Street Roots • Jan. 5-11,2018
M EDICINE, fro m page 4
expenditures were also $153 to $233
cheaper for each patient each month.
“The science tells us that using
medications as part of addictions treatment
has tremendous, positive impacts on patient
outcomes,” Noice said.
SAP participants are given the first
injection the day before they are
released from jail. They are taken to a
transition center when released, and a staff
member of the CSAP program then picks
them up and takes them to the residential
facility, which is located in Milwaukie.
Within the next couple days, they’re
taken to a doctor’s appointment, where,
among other things, another appointment is
made 28 days out, for the next Vivitrol shot.
Every 28 days, participants go to the doctor
for the month’s Vivitrol shot.
The program is intended to last between
a year and a year and a half, and participants
live in the facility for six months to a year.
Morrison said the program’s creation was
spurred by the fact that nearly all county
parolees with addictions abuse heroin, “a
huge difference in what we saw even five,
seven years ago,” she said, when
methamphetamine, alcohol, or marijuana
tended to be more common.
Noice, with CODA, said incorporating
medication-assisted treatment into the
county jail system ensures that treatment
goes uninterrupted for people serving brief
jail sentences.
“We don’t want them to disconnect from
treatment,” Noice said. “When we focus on
not disrupting the medication, we in turn
have a much better chance of keeping a
patient in treatment.”
The jail sentences people serve are often
short, anywhere between a few days to a
couple months. Even though the sentences
are short, Noice and others said there is a
very high potential for treatment to be
negatively impacted.
Not providing any medical service to
opiate addicts in jail can bring on the danger
of withdrawal. “It’s really traumatizing...
[and] increases the risk for relapse,” Dr.
Andrew Mendenhall, the senior medical
director for substance use disorder services
at Central City Concern, said.
A person can experience nausea,
vomiting, diarrhea, cold sweats and hot
flashes, and body aches.
“No appetite,” Davenport said.
“Hard to eat, hard to keep stuff down,”
Riehle said, adding that he also experienced
muscle spasms and restless leg syndrome
when he withdrew.
“It’s horrible,” Davenport said. “That’s
what drives the whole addiction part of it.
You know you’re going to be sick, so the
only way you can feel somewhat normal is
having those drugs.”
Jail complicates recovery on many levels.
Someone may refuse to start drug treatment
knowing that they’re about to start a short
jail sentence and could go into withdrawal.
In other cases, people are released from jail
without any connection to a treatment
program and immediately go back to using
drugs.
That happened to Riehle, and it almost
killed him.
Riehle, who used heroin for six and a half
years, relapsed soon as he finished a two-
month sentence for possession of heroin,
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which he served at the Clackamas Countv
Jail.
Three days after his release, he
overdosed on heroin and passed out. He lat
er found out that a nearby homeowner saw
him and called the police.
An officer revived Riehle with Narcan, the
powerful drug that reverses the effects of
heroin on the brain. “They found me just
laying by the river. I don’t remember any of
it,” Riehle said.
Morrison said the CSAP program is
designed so that the transition from jail to
the treatment program is as seamless as
possible, to prevent someone from having
the slightest desire to leave and start using
drugs again.
“I was told I had to come [to the CSAP
program]. I’m glad that’s what happened. I
don t think I would have come,” Davenport
said, conceding he would have started using
heroin again.
year).
Morrison said it will be at least another
six months before enough data is collected
to show whether cravings are substantially
reduced and if participants stay in the
program for the full course of treatment.
“We’re hoping that with Vivitrol, people
are able to move through our treatment
program a bit quicker” than if they were
taking methadone or buphrenorphine, she
said, both of which have side effects and
lengthen the time it takes to recover.
Jake Moses, who has been in the CSAP
program for eights months and used heroin
for 10 years, said being on Vivitrol has
helped him enormously.
“There’s no side effects,” he said. “It
takes away the cravings. It takes away the
anxiety. It gives my brain a chance to
concentrate on things important in my life.”
