Durham, North Carolina: First in the South to Provide Naloxone to Departing Inmates

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The county jail’s addiction treatment program in Durham County, North Carolina, just started giving naloxone overdose prevention kits to inmates leaving their program.

This program, called STARR (Substance Abuse Treatment and Recidivism Reduction) consists of around 83 hours of group therapy, addiction treatment education, and weekly 12-step meetings. STARR participants are also taught how to respond to an overdose, and how to use naloxone. Inmates completing this program are also eligible to enter an additional voluntary four-week program known as GRAD. All graduating inmates are offered a naloxone kit.

At any one time, the STARR program has about 40 inmates in treatment.

Only three county jails in North Carolina offer addiction treatment services. Besides Durham County, Mecklenburg and Buncombe Counties have similar addiction treatment programs, but neither of the latter two offer naloxone kits. The development of education and prevention of overdose was achieved only after long efforts by the STARR program’s director, Randy Tucker, collaboration with the Harm Reduction Coalition.

Durham County is setting the right example for the rest of the nation.

It’s important to teach inmates with addiction how to avoid overdose. Inmates with addiction are at high risk for a fatal overdose during the first few weeks after their incarceration. While in jail, their tolerance has dropped. If they leave jail and relapse using the same amount as before they went to jail, an overdose is likely, particularly if they are using opioids.

Studies on all continents show this marked increase in overdose death among opioid addicts leaving incarceration. The degree of increased risk is debatable. Some sources say the risk is increased four-fold and others estimate a hundred-fold increase in overdose deaths risk, mostly within the first two weeks after leaving incarceration.

Last year, four people leaving the Durham County jail had fatal overdoses.

If the US treated addiction as the public health problem that it is, all state, county, and federal jails would provide naloxone upon dismissal from incarceration. (I won’t even get into the arguably more important issue of providing adequate addition treatment to inmates whose main problem is addiction). But we don’t do that in this country, still preferring to see addiction as bad behavior by deviants.

Ferguson, Missouri…Baltimore, Maryland…think how the attitudes and outlook of citizens could change, if jailers started handing out naloxone kits to departing arrestees.

Even without words, this action would go a long way toward giving arrestees the message that law enforcement saw their lives are valuable and worth saving.

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2 responses to this post.

  1. Posted by Benjamin K Phelps on May 27, 2015 at 12:28 am

    Dr Burson, the LAST SENTENCE you wrote says it all. As it stands, you go to most any jail in NC, & law enforcement finds it seemingly funny that you’re dope sick. They have zero compassion for the pain you’re going through, & can’t be bothered to get you to the doctor if you say you need him or her. It’s a nuisance to them, not an important issue that needs to be handled. But then when someone finally dies from withdrawal, be it opioid, benzo, alcohol, or whatever, they wanna pass the buck like a hot potato all around the unit – it’s everyone’s fault but mine – I did MY job & I watched the inmates like I was supposed to. Throwing an addict in withdrawal in a cell & locking him or her down 23 hours a day or even putting him or her in a block with 50-60 other inmates who aren’t sick & have no idea what this person is going through & often make fun (try asking the nurse for something to control diarrhea in front of the other inmates, & you get at least 1 18-year old who thinks that’s the funniest thing he’s ever heard. Because, you know, he’s never had diarrhea before in his lifetime). And the answer you get from nursing staff is “it’s not in your chart for you to get anything for diarrhea, so I can’t give it to you.” at many jails. A few offer up Imodium w/o the doc writing for it, or Ibuprofen w/o an order for it. But many make you put in a sick call, which costs money from your account, then you wait 24 hours to get to be seen (or from Fri til Mon if it’s the weekend), then you get taken down to medical with 30 other inmates at a time, & you sit there, unable to sit still b/c of withdrawal, & when you FINALLY get called in to see the doc, s/he treats you as though you’re a social pariah, unwelcome in his jail or his office, wasting his time, & he’s NOT going to give you ANYTHING to ease your suffering. Period. This is what we face at a jail. Now of course, the argument can be made – well, don’t go to jail & you won’t face that. And that’s a great argument, & it makes great sense, & all that. But addiction has a way of wreaking havoc on the life of its victim, even when unintentional. And let’s face it, whether it’s frequent or not, wrongly arrested/wrongly convicted people face jail & prison time everyday. We have let untold numbers of people go after exonerating them because of DNA evidence that proved they weren’t the right person to be locked up. But it’s safe to assume most people in jail did do something to get there. And that’s a shame, but I know for me, personally, I faced being in 3 programs that didn’t get my dose raised & stabilized fast enough for me to quit passing fake scripts to supplement the opioid I needed to satisfy my cravings/receptors. I require a high dose of methadone (160mg), though I can stay clean on 120mg (I just have to fight with myself constantly to keep from taking my takehomes early at 120mg, which kinda – in my mind – defeats the purpose of being on methadone to start with. If I’m going to be in maintenance, I’m NOT going to spend my every day on this earth fighting against cravings. If I want to do that, I can just avoid the clinic bullshit altogether & white-knuckle it, pardon my French. But I believe that being on the program is about being comfortable & not craving every waking minute, not fighting against my own mind constantly, not relapsing, & not thinking & talking about drugs all day, everyday. Thank God, methadone prevents me from doing that when I’m at the right dose. It’s unfortunate that so little is told to patients when they enter some programs, & for all they know, if they’re on methadone or Suboxone, whether it’s 10mg of the former or 100mg, or 8mg of the latter or 32mg, they think they’re just on it & that’s that. That either it works or it doesn’t. They don’t understand that when you crave or relapse, instead of giving into it, just get through til morning & GET AN INCREASE. You CAN & you WILL eventually find your stable dose where you don’t want the illicit drugs anymore. But I had to go to jail on methadone 3 times b/c I didn’t know anything about getting to a stable dose or where mine was. And I had to kick in jail a 4th time for something else that was the result of something the clinic put me on & then after 5 years, decided to just stop giving me the prescription for it overnight, leaving me to get sick & beg & plead with them in vain for help. So I took it upon myself to try to taper off, & it blew up in my face & I ended up arrested & detoxing off BOTH things in jail. Anyway, I think Narcan/naloxone kits are a great thing to give to addicts on the way out. And I know Dr Burson didn’t want to touch on it here, but I’m gonna say it – HOW ABOUT DISPENSING SUBOXONE OR METHADONE ON THE WAY IN for addicts on a program or starting opioid addicts before release on a program so they can get out & immediately switch over to a local program & continue staying clean. WHAT A PERFECT TIME TO DO INDUCTION because the addict practically CAN’T use illicit drugs along with the methadone or Suboxone while being titrated upward, & they can work on finding a stable dose in the days prior to release. I’m SO sick of people having to suffer double-time b/c they’ve gone to jail like so many others, but then on top of that, they have to get sick for a month or more because they’re yanked off their LEGAL TREATMENT of methadone or Suboxone overnight & made to suffer like animals in a testing lab.

    Reply

  2. Posted by Diana Goodwin on May 31, 2015 at 6:35 pm

    It’s great to see that Durham is doing this. The larger issue continues to be making medication assisted treatment available to all persons in need upon entry into jail or prison. My son and I are still battling for the Federal Bureau of Prisons to provide him with Suboxone, which the BOP refuses to do in spite of my son’s known relapses. They just take away his visits, send him to a high security prison because of his “infractions”, and throw him in solitary. Hell of a treatment plan.

    Reply

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