Medication Assisted Treatment MAT in the Solano County

Medication Assisted Treatment (MAT) in the Solano County Jail Presented to: the Solano County Board of Supervisors on July 23, 2019 By: Sheriff’s Office with the Solano County MAT in Criminal Justice Settings Learning Collaborative Renee Smith, Solano County Sheriff’s Office Nancy Calvo, Solano Opioid Safety Coalition Dr. Christina Kinnevey, Med. Mark Treatment Center Raymond Courtemanche, Med. Mark Treatment Center July 23, 2019 Medication Assisted Treatment in the Solano County Jail 1

Why Use Medication Assisted Treatment? July 23, 2019 Medication Assisted Treatment in the Solano County Jail

National Data on the Opioid Epidemic Nationally, during the years 2016 and 2017: § § § § § 130+ people died every day in opioid related deaths 42, 249 people died in opioid related deaths 19, 413 people overdosed on synthetic opioids (not methadone) 17, 087 overdose deaths were attributed to prescription opioids 15, 469 deaths were attributed to heroin 2. 1 million people had opioid use disorders 11. 4 million people misused prescription opioids 2 million people misused prescription opioids for the first time 886, 000 people used heroin 81, 000 people used heroin for the first time Source: hhs. govopioids July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Opioid Use in Solano County In 2017: § Nearly 312, 952 prescriptions were written, or about 1 prescription for every adult resident § 3, 980 individuals had an opioid use disorder § 1, 155 to 2, 358 people with opioid use disorders did not have access to opioid treatment § Solano’s opioid prescription rate was more than 20% higher than the State average: • 625 per thousand (Solano) • 517 per thousand (State) § The Solano County Grand Jury released a report on the risks of opioid use to Solano County residents § The Solano Opioid Safety Coalition formed with over 35 partner agencies including local health care providers, public safety, County departments, and community-based organizations July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Solano Opioid Related Deaths In 2017: § Solano had 10 opioid overdose deaths § Solano’s opioid overdose emergency department visits rate was more than 20% higher than the State average: • 13. 4 per 100, 000 (Solano) • Between 11 and 11. 5 per 100, 000 (State) Source: California Department of Public Health July 23, 2019 Medication Assisted Treatment in the Solano County Jail

What is Medication Assisted Treatment (MAT) ? § Evidence-Based Practice in the treatment of Opioid Use Disorders (OUDs) and Alcohol Use Disorders (AUDs) § Viewed as a “Whole Person” approach, it includes: • • Medication Counseling Medical Treatment Services (Diagnostics) Recovery Services § What is Opioid Use Disorder? • Chronic disease of the brain • Causes permanent brain changes • Decreases ability to function at higher levels July 23, 2019 Medication Assisted Treatment in the Solano County Jail

What is Medication Assisted Treatment? (cont’d) The Goal of MAT Treatment is to heal the brain through: § Utilizing medicine to replace the illicit opioids in the brain that cause disease driven decision-making that may lead to criminal behavior, including low impulse control, by: • Developing new habits of thinking and behavior • Addressing medical and mental health challenges • Developing a positive support system July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Results of Study of MAT Implementation in France 80% Reduction in Heroin Overdose Deaths in the General Population Source: Carrieri, Maria Patrizia, et al. “Buprenorphine Use: The International Experience” July 23, 2019 Medication Assisted Treatment in the Solano County Jail

