Courtesy of Claire R Daniel
Claire R. Daniel oversees the medical and psychiatric nursing staff at Somerset County Jail in New Jersey, about 45 miles west of New York City, and oversees the program that provides opioid use disorder (OUD) medication for prison inmates and for people entering her community the publication. Such programs are a key component of healthcare for individuals in the criminal justice system, with an estimated 65% of this population suffering from a substance use disorder (SUD) – but the vast majority of these facilities do not provide drug treatment.
This interview has been edited for length and clarity.
Q: What are the most common challenges faced by prison inmates with OUD when rejoining the community?
ONE: The biggest hurdle is making sure they have support. They often end up back in jail simply because they couldn’t get help from themselves or from social services outside – especially during the pandemic.
Q: What resources in the community do you point them to?
ONE: SUD recovery centers are one of our counterparts. They take referrals from us, help set up Medicaid coverage, and let us know if the person doesn’t make it to a doctor’s appointment.
Together with the recovery center we connect the person to transportation services and make sure they go to their appointments. And we send all their medical records to the facility they go to. It is very important to come to the first two appointments; We found that people who make it to these appointments are more likely to continue treatment than those who don’t.
Q: Is OUD treatment available within a reasonable distance for most people?
ONE: It’s very important for us to ask, “Where’s home?” before publishing, and as long as we get their appointment within about 15 miles of where they live or are staying, they’ll likely make it there.
Q: Does the prison offer “bridging medication” or prescriptions for people with OUD so they have their medication until they can find a community health provider?
ONE: Yes. We call the buprenorphine prescription at a local pharmacy when they’re discharged, and they can pick up a seven-day supply of medicine for free thanks to government grants.
We try to schedule their first appointment two to three days after discharge, so having a seven-day supply gives them an extra cushion. We have found that the seven day supply is the right amount; If we were to give a two week supply we would be concerned that they might not make it to their dates at all.
Q: Approximately how many people are taking medication after being released from your prison?
ONE: About 80%. They can switch from the drugs they used in prison to another FDA-approved drug, but they’ll still be treated with one of those.
Q: Has the program changed during the pandemic?
ONE: If people test positive for COVID-19 when taking it, we need to switch their medication to sublingual buprenorphine tablets so we can spend less than 15 minutes with them. We’ve also seen many more relapses, in part because the shift from community programs to virtual surgeries created challenges for people leaving prison and seeking support.
Q: How do you measure the success of your re-entry program?
ONE: Each month, we submit data to the New Jersey Department of Human Services as part of our state grant agreement. We track whether people made it to their first and second appointments and whether they returned to prison. The data was very helpful in finding trends.
Q: What have you found out so far?
ONE: The majority of people make it to their first appointment in the first 30 days, and about half make it to their second. But about 30% never make it to any dates, and we’ll likely see them back in prison. For this group, we’re looking to see if there’s anything we can do to change our practices.