Update…

I first blogged about David Stojcevski on October 20, 2015, writing about his awful and senseless death from drug withdrawal while incarcerated in a Macomb County, Michigan, jail in 2014. He had been prescribed methadone, clonazepam, and alprazolam but when incarcerated for failure to pay a traffic ticket, he was denied his usual medications.

David died on day seventeen of his thirty-day sentence. When he began to hallucinate from withdrawal, he was sent to a mental health cell where his deterioration was recorded. He ate very little and lost around fifty pounds before his last moments, and he was observed to be having seizures prior to his death.

His autopsy said his death was due to “Acute withdrawal from chronic benzodiazepine, methadone, and opiate medication,” and mentioned seizures and dehydration as contributing factors.

His family posted all 240 hours of his suffering on the internet to protest the terrible treatment of people during incarceration. They sued both the county and Correct Care Solutions, the healthcare agency the county hired to provide medical care for inmates.

The family’s lawsuit took years to wind through the legal system, but they finally agreed to a settlement of $2.45 million dollars, with the county agreeing to pay $1.15 and Wellpath, the company that took over Correct Care Solutions, to pay $1.3 million.

I was pleased the family won their suit. The money won’t bring David back from a senseless and agonizing death, but maybe the dollar amount of the reward will discourage other county jails to ignore drug withdrawal symptoms.

Today I found that CNN has done an investigative piece on the problem of substandard medical care in jails:  https://www.cnn.com/interactive/2019/06/us/jail-health-care-ccs-invs/ Correct Care Solutions was mentioned repeatedly in the piece.

This lengthy article describes widespread lack of essential medical care to people incarcerated at facilities that contracted with Correct Care Solutions. This is the company that merged with another company to form Wellpath in 2018, and it is based in Nashville, TN.

Things are changing and there’s reason for hope, at least in North Carolina.

Our Department of Health and Human Services is trying to get key people in the same room, or at least on the same webinar, to learn from each other. Recently three webinars were presented to jail officials around the state, sponsored by MAHEC (Mountain Area Health Education Center), the NC Department of Health and Human Services, and the Buncombe County Sheriff’s Office.

The first webinar was presented by USDOJ attorneys and a MAHEC Addiction Medicine specialist, Dr. Shuchin Shukla. The attorneys discussed how people with opioid use disorders prescribed medications are protected under the Americans with Disabilities Act (ADA), and the addiction medicine specialist gave an overview of what opioid use disorder is and how medications help patients with this disorder. Repeatedly, the attorneys said they preferred to work with agencies and facilities to avoid ADA claims rather than issue punitive fines.

I was invited to talk on the second webinar, about services available at opioid treatment programs and how they differ from office-based programs. I talked more about methadone specifically, and ways jail personnel and treatment program personnel can work together to continue medications for opioid use disorder.

That webinar went very well, judging from the questions the audience asked at the end. Those questions showed the audience understood how important continued is, and showed they were willing to work for the benefit of inmate patients.

Then the third webinar gave details about how exactly three North Carolina counties are providing medications for opioid use disorder: Buncombe, Pitt, and Durham. They gave data about how many patients are being served and how medications are provided. This webinar was interesting to me about pointed out things I never would have thought about. For example, if patients are transferred to a prison that doesn’t provide medication, what can be done? The presenters talked about how to get buy-in from law enforcement personnel and how to deal with specific problems that arise when treating this population.

One of the presenters talked frankly about how he was skeptical initially, but then saw how medications help inmates with opioid use disorder. He finally decided that the reason he did his job was to help people, and providing treatment helped people, so he is now supportive of these medications.

That last webinar was much more moving that I expected.

This series of webinars is a good beginning and I hope collaboration will continue between the treatment community and law enforcement personnel at all levels. I hope we will soon see medications for opioid use disorder available in all county jails.

I’m grateful to Anna Stein, JD, MPH, for her tireless efforts to improve health care in our state. She works for the NC Division of Public Health, and has helped shape policy in positive directions around opioid use disorder treatment. And her husband Josh is our State Attorney General!

If you are interested, you can view each of the roughly 90- minute webinars here: www.mahec.net/jailmat