With the medication dealing with physical
cravings, anxiety and other symptoms of
opiate recovery, Davenport and his fellow
CSAP participants are able to focus on the
rest of the CSAP program, a combination of
he CSAP program - where medication
classes on interpersonal and life skills,
is central to treatment and used in
group therapy and other programs that help
combination with therapy, counseling, and them build the skills and resiliency they
other programming - is reflective of how
need to not rely on drugs.
great a challenge treating opiate addiction is
Davenport calls it “life college.” He,
compared to treating addictions to meth or
Moses, Riehle and other participants are in
cocaine.
classes from eight in the morning until four
Clackamas County’s residential treatment
in the afternoon. The range of classes they
program had been abstinence-based,
take include on anger and stress
Morrison said, meaning the residential
management, mindfulness, developing
program provided therapeutic and
coping skills, morality and accountability, as
behavioral services to discourage drug use.
well as group therapy.
But she and others said abstinence is
Participants also go on trips, watching
T
c o m p letely im p ractical for an ad d ictio n as
m o to r c y c le r a c e s a t t h e P o r tla n d R a c e w a y
difficult to detoxify and recover from as
opiates.
Mendenhall said it only takes a couple
days to two weeks to detoxify from drugs
like alcohol or methamphetamines. With
opiates, detoxification can take weeks to
months.
“They will experiences months of fatigue,
depression, lack of energy, and really severe
cravings,” Mendenhall said. “People are not
going to feel good.”
Opiate addicts also need to stay in a
treatment and recovery program much
longer, for a year to a year and a half. (The
standard recovery from meth, on the other
hand, averages between six months to a
and crabbing at the coast. “They show us
that we can have fun without drugs,”
Davenport said.
Davenport said he’s learned how to cope
when he feels triggered to use drugs; he’s
also learned how to be kind to himself.
Moses said he can hardly start to explain
how much he has changed since being in
the program. Among other things, he’s
learned how to use the word “love.”
“I had a hard time saying that in the
past,” he said. “I used to be a not nice
person.”
Other jail systems are starting to
incorporate less robust services for those
recovering from opiate addiction.
Methadone has
been used for
decades as a
treatment for heroin
addiction. The drug
creates a controlled
high intended to
prevent withdrawal
and the desire to
relapse to using
heroin.
Over the last two years, the Multnomah
County Jail has started prescribing
buprenorphine more often to inmates with
opiate addictions in order to blunt the
symptoms of withdrawal.
Dr. Mike Seale, the director of the
county’s corrections health programs, said
health staff “taper down” the amount of
buprenorphine over the course of a week as
an inmate’s withdrawal symptoms lessen.
Inmates are “safely and humanely get
them through the withdrawal process,” he
said.
CODA and the jail system have been
working more closely together in instances
where a patient of CODA who is about to
start a jail sentence in Multnomah County
and is taking buprenorphine is able to
continue taking the same prescription.
But, Seale noted, “Jail is not a treatment
facility.”
Approximately 100 people are booked
into Multnomah County’s jail each day,
according to Seale. He estimates that a third
“have some substance use issue.”
The short duration of the sentences, the
fact that an inmate’s bail can be quickly paid
and other factors make it difficult to have
“the therapeutic relationship with the
patients,” Seale said.
“We don’t have a lot of time for that case
management,” he continued.
Noice, for her part, would like to see the
services offered in Multnomah County’s jail
become more robust, even creating a way to
administer methadone in the jail.
M e th a d o n e is s t r i c t l y r e g u l a t e d b y t h e
federal government, Noice said, and “a clear
chain of custody” would need to be created,
which would involve a CODA staff member
traveling to the jail with the methadone
doses.
“We’ve had lots of conversations about it,”
she said. “It takes some real logistical
planning.”
Morrison said Clackamas County is also
exploring whether to integrate
buphrenorphine into the CSAP program.
But there are federal regulations mandating
that a medical doctor have a particular
license to prescribe the drug, and they are
also only able to write a certain number of
prescriptions.
“I support medical assisted treatment,”
she said. “It’s trying to figure out the best
way to integrate it into our population.
Vivitrol is not the answer for everything,”
especially if someone in the CSAP program
decides to leave and the medication wears
off.
As jails continue exploring how to start
medication-assisted treatment programs for
their inmates and parolees, “it’s important
to [remember] we have three medications,”
Noice said. “They’re all equally valuable.”
And, it is a reminder that there is no
silver bullet to the opiate epidemic - that
each person’s recovery is a personal victory,
a mysterious combination of drug treatment,
therapy and medical services, and social
support.
“This is not about solving it and winning
this battle,” Morrison said. “Right now, it’s
about harm reduction.”