Pubdate: Tue, 23 Jan 2007
Source: Morning Call (Allentown, PA)
Copyright: 2007 The Morning Call Inc.
Author: Ann Wlazelek
Bookmark: (Methadone)
Bookmark: (Treatment)


Advocates Say Continuing Treatment For Short-Term Inmates Cuts Recidivism

With critics long holding that methadone is nothing more than a legal 
replacement for an illegal heroin addiction, few prisoners nationwide 
have received the bitter medicine in jail unless they were pregnant 
and at risk of losing an unborn child to withdrawal.

But that is changing. Lehigh County Prison has agreed to join 
Northampton and Berks county prisons in taking the next controversial 
step: continuing methadone treatment for short-term inmates who had 
been taking the medicine before incarceration.

"It's effective immediately," Lehigh County Director of Corrections 
Edward G. Sweeney said about providing methadone maintenance in the 
prison. Spurred by proponents who say treatment helps addicts resist 
heroin and avoid returning to jail, Sweeney said, "It's a growing trend."

Not to be confused with the illegal stimulant methamphetamine, 
methadone is a legally prescribed and controlled drug that quells the 
cravings for heroin but does not produce the highs. Administered 
daily at government-regulated clinics, methadone helps long-time, 
heavy-use heroin addicts abide by the law, hold jobs, raise families.

Yet for years, a Rikers Island jail in New York was the first and 
only correctional facility in the country providing methadone 
treatment to more than pregnant inmates.

Regulations and costs associated with establishing a methadone clinic 
and a mindset that prisoners "deserve to suffer" have kept the 
treatment a rarity in most county jails and state prisons.

"Jails weren't methadone centers," explained Todd Haskins, vice 
president of operations for PrimeCare Medical, the Harrisburg company 
providing medical services to 27 county prisons in Pennsylvania, 
including Lehigh, Northampton, Berks, Monroe and Schuylkill.

"It was illegal for them to prescribe it," he said. And few jails 
have had enough money or heroin addicts to start their own.

Also, questions have lingered about who should receive the controlled 
medicine and for how long, especially among drug treatment officials 
who believe all addicts, even those on methadone maintenance, deserve 
a shot at drug-free alternatives.

"If you are legitimately on methadone, I would stand in favor of that 
continuing at the prison level, but an assessment should be done by a 
neutral party, not the methadone provider," which could benefit from 
continued business, said Robert Csandl, executive director of 
Treatment Trends, which offers a variety of residential, partial day 
programs and outpatient drug rehabilitation programs in Allentown.

If maintenance works so well, he adds, "How does that person on 
methadone wind up in Lehigh County Prison?"

But local and national authorities say resistance is falling in the 
face of positive results from treatment studies and experiences at 
the small number of prisons that have taken the plunge.

"Methadone maintenance isn't a right of a prisoner unless he or she 
is in withdrawal and a life is at risk. It was not something prisons 
had to provide, but we certainly believe more jails and prisons 
should provide it," said Jody Kent, public policy coordinator for the 
national Prison Project of the American Civil Liberties Union.

She called methadone maintenance "a beneficial treatment."

Kent pointed to a Federal Bureau of Prisons survey of prisoners who 
underwent drug abuse treatment, including methadone, before being 
released in 1995. The survey found that 3.3 percent were likely to be 
rearrested in the first six months after release compared to 12 
percent of inmates who did not receive treatment.

"It's a good opportunity to reduce recidivism and increase public 
safety," Kent said.

Maintaining methadone treatment in prisons also has the support of 
federal health officials, such as former White House drug czar Barry 
McCaffrey, private foundations and state drug and alcohol agencies. 
And authorities say it could be argued that the Supreme Court's 
recent rulings against withholding prior medical care to prisoners 
could apply to methadone as well.

"People don't understand that heroin is a lasting addiction, a 
chronic condition like diabetes," said R. Scott Chavez, 
administrative vice president for the National Commission on 
Correctional Health Care, which accredits prison methadone programs. 
"You wouldn't think of not giving diabetics insulin," he said.

"Studies have pretty much shown that the heroin addict must consider 
some replacement therapy or he will go back into heroin-seeking behavior."

A handful of jails and prisons in Connecticut, Chicago, California 
and New York have started their own methadone clinics within the 
correctional facilities, Chavez said. More, though, have gone the 
route of local jails -- working with community methadone programs to 
bring the service inside.

