Is using drugs to quit drugs a viable solution for opioid crisis?


Davin Eldridge – Staff Writer

Editor’s note: Are local jails actually making the opioid epidemic worse? Read more in our latest installment of an ongoing series on the opioid crisis.

Thirty five year-old Michael Kovtuschenko looked into the air above him, scanning it for the right words. He grimaced and shook his head.

“Yeah, there’s really nothing worse than withdrawing from opiates when you’re an addict,” he said, sucking down another puff from a hot-boxed cigarette. “I’m here to tell you right now, it ain’t fun, not in the least. You can’t eat, you can’t sleep, your legs either cramp up or they’re restless, your skin feels like it’s on fire, you get diarrhea—hands down, it’s the worst thing ever.”

Kovutoschenko—or “Schenko,” as his friends call him—was on his smoke break. As a Jackson County gas station clerk, he seldom gets a moment away from the counter. Today, he was eager to talk, and as soon as no customers were in sight, he rushed outside to do this interview, which he requested.

“You know, everyone keeps talking a big game about how ‘we got to do something about this opiate epidemic’,” Schenko said. “But, until they stop treating people trying to get clean as just criminals, they’re only going to make it worse. They’re people.”

It was supposed to be Schenko’s day off, but he needed all the hours he could get, he said. He was still paying for an arrest which landed him in jail about a month before. While on his way to work, in early January, Schenko was stopped by a state trooper for having a broken taillight. Instead of getting a ticket, however, he ended up getting brought into custody for an old warrant from five years ago. “I’d forgotten all about it,” said Schenko. “I’ve been working hard for years to turn my life around. I paid all my dues, y’know? At least I thought I did. But, I haven’t touched any kind of opiate or pill for over four years, and I’ve pretty much quit drinking. So having an old warrant out for my arrest was the last thing on my mind.”

Schenko credits a great deal of his sobriety to a local Suboxone program he entered a few years ago. Suboxone—a prescription drug akin to Methadone—is designed to help recovering addicts like him kick the habit of harder drugs like heroin or morphine. When Schenko told his arresting officer about his medication, he said the officer would not let him take it before he went to jail, and that it would be up to jail staff what happened with his treatment.

“So, I get down to the jail and I tell them ‘I need to take my meds,” said Schenko. “Five hours later I finally get to speak to the jail nurse and she says ‘I can’t let you take that’. I tell her ‘I’m in full withdrawal, I have to take my medicine now—please. I’m on doctor’s orders.’ She said she could maybe give me something in a couple hours, but ‘under no circumstances’ would she give me my meds.”

Schenko said he wasn’t given a reason why he couldn’t take his Suboxone, which is why he wanted to tell his story. As his cigarette got down to the nub, he put it out and proceeded to go back inside.

“That can’t be legal,” Schenko said, turning around angrily. “How they can do that? They can’t just do that to people. It ain’t right. It felt like I was being assaulted—both physically and mentally—by jail staff who view my meds as a joke, or some kind of reason to get high. They didn’t care. All the work I’ve put into getting clean these last few years didn’t seem to matter to them at all.”

Stories like Schenko’s are all-too-common throughout the mountains. Several others have either shared this experience, or know someone who has. The problem seems to be the same, no matter the county—it just isn’t clear to much of the public why no medically-assisted treatment for jail inmates is available.

At a time when America is in the midst of an opioid epidemic—one the Center for Disease Control says claimed the lives of more than 42,000 people in 2016—there’s still much work to be done.

According to Stephanie Almeida, founder of Full Circle Recovery, a private substance abuse, harm reduction and treatment program, this hard-line stance taken by county jails on medically-assisted treatment is counterproductive.

“We have a big drug problem in our community,” said Almeida, who’s been in the treatment game for nearly two decades now. “You’d think it would be all hands on deck to protect and support our young people. But some of these young people—many of these young people in treatment—they want to do what’s right. But if they mess up and get into any trouble around here, then they won’t be able to continue working on what’s important to them—their sobriety… Not without suffering anyway.”

Almeida, like Kovutoschenko and others, feels withholding treatment for inmates comes off as foolish. It’s something deeply embedded within American culture, from back when drugs were a thing to go to war with.

“Oh, you’re withdrawing from drugs? Tough luck. You should’ve thought about that before breaking the law, addict.” “I think we have to remember that relapse is a symptom of their disease,” Almeida said. “Yet when they are affected by their disease’s symptom, we want to kick them out and tell them they’re not ready yet. What other disease do we do that with?”

There are other implications for denying inmates such prescriptions as well, according to the parents of one young person who was recently sent to prison for possession with intent to sell. They asked to remain anonymous.

“When our son was placed into custody at the county jail, he was not given his Suboxone for nearly three weeks,” said the mother, on the verge of tears. “Well, that will take a toll on anybody, I don’t care who you are. Our son was depressed, erratic. Yes, he had problems, but they basically tortured the boy for nearly a month. When he finally went to trial, we couldn’t put him on the stand to tell his side of things because the lawyer took one look at him and said it’d be a bad idea. It all turned out well for the state, even though they would have had less of a case if he could have just spoken for himself.”

