Pubdate: Fri, 10 Jul 2015
Source: Coshocton Tribune (OH)
Copyright: 2015 Coshocton Tribune
Author: Jessie Balmert


COLUMBUS -- Heroin addicts leaving Ohio's prisons will soon receive 
the gold standard of treatment -- a combination of counseling and 
medication. But the state's largest detox centers, county jails, 
receive little money for medication, and law-and-order legislation 
proposed by Southwest Ohio lawmakers would lock them up longer.

State lawmakers' reaction to the heroin epidemic has been bipolar. 
Some changes treat addicts like victims of a brain disease, while 
others punish them as a scourge on society. Meanwhile, thousands of 
Ohioans are dying of drug overdoses.

Prisons director Gary Mohr wants lawmakers to stop adding stricter 
penalties while he and other professionals review Ohio's criminal 
laws, which are littered with gut reactions to terrible circumstances, he said.

"The accumulative effect over decades is misdemeanors have become 
felonies, felonies have become mandatory sentences, and judges have 
lost some discretion," Mohr said.

The effect is too many people who have never physically hurt anyone 
are sent to prison, Mohr said. The prison population has ballooned to 
about 50,000 prisoners, with at least 80 percent of them addicted to 
drugs. That was too much work for the 120 counselors employed by the 
state prisons.

Only 4,500 of the 30,000 prisoners struggling with addiction received 
treatment in 2013. Thousands of prisoners spent fewer than seven 
months in prison for charges like drug possession, leaving little 
time for treatment and making them much more likely to return, Mohr said.

"Quite frankly, we did little with them at all," he said.

Gold standard for treatment

But more money in the state budget signed June 30 will pay for 
another 60 counselors to work with prisoners, in an attempt to 
improve the transition from behind bars to home. Paperwork on 
prisoners' counseling while incarcerated rarely transfers to 
providers when they go home, said Tracy Plouck, who directs Ohio's 
Department of Mental Health and Addiction Services that is taking 
over prisoner treatment.

That also means signing up more prisoners for Medicaid just before 
they're released. Medicaid will pay for the combination of 
medication-assisted treatment and counseling that addiction 
specialists find most effective. While abstinence-only treatment ends 
in relapse about 95 percent of the time, researchers say 
medication-assisted treatment -- such as Suboxone, methadone and 
Vivitrol -- eventually will succeed, under optimal conditions, 50 
percent to 65 percent of the time.

"Most addiction people feel it's the gold standard for treatment 
now," said Dr. Steven Matson, president of the Ohio chapter of the 
American Society of Addiction Medicine.

Starting as early as January, prisoners will receive a pill or shot 
immediately before leaving and continue treatment at home, Plouck 
said. Medicaid won't pay for treatment while people are incarcerated, 
but many people leaving prison are eligible.

However, the state's prisons have been slow to sign prisoners up for 
Medicaid, adding only 737 people since September while about 20,000 
eligible people leave prison each year. Staff at four of 27 prisons 
are trained to enroll prisoners in the low-income health insurance; 
the goal is to have all prisons enrolling prisoners by the end of 2016.

Mohr said he's not disappointed in the progress, which should ramp up 
quickly. The prison director said he supports use of 
medication-assisted treatment as long as medical providers are 
selecting the correct drug.

Many judges and law enforcement officials reject medication-assisted 
treatment, saying addicts are swapping one drug for another. Suboxone 
and methadone are powerful drugs and sometimes are sold illegally. 
That hesitance is one reason medication isn't widely used in prisons 
and county jails, which have become the largest detox centers in the state.

But addiction specialists worldwide say medicine and counseling are 
the best tools for treating heroin addiction.

"We're not treating a drug with a drug. We're treating a disease with 
a drug," said Matson, who works at Nationwide Children's Hospital in Columbus.

Money in the budget, $11 million over two years, helps 15 counties 
provide medication-assisted treatment to jail inmates involved in 
specialized drug courts. Another $3.3 million is available for mental 
health or drug addiction programs, which could include medication for 
treatment. That helps, but won't make medicine accessible to all inmates.

Another $58 million will go toward ideas to keep low-level, drug 
offenders out of prison. That might mean more beds at a halfway house 
or counseling. Mohr called the money a much-needed boost for local 
judges, jails and law enforcement trying to treat addiction. 
Lawmakers also asked Mohr's office to look at converting a prison 
into a substance abuse facility, putting the addicts in one place to 
focus treatment resources.

Another addition allows county health departments to set up 
needle-exchange programs, where drug users can swap dirty needles for 
clean ones to reduce the spread of Hepatitis C and HIV. Those who 
drop off needles aren't prosecuted but often receive information 
about drug treatment. An early needle exchange in Cincinnati set off 
a firestorm from opponents last fall.

Doling out punishment

But most of those changes, including adding medication-assisted 
treatment and coordinating counseling with the department of mental 
health and addiction services, were pitched by Gov. John Kasich and 
his administration, rather than by lawmakers.

"We've not left anybody behind. If you are drug addicted, we're going 
to help you. We have been able to treat the drug addicted in our 
prisons," Kasich told reporters before signing the budget.

Meanwhile, lawmakers are proposing law-and-order legislation and 
incremental tweaks. A bill sponsored by Rep. Jonathan Dever, 
R-Madiera, and Rep. Bill Blessing, R-Colerain Township, would 
increase the penalty for people selling large amounts of heroin -- 
the kind of increased penalty Mohr warned against. Dever and 
Blessing's bill passed the House before summer break. Another 
proposal from Dever would make it easier to prosecute drug dealers 
who provide narcotics used in fatal overdoses.

Dever said his bills focus on punishing people who supply the drug. 
Others, such as a Republican-sponsored proposal that would make it 
easier for people to access an overdose antidote, address demand. 
Rep. Robert Sprague, R-Findlay, and Rep. Denise Driehaus, D-Clifton 
Heights, have reintroduced a Good Samaritan law that would protect 
people, who call 911 to help a friend who overdosed, from facing 
prosecution for drug possession themselves.

Kentucky has a Good Samaritan law, but Ohio lawmakers dismissed it 
last year, fearing it would enable drug use.

"There's so many different ways of dealing with this. One bill isn't 
going to fix everything," Dever said.

But threats and punishment alone don't work, addiction specialists 
say, because addicts want heroin more than anything else. Many heroin 
addicts, who are criminals in the eyes of the law, steal to feed 
their habits. They aren't making money off the drug, and throwing 
them in jail does little to solve the problem, Matson said.

Put another way: "People that we're afraid of ought to be locked up 
in prison. People that we're mad at might not have to be," Mohr said.
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