Pubdate: Sun, 29 Mar 2015
Source: Blade, The (Toledo, OH)
Copyright: 2015 The Blade
Author: Jeff Gerritt


Novel Program Helps Offenders Battle Addiction, Avoid Prison Time

Theodore Twigg of Holland was headed for prison. A 37-year-old heroin 
addict, he was locked up in the Lucas County jail on Jan. 20, facing 
a five-year sentence for breaking-and-entering and fleeing from a 
police officer.

Nonviolent addicts like Twigg are flooding local jails and state 
prisons, as their addictions continue to drive them to crime.

But Twigg and Lucas County officials are trying to break that cycle. 
Twigg took a plea deal earlier this month that requires him to 
complete a new program that, for the first time in Ohio and maybe the 
nation, starts medication-assisted treatment for addiction while 
offenders are still in jail. Sheriff John Tharp and local providers 
will announce the program on Monday at the sixth annual Opiate 
Conference in Columbus.

After talking to Common Pleas Judge Stacy Cook, Twigg became Project 
Direct Link's first participant. He got a Vivitrol shot in the jail's 
medical unit on Feb. 12, the day before he was released and put on 
electronic monitoring. One of three kinds of medication-assisted 
treatment, Vivitrol eliminates cravings for opioids for about 28 days.

Twigg pleaded guilty to breaking-and-entering, a minor felony. 
Prosecutors dropped the fleeing charge. Instead of prison time, Twigg 
was sentenced to up to four years' probation. He now wears an ankle 
bracelet, which confines him to his house except for court, medical, 
and addiction-treatment program appointments.

"This program and Judge Cook probably saved my life," Twigg told me 
during an interview at his house in Holland. "I would have either 
been in prison for a lot of years or dead."

Funded by a $100,000 grant from the state Department of Mental Health 
and Addiction Services, Project Direct Link aims to keep nonviolent 
drug offenders in treatment, away from crime, and out of prison. The 
pilot program is run by a local treatment agency, A Renewed Mind, and 
could change how the criminal justice system statewide treats minor 
drug offenders struggling with heroin and other opioid addictions.

Slowing the revolving door

Of the more than 20,000 people entering Ohio prisons each year, the 
share of those admitted for opioid and heroin-related crimes, mostly 
possession and theft, has quadrupled in the last decade. Now, nearly 
2,000 people a year go to Ohio prisons for such offenses - at a cost 
to taxpayers of $45 million a year. Untreated, their disease just gets worse.

County jails have become the state's biggest detox centers. The Lucas 
County jail holds an average of 425 prisoners, with nearly 60 inmates 
coming in and 60 going out every day, Aaron Nolan, director of inmate 
services, told me. Up to half of those entering the jail each day are 
coming off a drug - mostly heroin and other opioids - said medical 
services Director Anissa Floure. That means up to 200 prisoners on 
any given day are going through five to seven days of hell as they 
withdraw from heroin and other drugs.

Addiction will drive almost all of them back to drugs - and crime. 
Here's how the revolving door works: Addicts are arrested for drug 
possession or petty theft. In jail, they sweat out an involuntary, 
agonizing detox. A few days later, they're released. They may stay 
clean for a week or a month, then relapse and start the cycle over 
again. As repeat offenders, they eventually graduate to prison, where 
they each cost taxpayers $25,000 a year.

It's easy to shake your head. But if you haven't been addicted, you 
don't have a clue about how tough it is to kick heroin or other 
opioids. The drugs hijack your mind. It's not unusual for an addict 
to relapse 10 or more times.

Still, medication-assisted treatment, including Vivitrol and 
Suboxone, has shown remarkable success when coupled with counseling 
and therapy, taking sobriety and recovery rates to 50 percent or more.

Vivitrol - a brand name for naltrexone - blocks the brain's opioid 
receptors, easing or eradicating the brain's relentless cravings. 
Recovering addicts typically get Vivitrol shots once a month for a 
year or less.

