good at bending the curve on opioid deaths.”

Kalamazoo County Sheriff Richard Fuller said his office has implemented SUD treatment through the program. He said the jail there had two nurses attempting to administer treatment for 380 inmates there in 2009 when he was elected.  

“It was very difficult and things went undone. People came in sick and they left sick. So we steadily increased to five nurses—one of them is a MAT (medication-assisted treatment) nurse—and a nurse supervisor. What we found is someone who is suffering through a SUD; they’re not themselves. The behaviors we were seeing were driven by how they were treating themselves on the outside. And they can’t treat themselves that same way inside a jail. So we had to quickly learn more about withdrawal syndrome, how to treat withdrawal, and make sure people were safe.”

— Fuller

Fuller said some inmates suffered overdoses, however, due to the smuggling of narcotics into the jail, which was done in ways that were undetectable to the guards.

“Now we have better ways to detect that,” Fuller said. “But it still left things for us to do. And that’s why we joined the MAT program, (and) made sure we had people utilizing the right drugs through professionals to help somebody with their stay in jail. Every day at the office, we have 50 people on the special needs list. They are struggling through some sort of SUD or mental health disorder, or a combination of both, which is the lion’s share of that 50.”

Fuller said the Kalamazoo jail modeled its treatment on services at Eaton County Jail. The jail was one of the first to put narcan in every deputy’s hands in 2015, Eaton County Undersheriff Jeffrey Cook said. It also offers discharge planning as part of its MOUD program.

“It’s very critical that our MAT physician can make sure (inmates) can see a physician in their community and continue their medication treatment,” Cook said. “We have peer recovery coaches. MDOC (the Michigan Department of Corrections) came to our jail, saw what we were doing, and wanted to use that as a model at MDOC, which is quite a compliment. Our program grew through a Building Bridges Initiative 16 counties from across the country (were) invited to participate in.”

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