Aside from keeping track of the rise in fatal opioid overdoses each year, the CDC also supports numerous preventative measures, like improving prescription practices by doctors, expanding the use of overdose reversal drugs like naloxone, enriching the detection of illicit drug trends, as well as increasing access to evidence-based substance abuse treatment—including medication-assisted treatment.

“An estimated 65 percent of individuals in United States prisons or jails have a substance use disorder, and a substantial number of these individuals are addicted to opioids,” reads a 2011 report by the Legal Action Center, a non-profit law and policy organization which fights discrimination against people with histories of addiction, HIV/AIDS, or criminal records. “This enormous amount of substance use among individuals with criminal justice involvement has far-reaching consequences, including higher recidivism rates, harm to families and children of criminal justice involved individuals, and negative public health effects, including the transmission of infectious diseases and overdose deaths.”

The report—funded in part by Reckitt-Benckiser, the corporation which holds the patent on Suboxone—examined the legality of denying access to medication-assisted treatment to inmates. It examines opioid addiction in the criminal justice system, and what it calls “the widespread denial of access” to medication assisted treatment.

In short, the report analyzed the denial of such treatment as a violation of the federal anti-discrimination laws of the Constitution. Seventy-seven percent of jails surveyed in 2004 failed to use a specific standard treatment for opioid detoxification, according to the report.

The lack of medication-based opioid treatment at the county-level has far less to do with a lack of compassion, and a lot more to do with a need for safety, according to Macon County Sheriff Robert Holland.

“Many times people come in claiming they are on certain meds when actually they are addicted and their doctor says. “I’ve not prescribed them those medications. We utilize our doctor to make those decisions.”

By and large, most county jails throughout Western North Carolina rely on an independent contractor for medical services. Once in custody, an inmate is no longer subject to the orders of their physician as a ward of the state. Instead, these medical contractors refer to the jail’s doctor, who approves or denies administration of prior medications.

Jail staff throughout the region are reluctant to confirm their policy on narcotics-based medications. When asked what inmates can expect if they’ve been prescribed something like methadone or Suboxone, they defer to their medical contractor.

“Our medical provider is a contractor who specializes in working in jail settings,” said Major Shannon Queen, spokesman for the Jackson County Sheriff’s Office.  “We have a nurse here that assesses the person who has been placed into custody.  Their nurse coordinates with the person in custody to determine if they have any prescriptions.  If so, then the nurse and/or the medical provider’s staff doctor coordinates their treatment needs.”

Inmates in Haywood County, just like those in Swain or Jackson, who come in with a Suboxone or methadone prescription, are put under new orders for the duration of their stay.

“The practice of the Haywood County Detention Center is when an inmate is in custody and has been prescribed by an outside provider methadone or Suboxone, is to place the inmate on a medically prescribed detox, unless the inmate in custody is pregnant,” said Lindsay Regner, spokeswoman for the jail. “In the case of pregnancy, the inmate will continue on the prescribed dosage of methadone/suboxone due to the concern and risk to the unborn child.”

For those who can’t make bail that are in clinical treatment, it’s best to avoid jail at all costs to begin with If they want to continue that treatment.

Asked why these “medically prescribed detoxes” have been adopted as the protocol for county jails, not a single none of them was able to provide an answer, or clearly state why they engage in the practice.

Instead, like Jackson County, every detention center contacted for this report  referred to their medical contractor—Southeast Correctional Medical Group (SCMG), of Statesboro, Ga.  SCMG is a privately-owned medical provider that services Jackson, Swain, and numerous other county jails throughout the region.

After repeated attempts by phone and email to find what their reasoning is for taking a non-narcotic stance with inmates, the company stated that they would not comment. SCMG’s parent conglomerate H.I.G. Capital is a private investment firm with some $19 billion in investment capital. The group states on its website that it believes in community engagement, emphasizing the importance of local coordination between the company and its clients.

“We understand the challenges that counties face with rising medical cost, rising pharmacy cost, and the difficulty in managing health issues created by patient lifestyles,” reads the site. “We believe in applying technology to get specific results. Our Dashboard system allows all stake-holders to continually monitor the progress of our programs focused on cost savings, utilization, and patient outcomes. We strive for a eco-friendly paperless environment using an internet based Electronic Health Record and reporting system. We also use video conference technology to communicate internally between our clinics to encourage best practice exchange… We believe in partnering with our industry stakeholders and taking a leadership role in reforming the corrections healthcare delivery system.”

Allison Judge, the CEO and founder of Transform, the company charged with managing outsourced inmate medical services under SCMG, said the company plans to improve its infrastructure, expand its footprint, and “positively impact the lives of more patients.”

According to Almeida, two Methadone clinics are located outside of Asheville, and 11 Suboxone clinics operate within a 50-mile radius–all of which handle hundreds of patients–not counting private general physicians. Each county has its own jail, and most of them use SCMG.