CINCINNATI (AP) — The "dope boys" hang out near the jail awaiting newly freed inmates with addiction. They'll hand you a free sample to get you back. Triggers to use drugs again — the corners where you've used, for one — are all around, and any plans for a fresh start easily evaporate.
"In here, it's black and white," said Ashley Pels, a Hamilton County jail inmate, looking around the recovery pod for women. Get released, she said, and "it's like 'The Wizard of Oz.'"
The opioid receptors in her brain just "light up," she said, and her cravings roar back.
There's a big chance of relapse after release, and some who do will die. If they survive, three of four ex-inmates like Pels will end up returning to their addiction — and potentially returning to the crimes they committed to support their addiction.
It's a vicious cycle for the addicted and their families, one that has safety, financial and other consequences for the rest of society. But since May, health care providers at the Hamilton County jail have been using medicine to help break the connection.
Fifty-two inmates now are receiving buprenorphine, an FDA-approved medication that is to temper cravings. They represent about 3% of the jail's daily population.
It may seem like a small number and a simple change. But the jail's health provider, NaphCare, is among a fraction of programs to start medical treatment behind bars.
Jails and prisons across the country have been slow to get on board with this kind of medication-assisted treatment, and addiction specialists say that's just wrong.
Medical studies show that buprenorphine and other opioid treatment medications can keep people safe from overdose and death.
"Addiction is a disease. Even if an individual does not have access to substances during incarceration, the disease remains if it is not treated," said Lindsey Vuolo, director of health and law policy for the Center on Addiction, a national nonprofit focused on the development of evidence-based drug policy.
"Within three months of release from custody, 75% of people who were in prison or jail with an opioid-use disorder experience a relapse to opioid use," said Jon Berg, a public health adviser with the U.S. Substance Abuse and Mental Health Administration.
Yet the most recent U.S. Department of Justice data shows that only 1 in 20 jails and prisons nationwide offer medication for addiction. Only 1 in 200 offer buprenorphine with naloxone, which is known commonly by its brand name, Suboxone.
That's because buprenorphine, classed as an opioid, is often judged by criminal justice officials to be a simple substitution for heroin or other drugs. Medical experts say that's not true: Buprenorphine stabilizes people and lets them function normally without euphoria when prescribed and taken correctly.
"I didn't believe in it," said Albany, New York, Sheriff Craig Apple, who speaks nationally on the opioid epidemic for the national Law Enforcement Action Partnership, an organization that promotes criminal justice solutions. Now he does.
In 2012, Apple started his Sheriff's Heroin Addiction Recovery Program in Albany, providing counseling and only a non-narcotic medicine, FDA-approved naltrexone (known by its brand name, Vivitrol) in his jail. When inmates were released they were directly transported to treatment centers.
The sheriff saw a direct decline in these inmates returning to jail.
But as of December 2018, Apple expanded the program to include all FDA-approved medications, including the opioids buprenorphine and methadone.
And the current recidivism rate — or rate of return to jail — among those who got the treatment is at 16 percent. It's fluctuated from 12 percent to 20 percent, Apple said.
"The addiction isn't making them commit the crime," Apple said. "The lack of money and ability to feed their high is doing that."
To the women in the Hamilton County jail's recovery pod, anti-addiction medicine can mean a second chance at living.
"I can't do this without the medically assisted treatment," Pels said. "I will die.
"This is a disease and it's a progressive disease," she said. "It lays dormant if you treat it, but if you don't treat it . it just progresses."
NaphCare started using buprenorphine to ease withdrawal for inmates last year, but those who were prescribed it were weaned from it after withdrawal ended. The new plan lets inmates stay on the medicine as a daily treatment, said Brad McLane, the company's chief administrator.
The Birmingham, Alabama, company has, or is developing, 20 medication-assisted treatment programs across the nation. The latest are in Ohio's Hamilton, Montgomery and Franklin counties, but others are in Washington, Massachusetts, New Jersey, Oregon, Georgia, Florida and Nevada.
While the programs remain scarce across the country, support among law enforcement officials for medication-assisted treatment behind bars is gaining momentum.
As someone who's struggled with addiction for about seven years, Pels understands the value of buprenorphine. She stayed in recovery for six months while she was prescribed the medicine.
"It helps clear that fog. Makes it to where you don't focus so much on the cravings and getting high," Pels said. "I was able to focus when I went to my meetings, when I went to group therapy or one-on-ones. I was able to focus on my recovery."
Ohio is slowly getting more medication-assisted treatment in its jails through federal money provided this year, said Ellen Augspurger, who's the project director for Ohio's opioid response program.
Butler County, for example, now provides a buprenorphine brand for pregnant women, state records show. Some jails only offer an injectable form of the drug, because that can't be diverted for misuse by inmates.
NaphCare has staff trained to provide all the approved medications, McLane said. In Hamilton County, it's covering the costs as part of its $7.5 million annual contract with the jail.
"If you're in a program where you're taking buprenorphine or methadone and it's keeping you off drugs, we want to continue that," he said.
The effort also continues after jail. The NaphCare team works with Talbert House, an organization that counsels women in the recovery pod, to connect inmates to medication services after their release.
McLane was instrumental in convincing the State of Ohio Medical Board to set aside office-based buprenorphine treatment rules for jails and other short-term treatment locations such as emergency departments.
Hamilton County Sheriff Jim Neil supports NaphCare's plan.
"The county jail is ground zero for opiates and synthetics," Neil said, "because this addicted culture finds its way to the county jail through their behavior. It's something else controlling them and what they do."
If more people are treated and continue treatment, he said, fewer will return to jail, and the jail's chronic overcrowding could lessen.
A program similar to Hamilton County's is in place in Northern Kentucky.
The Kenton County jail has been using a medication-assisted treatment plan that was touted a first in the nation as a partnership with the Hazelden Betty Ford Foundation.
And in Warren County, Common Pleas Judge Robert Peeler, who pioneered the use of injectable naltrexone in 2013 for his Drug Court, said participants with opioid addiction there now may be treated with methadone or buprenorphine.
Peeler, a strong proponent of medication-assisted treatment, made the change after the Ohio Supreme Court encouraged its use.
Jail treatment programs just make sense, addiction experts say.
"Any interruption in the recovery process is going to increase the chances of relapse," McLane said.
The women are educated about all the medications approved for opioid addiction while in Hamilton County jail's specialized pod.
"Everybody has their own opinions on what they want to do," said Samantha Thomas, a 37-year-old inmate who spent time in the pod in May. "A lot of girls said Suboxone helped them stay(drug-free) for a very long time."
Knowing about the options gives them hope, she said. A lot of the women say they're afraid to leave the jail without being on medication for their addiction.
Pels has a plan to try to thwart relapse when she's released in mid-July: She will request the oral medicine naltrexone several days before she leaves. It blocks the effects of opioids and helped her stay in recovery for two years the last time she was prescribed it.
Then, when she's ready to go, she will have a peer mentor pick her up at the jail doors and drive her directly to a medical provider for the naltrexone injection, which is stronger and longer lasting than its pill form.
Thomas, who's now in the jail's general population, intends to come up with a similar plan because she, too, is scared to leave.
"I don't know sober people outside of jail," she said. "I am from downtown. So this is where I get high. So walking out this door, yeah, I'm automatically in the devil's playground.
"I'm taking this very serious. As serious as life and death," Thomas said. "Because that's what it is for me."
Information from: The Cincinnati Enquirer, http://www.enquirer.com