MAT in Criminal Justice Settings Learning Collaborative § Received $25, 000 grant in 2018 to form a team to learn about MAT and develop an implementation plan § Attended in-person learning collaboratives, consulted with advisory groups, and participated in coaching calls, webinars and podcasts § Learned best practices and results from other jails with MAT programs § Identified local treatment center as partner to provide the medication at no cost July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Learning Collaborative Members July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Challenges Facing Local Jails Today § Nationally, an estimated two-thirds of people in jail meet the criteria for drug dependence or abuse • 25% of which have an Opioid Use Disorder (OUD) • Approximately 16 -17% of Jail detainees have an OUD (many more have alcohol and methamphetamine addictions) Source: Bureau of Justice Statistics § The Solano County Jail: Opioid Use Disorder • In FY 2017/2018, 571 individuals were withdrawn from opiates. • During this same time period, 60 individuals entered the jail on some form of MAT but were withdrawn July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Concept: Treat Addiction with MAT in Jail § Continue MAT for inmates in custody • Inmates continuing MAT during incarceration are 3 X less likely to have disciplinary issues than those on forced MAT withdrawal Source: Addiction Medicine March/April 2 -18 § Treating pregnant women with OUD in jails can profoundly impact the health of the fetus and the recovery of the mother § Release from jail without sustained treatment creates high risk of overdose death – risk increases 40 X § Evidence/research shows MAT to inmates works to stabilize and reduce risk of overdose • Rhode Island DOC and Riker’s Island Jail statistics Source: Kelly Pfeifer, MD, MAT in Criminal Justice Settings, 4/23/19 July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Concept: Treat Addiction with MAT in Jail (cont’d) § Highly controlled and regulated facilities provides stability to ensure treatment plans are followed § The National Sheriffs’ Association suggests MAT can reduce recidivism and decrease costs July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Proposal: Solano County Jail MAT Program § Annually maintain up to 60 individuals on their medication if at time of booking they are already on a MAT treatment plan § Med. Mark to provide medication free of charge through grant funding § Wellpath (contract jail medical provider) and Med. Mark to work on medication administration (MOU pending) § Sheriff’s Office to hire a Mental Health Clinician LT with grant funding to coordinate program § § Coordinate tracking, assessment, placement in in-custody MAT program Monitor progress; serve as liaison with partners Coordinate planning community transition Coordinate Naloxone Distribution project July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Proposed Solano County Jail MAT Program (cont’d) § Train Jail Custody, Medical, Mental Health, and Substance Abuse staff in the understanding of and MAT Jail Protocol MAT § Establish data systems to be able to extract project data § Staff program with Sheriff staff as Coordinator with agreement with Wellpath and Med. Mark § Provide progress report to Board prior to FY 2020/21 Budget Hearings July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Proposed Solano County Jail MAT Program – Upon Release § Implement a Naloxone distribution program for inmates upon release from jail and assigned to providers outside the jail § Develop Naloxone administration training module for inmates § Provide Naloxone training to 750 inmates during the year § Develop Naloxone administration instruction card and substance abuse resource card to attach to Naloxone dose and be given to inmates upon release July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Financial Impact § Medications • Provided at no cost by Med. Mark and administered through Wellpath, the jail’s contract medical services provider ü Medications paid for through MAT Expansion Grant (federal/State funds) § Limited-Term Mental Health Clinician (Licensed) will be funded through June 30, 2020 by grants to coordinate inside the jail • Sheriff’s Office to seek additional funding for staffing beyond FY 2020/21 § No additional increase in contract with medical services provider as a result of MAT § No increase to County insurance costs • Will require partners (Wellpath, Med. Mark) to carry insurance • May decrease County insurance costs if fewer injuries to correctional staff result July 23, 2019 Medication Assisted Treatment in the Solano County Jail

Recommended Actions § Authorize County to proceed with implementation of a Medication Assisted Treatment program in the jails § Accept grant for $159, 347 and approve Appropriations Transfer Request to allocate funds § Adopt Resolution to amend the position allocation list to include a Limited-Term Mental Health Clinician (Licensed) through June 30, 2021 § Authorize execution of an MOU for the program § Direct staff to provide update/results of the program before Budget Hearings June 30, 2010 July 23, 2019 Medication Assisted Treatment in the Solano County Jail

QUESTIONS ? July 23, 2019 Medication Assisted Treatment in the Solano County Jail