To safely take Vivitrol, patients must be clean. Jail time makes that 
happen. "This is an opportunity to start them in treatment right 
there, before they run back to the dealer and start reoffending." 
Matthew Rizzo, CEO of A Renewed Mind, told me.

Up to now, however, that opportunity has been wasted, partly because 
Medicaid does not cover any medical expenses for the incarcerated. A 
monthly Vivitrol shot costs roughly $1,000. Project Direct Link will 
use state grant money to pay for the first shot in jail. After 
participants are released, Medicaid will pick up the tab.

The first shot is given in the jail's medical unit a day or so before 
an offender is released. The program then moves him or her 
immediately into community-based treatment. Appointments will be 
scheduled with counselors or case managers before prisoners are released.

To qualify for the program, inmates must be generally nonviolent, 
opiate-dependent, motivated, and Medicaid-eligible.

Direct Link will treat 60 inmates over the next year, enrolling an 
average of one or two a week. The state will then evaluate the program.

Having hit rock bottom in jail, many addicts are ready for change. 
"They're at a point where they think their life sucks," said Wendy 
Shaheen, vice president of A Renewed Mind. "They're having those 
come-to-Jesus moments."

Road to recovery

In an epidemic of addiction, Twigg's story is typical. More than 90 
percent of those addicted to heroin started with prescription opioids.

Three years ago, while deer hunting in Williams County, Twigg fell 
out of a tree stand nearly 30 feet above the ground. He broke more 
than two dozen bones, and his doctor prescribed Vicodin and other 
potent painkillers.

Twigg became addicted to opioids. A year after his accident, he 
started using heroin as a cheaper alternative to dozens of pills. For 
a year, he snorted the drug. After that, he shot it to heighten its 
euphoric effects.

Last September, Twigg overdosed and almost died. It took four units 
of Narcan to bring him back to consciousness. After that, he stayed 
clean for a month before falling off. "I had a couple of bad days, 
and that's all it took," he told me.

At his peak, Twigg used a gram of heroin a day - about $150 on the 
street. An experienced concrete finisher and roofer, Twigg made 
decent money, but it wasn't enough. Four months ago, he started 
boosting - stealing and fencing goods.

"That's the worst side of this [addiction]," he told me. "You'll do 
whatever you need to do."

On Jan. 20, police caught him breaking into a building containing 
golf carts. For seven days after he was arrested, Twigg detoxed in 
the Lucas County jail. "It was hell, living hell," he said. "Puking, 
diarrhea. I was sick, couldn't sleep. You toss and turn, and your 
legs jump around like they're on fire."

Since his release, Twigg goes to A Renewed Mind three times a week 
for counseling and group sessions. He drops, or gets drug tested, 
five times a week.

Last Monday, he got his second Vivitrol shot at a branch office of A 
Renewed Mind. He will see Judge Cook again on April 7.

A rigorous treatment program gives the court "another set of eyes" to 
monitor clients, said Judge Cook, who is leading Lucas County's 
efforts to launch an adult felony drug court. "Vivitrol buys us time. 
The person and the addiction treatment providers do the rest."

At a sentencing hearing before Judge Cook on Tuesday, Twigg was 
disappointed that he would have to keep his ankle bracelet on for 
another 30 to 60 days. He's eager to start work, but he's not complaining.

"I know I'm lucky," Twigg told me outside Judge Cook's courtroom. 
"I'm going to make this work."

Twigg has three kids and a supportive family. And he has hope. He 
wants to get a union job working in concrete and rebuild his life.

Over the next few years, Twigg will recover in the community. If 
things go as they should, he will work, pay taxes, support his 
family, and turn his life around - instead of languishing in prison 
at a big cost to taxpayers. It's a good deal for everyone.

"When someone is off heroin, that person is not overdosing or robbing 
people to get a fix," Sheriff Tharp told me. "It's just common sense."

Sadly, this pilot program will serve only a fraction of those who 
need it. But it's a start, and another encouraging sign that law 
enforcement, after decades of getting tough on crime, is finally getting smart.
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MAP posted-by: Jay Bergstrom