Hazelden Betty Ford turned some heads when it began offering medication assisted treatment (MAT) five years ago. This September will mark a new era, however, as the Hazelden model is adopted for the first time in a jail-based program that treats inmates in Kenton County, Kentucky.
Known as Start Strong, the jail’s treatment model will apply Hazelden’s COR-12 (Comprehensive Opioid Response with the 12 Steps), which includes a combination of MAT, enhanced opioid treatment services, clinical interventions and active engagement. According to Jordan Hansen, senior manager of clinical systems for Hazelden Publishing, with demonstrated efficacy over time, the Kenton model could be replicated in other jails and in community supervision programs.
“There are some folks in the field of corrections and treatment for justice-involved populations who have been working at this for a long time,” Hansen says. “This population experiences overdose at an incredible rate. It’s one of the few sectors, in my belief, yet to see any movement on medication assisted treatment for opioid use disorder specifically. There’s been a huge reluctance to implement evidence-based programming.”
Why the setting matters
Kenton County Detention Center launched residential addiction treatment in 2015 and has used naltrexone in the past. But this is the first time it will use buprenorphine and the first time it will apply COR-12 from Hazelden Betty Ford, according to Jason Merrick, MSW, CADC, director of addiction services.
Merrick says the jail setting offers a unique opportunity to impact lives.
“In a community-based program with MAT, especially in an outpatient setting, clients have the opportunity to manipulate because the disease will often steer them into unhealthy relationships with their medications and perhaps with their providers,” Merrick says. “Being in confinement in residential care gives us the chance to help them understand healthy relationships with medications. And the ultimate goal is to be off of the medication, not to use it forever.”
Start Strong’s services are delivered by eight clinicians who are civilian employees of the jail, with a dedicated space for 125 people to participate in addiction treatment. It’s a fully licensed residential drug and alcohol treatment program that must meet the same standards as any licensed facility in the state.
For example, clinician caseloads are limited to no more than 20 clients at a time. Cognitive behavioral therapy, 12 Step work and therapeutic communities are among the modalities.
“It is very much a robust, full-time, residential care center,” Merrick says. “It just happens to be in the county jail. The differences are few.”
There are three referral sources: current inmates who volunteer to participate in addiction treatment; those referred by the county circuit court; and those referred by the state department of corrections. On Monday, Merrick told Addiction Professional he was compiling a waitlist of about two dozen individuals. Addiction treatment in the detention center is currently funded through the state, and the limitations are mostly related to space allocation, he says.
The program also has a somewhat open-ended timeline.
“In the male and female county program, treatment time is 90 days, and for the state, it’s six months,” Merrick says. “But with each program, there is an opportunity to stay on after that time to be a peer mentor. You take on more responsibility and job duties and track the progress of the men and women and facilitate groups. They can complete the program, and if their charges or a conviction require them to stay longer—if they’re willing—they can stay on as peer mentor.”
It happens that Kentucky is the only state that elects its jailers, so there’s an incentive to be innovative and to provide evidence of efficacy. Merrick believes applying the COR-12 model for the inmate population is particularly unique. But to gain buy-in, the programs must be measured rigorously and produce positive outcomes.
“Jason [Merrick] and his team had solid programming, however, like everywhere else in the country, they struggled to get everyone on board with MAT,” Hansen says.
Hansen also hopes that additional advances will help prove out the value of Start Strong and COR-12 soon, including use of long-acting formulations of buprenorphine, such as Sublocade.
“We hear that buprenorphine is one of the most problematic forms of contraband that jailers struggle to deal with, so diversion is a concern,” he says.
While the diversion issue can be addressed in other ways, naltrexone or long-acting buprenorphine where appropriate can be helpful. According to Hansen, participants can also opt out of medication entirely.
The jail and other partners have requested federal grants of $2 million, and Hansen believes the funding will follow.
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