Massachusetts prison efforts are helping prevent fatal overdoses when people return home

Mark Hertz: good morning. This is the morning edition of GBH. Overdoses due to the opioid epidemic will claim approximately 2,000 lives in Massachusetts for eight consecutive years through 2024. And one particularly vulnerable group are those who have recently been released from prisons and prisons and are re-entering society. But this is also a specific group of people where real progress has been made. And to talk about this, I'm joined by Dr. Andrew Kolodny, an expert in the treatment of opioid use disorder. He is the medical director of the Opioid Policy Research Collaborative at Brandeis University's Heller School. Dr. Kolodny, welcome.

Dr. Andrew Kolodny: Thanks for having me, Mark.

Hertz: I'm glad you're here. So let's start with what we know: facts and figures about the risks for people with opioid use disorder as they return to normal life after serving time in prisons and jails. There's research out there that really highlights this and the urgency of doing something about it, right?

Kolodny: Yes, we've known for decades that discharge from jail or prison is one of the biggest risk factors for opioid overdose death. And unfortunately, even though we've known this for years, it's taken us a long time to start doing better to reduce the risk of overdose after hospital discharge. Ta.

Hertz: But please explain why it is especially dangerous. And I think it's especially dangerous, for example, in the first few months when someone is released from jail or prison. why is that?

Kolodny: People who are addicted to opioids and use opioids on a regular basis quickly develop tolerance. This means you need to take a higher dose to get the same effect. When someone stops using opioids, rapidly lose That tolerance. And if someone is incarcerated, or maybe recently detoxed and their tolerance is back to normal, then they go out into the community and become infected again and use something close to what they were using before they stop. The risk of death is very high.

Hertz: Well, that's understandable and very troubling. But also, as I mentioned above, things are currently changing significantly for the better, especially in Massachusetts. And when we talked earlier, you said that the prison here that I visited, the Middlesex Prison and Correctional Facility in Billerica, is truly a model. And then there's the sheriff who runs this place, Peter Koutoujian.

Sheriff Peter Koutuzian, pre-recorded: We were thinking about this in terms of recidivism and whether we were making a profit based on recidivism. But it didn't take long for us to realize that the more important metric was: Are we keeping people alive?

Hertz: Now, Dr. Kolodny, you've been paying close attention to what Sheriff Koutuzian is doing in Billerica. Tell us what's going on there and why he's had the success he's talking about.

Kolodny: Peter Koutuzian was one of the first sheriffs in the country to learn that inmates are given naltrexone injections before they are released into society from prison. Naltrexone is an opioid blocker and is one of the medications used to treat opioid use disorder. And if opioid receptors are blocked with naltrexone, the risk of an overdose is certainly reduced while the drug remains in the body.

They sent the inmates out with naltrexone injections, worked with people while the inmates were in the community, and stayed involved to make sure the inmates continued their injections. And a few years later, the sheriff modified the program after seeing that inmates had access to drugs that really worked well for most people with opioid use disorder: buprenorphine, also known as Suboxone, and methadone. And now his program offers all three drugs to individuals before they are released. There is good data showing that treating opioid use disorder with medication reliably reduces overdose deaths and criminal recidivism.

Hertz: One gentleman I spoke to there, Adam DeYoung, said that before he turned himself in after being sentenced to serve time, he had planned to run away if he wasn't given methadone. .

Adam DeYoung: They are now administering it to people. And that took a huge weight off my shoulders. Like, that was the defining moment where I decided, “Okay, I don't have to run anymore.'' It was very scary.

Hertz: That means treatment with proven medical therapies, and comprehensive services when people leave the community. Are there any lessons that lawmakers and public officials in Massachusetts and across the country can learn from that approach?

Kolodny: absolutely. Every jail, every prison in this country should do what we're doing with the Middlesex Sheriff's Office. We should say that people with life-threatening conditions such as opioid use disorder should receive treatment while incarcerated and should be linked to treatment after they are discharged.

It's simple. It reduces recidivism and saves lives. And in prisons and jails, where we see a disproportionate number of people with opioid use disorder, it's a great place for us to be able to know that treatment is available for people with this condition.

Hertz: I also wonder about overdose prevention centers, formerly known as supervised injection facilities or otherwise known. There is a successful facility in New York City. There is also a store scheduled to open in Rhode Island. And in the last Congress here in Beacon Hill, Massachusetts, there was a push to create an overdose prevention center. Now, in your opinion, what role could they play for people reentering prisons and jails who are trying to avoid overdosing?

Kolodny: Overdose prevention sites are, for example, places where individuals can inject opioids in a safer environment and where naloxone and supplemental oxygen are kept in case someone overdoses. And I think these interventions make sense in urban areas, especially in urban areas where there are a lot of homeless people and people who inject drugs. Because I think those areas can be places where people can access those services, where they can save lives, and where they can connect people to treatment. That's the best way to avoid overdosing in the long run.

Hertz: Dr. Andrew Kolodny, Medical Director of the Opioid Policy Research Collaborative at Brandeis University Heller School; Thank you for your participation.

Kolodny: Thank you for having me.

Hertz: This is GBH.