For the past three months, a select group of inmates in the Bernalillo County's Metropolitan Detention Center in Albuquerque have been receiving maintenance doses of methadone as a treatment for heroin addiction, New Mexico officials announced at a Tuesday press conference. Some 50 inmates have participated in the program since it began in late November. The program is part of the Department of Health's comprehensive public health office inside the jail, where staff provides immunizations, STD testing and treatment, educational programs and other public health interventions.
Although controversial in some sectors, giving maintenance doses of methadone to heroin addicts is a scientifically proven and accepted means of treating heroin addiction. Hundreds of studies of methadone maintenance therapy have been conducted by researchers around the world, and they show that it leads to decreases in heroin injection, overdoses, infection rates for HIV, hepatitis B and C and sexually transmitted diseases, criminal activity, and the use of other non-opiate drugs, while allowing clients to improve their chances of securing and keeping employment and maintaining normal lives.
Despite methadone's proven efficacy, its use among prison or jail populations is almost unknown in the United States. The number of correctional institutions that allow methadone maintenance therapy in the US is in the single digits, with most concentrated in the Northeast. The Bernalillo County Jail program is the only one in the Southwest.
The program is a collaborative project between the New Mexico Department of Health, Bernalillo County, the city of Albuquerque, and CRC Health Care, the nation's largest drug treatment provider. If the two-year pilot program proves successful, it could be expanded into other jails and prisons in the state, officials said.
"We are conducting the pilot study to determine whether methadone maintenance treatment improves jail operations by reducing infractions, and improves inmates' wellbeing by reducing the need for medical care," said Dr. Sandra Lapham, director of the Behavioral Health Research Center of the Southwest, which has received a grant from the Robert Wood Johnson Foundation to evaluate the program. "This program, if successful, could serve as a model for the rest of the state and nation," she said.
"The Department of Health opened one of the nation's first public health clinics inside of a jail in 2004," said Health Secretary Michelle Lujan Grisham. "We're building on the success of that program and continuing to lead the country in providing public-health interventions that will make our communities healthier and safer."
"Drug treatment, community education and employment are ways of dealing with the problem, not just the symptoms," said Bernalillo County Commissioner Tim Cummins. "That's why Bernalillo County took the lead in locating a public health facility within the Metropolitan Detention Center that represents another component in the continuum of mental health, medical and substance abuse care within this community." Under the pilot program, inmates who were enrolled in an outside methadone maintenance program when they were arrested and who are not headed for prison are given the opportunity to continue their treatment while imprisoned.
The pilot program won praise from former drug czar Gen. Barry McCaffrey, who attended the news conference. "Drug treatment for the prison population provides an opportunity to reduce crime and recidivism in a prime target group -- it can make a big difference in crime," Gen. McCaffrey said. "The New Mexico methadone program will help addicts who otherwise would return to heroin, OxyContin and other opiates, as well as a life of crime. This is a national model program with huge potential."
It didn't come easy, though. "This has been an extremely long process," said Dr. Bruce Trigg, the Department of Health public health specialist who played a key role in keeping the idea alive. "It only took five years," he laughed. "They used to allow an outside methadone clinic to deliver doses to the jail in the 1990s, and that happened in other jails across the country, too, but the idea of providing methadone to inmates went out of favor because people thought it was not keeping people 'drug free,'" he told DRCNet.
"We talked to the previous jail director for five years because we were concerned that methadone had been removed, and he suggested that we put an entire public health clinic in the jail and methadone maintenance could be part of that," Trigg explained. "But then they built a new jail, and that put everything on hold for two years. Then we had to scramble to get money that had been set aside earlier and reallocated. Then the original treatment contractor was sold to CRC, and it took them awhile to get on board."
It wasn't just institutional obstacles, but also a culture clash between law enforcement and public health approaches, Trigg said. "Two very different cultures had to establish a relationship and a basis for trust, and that took some doing. But after we were operating in the jail for two years, they know pretty well who we are. We met with correctional officers to educate them on this before the program started, and we continue to meet with cadets during training to explain the concepts of harm reduction and methadone maintenance to them."
"It is not a natural marriage between health care and corrections," said Phil Herschman, president of CRC Health Care's opiate treatment division. "There is a lot of work that has to be done around winning acceptance of such programs in correctional facilities. There is also a sense that you should be able to 'just say no' rather than an acknowledgement that substance abuse is a disease that can be treated," he told DRCNet. "One of the most impressive things about the Albuquerque program is that it has surpassed those obstacles to become a state of the art collaboration."
"This has been a wonderful collaboration now that we are all working together," said Deborah Busemeyer, a spokeswoman for the Department of Health. "The jail has found it really useful to have public health people inside the facility and they accept methadone maintenance. People recognize this is a way of reducing overdose deaths," she told DRCNet.
"As a medication, methadone is superb at what it does with virtually no side effects," said Herschman. "With heroin and other opiates, addicts get an immediate high that then drops off and then they have to look for the drug again," he explained. "With methadone, a dose will last for 24 to 36 hours, and there is no peak, no high, associated with it."
Now, with the state Department of Health leading the way, the jail in Albuquerque has become a proving ground for the drug's efficacy among prisoners. At a cost of $5,000 a year, methadone maintenance may well be found to be an effective way of reducing recidivism among offenders and preventing the state from having to pay $25,000 a year to lock them up on new charges.