2018-08-15 / Front Page

IDOC changes treatment policies for opioid addiction

Nicole DeCriscio

A panel discussion during a break out session from the Statewide Opioid Summit revealed details of what the Indiana Department of Corrections (IDOC) is doing to help criminals with substance use disorders.

Stephanie L. Anderson, the executive director of addiction recovery services for the Indiana Department of Correction, talked about the changes made in the medication-assisted treatment (MAT) given to prison inmates.

“We’ve done a lot more than just implementing MAT,” Anderson said. “Recovery While Incarcerated (RWI) is our new treatment program… What we need to know about RWI for us is that it was really transforming the way we did all of our treatment services at DOC, our behavior health services in general.”

Anderson said RWI was a response to Governor Eric Holcomb’s call to action and that it shifts to a recovery- oriented system.

“We’ve changed policies so we can provide the right treatment at the right place at the right time to the offender that is needing and wanting it right now. We developed a full continuum of care treatment services as opposed to a one size fits all model that we did in the past. We looked at this recovery-based environment, which meant we had to train staff across the board on what we mean by recovery, not just our treatment providers but our officers, our administration, our secretaries, anybody that comes into contact with anybody needed to know what recovery meant to us,” Anderson said. “And then we needed to learn how to individualize treatment curriculums so community-based treatment does individual treatment plans really well but in corrections, we haven’t really quite figured that out yet. In this RWI shift, we really needed to know how do I individualize all of my treatment for this singular guy in front of me, or gal, as opposed to the grand masses that come into us.”

Anderson said they also switched from CBT, or Cognitive Behavioral Therapy, to a 12-step integrative model of DBT, or Dialectical Behavior Therapy.

“What we realized at the Department of Correction was that the men and women we serve are not in a place that’s safe to really explore and change cognitions. There’s still a lot of risk that’s involved with living a life in prison, and so while you’re still feeling that unsafe environment, they’re not going make a whole lot of cognitive process in exploring your feelings and emotions and how those impact your behaviors, but what you can do is learn some skills and learn how to manage your affect and regulate your affect,” Anderson said.

The IDOC also addressed their MAT model.

Historically, IDOC provided Vivitrol, which is an injectable form of Naltrexone, voluntarily to inmates five to seven days prior to their release on parole and set them with a treatment provider. Naltrexone is an antagonist, which is a drug that blocks opioids by attaching to the opioid receptors of the brain without activating them. Naltrexone, in essence, blocks the effects of opioids. A similar drug, Naloxone, also known as Narcan, is used to reverse opioid overdoses.

Other medications used in MAT include Suboxone, Methadone and Buprenorphine which attach to and activate the opioid receptors to suppress withdrawal symptoms and cravings and reduce the impact of other opioids.

With the Vivitrol injections, 12 people elected for the treatment over a three-year span, and only three individuals continued care after release.

“That is a really poor success rate. So we took a step back and said we know there’s an opioid epidemic, what are we missing here?” Anderson said. She said IDOC asked if Vivitrol is still the correct MAT for IDOC to use.

“What we learned was yes, but waiting until they were within five to seven days of release to provide them that injection was really not working well,” Anderson said. “By that point, they knew their release date was coming and they had already started either consciously or subconsciously planning for their relapse, so we were not catching them soon enough in their symptomology for the Vivitrol injection to be really effective.”

She said they determined that Naltrexone was still the best medication, as inmates are not daily users of opioids, but rather occasional users as the drugs are trafficked into the prison.

IDOC did, however, change their MAT protocol.

They started offering maintenance MAT in oral Naltrexone, which comes as a daily dose pill. As a requirement to receive the oral Naltrexone, the inmate must participate in therapy programming.

IDOC expanded the program to include all release types not just those on parole, and they started the oral Naltrexone 60 days prior to release and offer the injection if needed. IDOC also supplies released inmates a 30 day oral supply of Naltrexone and a prescription for an additional 30 days as a backup, just in case they cannot get into a provider within 30 days after release.

As of July 1, the change in MAT has been in effect for nine months. During that time, 341 inmates have initiated MAT, 22 inmates have been released on injected Naltrexone and 12 of those with the injected Naltrexone have continued treatment. Additionally, 23 inmates have been released on oral Naltrexone.

“We’ve really done a huge service I hope,” Anderson said.

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