For as long as Dr. Carlos Menendez has been there, Family Health Services of Darke County, Ohio, has managed the withdrawal symptoms of patients entering the local jail.
Shakiness, insomnia, nausea, vomiting, and anxiety are all common, said Menendez, who is the chief medical officer at Family Health Services. Without medical attention, death is “always a risk” when a patient with substance use disorder enters incarceration, he said.
In addition, the health center provides treatment to patients who have recently left jail, offering them a combination of medication and mental health services to treat substance use disorders. “Because of our presence in the community, most of the people in jail are our patients anyway,” Menendez explained.
Treating substance use disorders is part and parcel of Family Health Services’ work. In 2020, Direct Relief awarded the health center a $50,000 AmerisourceBergen Innovation Award in Community Health, designed to address the opioid crisis in underserved communities. Within the first six months of funding, Family Health Services reached more than 10,000 patients through their substance use disorder program.
But not long ago, they became aware of an additional need. “The sheriff started telling us too that the county jail is one of the biggest detox units in the area,” recalled Dr. Anna Hatic, who oversees the medication-assisted treatment program at Family Health Services. “If we could find ways to offer better treatment and options…[we could] really help people to live their best lives.”
Working closely with the Darke County Sheriff’s Department and local providers of medication-assisted treatment and medication for opioid use disorder, Family Health Services has begun offering precisely that.
When people are booked into a local jail, they’re screened for drug and alcohol use. Medical staff evaluate whether medication-assisted treatment is an appropriate option; if so, it’s offered to each person who qualifies.
If a prospective patient is amenable, they’ll receive telehealth care from a Family Health Services doctor, and any accompanying medications will be given by a jail nurse who’s been trained in the protocols.
Because patients are in a controlled setting, Hatic explained that a doctor might be more likely to choose vivitrol, a time-release, injectable form of naltrexone that’s one of three medications approved by the FDA for opioid use disorder. “In a jail-type setting, if they’re detoxified,” it’s a good option, she explained. “The health provider controls it a little more.”
Hatic said that a jail setting may be the first time a substance use disorder is identified. “If somebody’s actively using opiates without a prescription, they tend to try not to seek medical care,” she said. “I think they don’t want to be identified.”
Asked what’s unique about treating patients in a jail setting, Menendez said it’s quite similar to offering medication-assisted treatment through telehealth more generally, which the health center began doing in earnest once Covid-19 hit.
Treating a patient for substance use disorder is similar to treating other mental health issues such as depression and anxiety, Menendez said. “Although they probably have depression and anxiety along with their substance use,” he added.
About 60 patients have been screened thus far, and Family Health Services doctors have already noticed some challenges.
“You can understand that a lot of people are distrustful of the system, and they’re not really sure if it’s for their well-being that they’re being asked these questions,” Hatic explained. Complicating matters is the fact that a nurse isn’t always available to screen patients, which means that a correctional officer will conduct a screening instead.
In addition, she said, the variable length of a patient’s stay can present complications. If a doctor has an intervention planned, but the patient posts bail, “they lose the opportunity with very little notice.”
That’s part of why, for Hatic and Menendez, it’s important that treating patients in a jail setting is the beginning of a relationship rather than a one-time event.
On release, patients are given the opportunity to watch an informational video about naloxone, a lifesaving drug that can instantly reverse an opioid overdose, and to receive their own doses of naloxone to carry with them.
In addition, patients have the opportunity to continue receiving care from Family Health Services.
Menendez explained that an advantage of the program is that “we can begin some interactions while they’re still incarcerated,” and continue treatment once a patient is released.
“It is important for us to make contact and for patients to know…‘Once you come back to the community, we have resources here to continue to help you,” Hatic said.