In this area, Berks County Prison led the way 11/2 years ago, when 
prisons and PrimeCare officials agreed to give continued methadone 
maintenance a try. Northampton County Prison followed suit six months ago.

The concept came largely at the suggestion of Glen J. Cooper, a 
former Bethlehem health director who 10 years ago became executive 
director of New Directions Treatment Services, a multi-service 
organization that provides methadone, drug testing and counseling, 
mental health and HIV and hepatitis education at clinics in Bethlehem 
and West Reading.

Cooper's clinics provide daily doses of methadone to 665 people who 
had been addicted to opiates such as heroin, morphine and oxycodone. 
Some have been free from illegal drugs for 30 years by coming to the 
clinic, he said, but the average length of treatment is 31/2 years.

In prison, however, only those held for six months or less are 
considered, Cooper said. No "lifers." Also, the methadone clinic 
confirms by phone call that the prisoner had been a client before 
treatment begins.

Appropriate doses for the week are delivered to the jail for the 
medical staff to administer to prisoners each day. And a clinic 
staffer goes to the prison to provide counseling.

Cooper sent the protocol to all 41 methadone clinics in Pennsylvania, 
emphasizing that studies show methadone maintenance reduces the 
demand for heroin inside the prison and reduces the transmission of 
HIV and hepatitis, which can be spread by sharing drug-injecting needles.

"We are very proud of this," he said.

At the Berks County Prison, Warden George Wagner said "a couple 
dozen" inmates have received methadone for an average of 31/2 months 
in the last year and a half.

That's not a lot, he said, considering the prison houses 1,250 men 
and women on any given day and incarcerates 8,500 to 10,000 in a year.

Although Wagner could not provide statistics on recidivism or other 
impacts of the new program, he said he believes it was the right thing to do.

"I'm a fairly conservative person," Wagner said of his initial 
ambivalence about offering inmates methadone. "But in the jail 
setting, an inmate could be here as little as an hour. We don't know 
if he or she will be bailed out in an hour, five days or a week. And 
just about the time the prisoner gets through detoxification, he's 
released, will go get a heroin fix and start all over.

"We could do more harm than good" by not continuing methadone 
maintenance, he said.

Northampton County Prison Director Todd Buskirk sees methadone 
maintenance as an extension of the service provided to pregnant 
inmates for years.

The numbers so far are small: In the Northampton jail, which houses 
about 815 inmates on a given day, three inmates were on methadone 
maintenance last week, Buskirk said.

"It appears to be working well," he said. "At least, I've not 
received any complaints."

PrimeCare's Haskins said the service works well in counties that have 
a methadone treatment center like New Directions.

"It doesn't cost more," he said. "It actually saves the prison money 
because instead of transporting patients to the clinic for the 
medicine and counseling, the clinic provides the service at the jail."

The problems come in counties that have no methadone clinics, Haskins 
said. "In some places, we need to drive across two or three counties" 
to transport inmates to methadone treatment centers, he said. 
Security guards or someone from the sheriff's department must go along.

Cost may not be a problem now, acknowledged Cooper, because New 
Directions is supported by a five-year, $500,000 federal grant. But 
when that grant runs out, he said, counties will most likely be asked 
for additional money. In Berks, for example, methadone maintenance 
and counseling cost New Directions about $9,800 last year, Cooper said.

Lehigh County's Sweeney does not expect a community backlash to the 
plan to provide continued medicines to about 20 of the 7,000 
prisoners who come through the jail each year.

"Methadone is becoming more accepted and mainstream," he said, noting 
support from county drug and alcohol officials and training sessions 
offered at the Pennsylvania County Corrections Association, of which 
he is first vice president.

Methadone maintenance is not yet a standard of care, required for 
accreditation, Sweeney said. "But my expectation is next time they 
put standards out, it will be recommended."

BITTER MEDICINE What is methadone?

A legally prescribed and controlled drug that quells the cravings for 
heroin but does not produce the highs.

What's the controversy?

Critics say methadone is nothing more than a legal replacement for an 
illegal heroin addiction.

What's new?

Lehigh County Prison will join Northampton and Berks county prisons 
in continuing methadone treatment for short-term inmates who had been 
taking the medicine before incarceration.

What do proponents say?

The treatment helps addicts resist heroin and avoid returning to jail.
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