A recovery program housed in Franklin County’s municipal courthouse connects the recently incarcerated with medication-assisted treatment as well as peer support specialists, housing and other services.(Getty Images)
When Nathan Williams was released after a monthlong stint in jail last summer, he headed straight back to the courthouse.
But the 27-year-old from Columbus, Ohio, wasn't headed to a probation meeting or drug court – he was seeking treatment for an opioid addiction that's plagued him for years. Now sober for nearly nine months, Williams credits his recovery in large part to a program housed in Franklin County's municipal courthouse that connects the recently incarcerated with medication-assisted treatment as well as peer support specialists, housing and other services.
Williams had tried to quit heroin before, but says this time is different: The medication he's on ensures he couldn't get high if he tried.
"One of the things that I enjoy is that safety-net aspect," Williams says. "Why am I going to go waste my money to get high when I'm not going to feel anything? Now if I get a thought of using, or an old memory kicks in, within five to 10 seconds it's the furthest thing from my mind."
A Rebirth Behind Bars
The courthouse-based clinic and resource hub is open once a week and represents a unique approach to addiction treatment in a state that's been ravaged by the opioid crisis. There were 4,293 opioid-related overdose deaths in Ohio in 2017, occurring at a rate of 39.2 per 100,000, according to federal data. Only West Virginia had a higher rate that year.
Franklin County, with Columbus as its county seat, has been no exception, with more than 450 residents dying of unintentional drug overdoses in 2018, according to preliminary data.
Often, such treatment programs are run by health departments or nonprofits. Launched in July 2018, the courthouse initiative seeks to help drug users by providing a path for them as soon as they leave jail and addressing the upstream issues driving addiction, rather than continuing to cycle low-level offenders through the criminal justice system.
"If folks are out committing nonviolent misdemeanor crimes because of their opioid addiction, or to feed that addiction, then really the only way we're going to be able to stop that cycle of crime … is to treat the underlying reason," says Columbus City Attorney Zach Klein, whose office secured about $900,000 in federal grant funding to help kick-start the program.
Medication-assisted treatment relies on a combination of behavioral therapy and drugs that can help stave off opioid cravings or block an opioid-induced high. For its medication component, the courthouse clinic uses Vivitrol, a once-monthly injection of extended-release naltrexone, which is one of three drugs approved by the Food and Drug Administration to treat opioid use disorder.
Vivitrol has been linked to "significantly better retention in treatment and lower rates of opioid relapse" compared with no treatment at all, according to a 2018 report for the Department of Health and Human Services. It also can be used to treat alcohol dependence.
Patients must not have taken opioids for at least seven days before starting Vivitrol, though. So while the medication may be well-suited for a drug user coming from detox – whether voluntary detox or through incarceration, like Williams – a person wouldn't be eligible to use the drug if they're actively using opioids.
Q&A:Treating the Trauma Behind Addiction?]
Wiliams says his month in jail without heroin is ultimately what spurred him to seek treatment. Now, he's recruited several of his friends into the program, and plans to continue his medication-assisted treatment for at least another year.
"For what it's done for me in nine months, I can only imagine what my life is going to be like in another year," Williams says. He's back at work in construction, and is hoping to buy a house soon.
Inmates in Franklin County jail are screened for opioid withdrawal, and if they qualify and express an interest in getting sober, they're brought to the clinic as soon as they're released. As a condition of probation, judges also can refer them to the clinic, where they typically receive a first shot of Vivitrol and are connected with social services such as the Supplemental Nutrition Assistance Program, Social Security or Medicaid.
Williams, for example, got help getting into an inpatient recovery program and applying for Medicaid so he could afford Vivitrol, which is significantly more expensive than other medications used to treat opioid addiction.
"After giving them the Vivitrol, they have at least 30 days at that point where their cravings are completely eliminated, and they're blocked from getting high on opiates and drunk on alcohol," says Jessica Gurwin, who oversees the program's Vivitrol component as the regional program director for Positive Recovery Solutions, which coordinates addiction treatment services in Ohio and Pennsylvania.
"It really helps give them this safety net to take all those next necessary steps: counseling, behavioral health, housing, whatever that might be," she says.
When patients come back for their next Vivitrol shots, program coordinators already have contacted their behavioral health providers to ensure patients are keeping up with their counseling. Patients on probation also can schedule their Vivitrol appointments for the same day as check-ins with their probation officers.
Convenience and collaboration have been key to getting people started in treatment and keeping them on track, Gurwin says. Since the courthouse clinic launched last July, 144 people have come in for a first visit and Vivitrol shot – including 120 who came directly from jail – and 83 remain engaged in treatment, she says.
"The window for wanting to get clean is pretty small," Gurwin says. "When somebody is coming to you for help, you want to do that right away, because they could change their mind an hour later."
As the program grows, the city attorney's office plans to measure recidivism to determine whether it's keeping participants out of jail. Officials also hope to pilot a similar program that specifically targets nonviolent offenders whose crimes are tied to issues like alcohol abuse, mental health problems, poverty, lack of housing and food insecurity.
People who qualify would work with coordinators to create "a truly encompassing plan that guides and allows the defendant to get back on his or her feet," Klein says. The program would focus on "treating them and linking them with services to deal with (them), and then if you're able to show progress, then we're going to consider dismissing the charges."
Gurwin hopes the initial success of the courthouse program will allow her to bring a similar model to more areas in Ohio, particularly to rural counties, which may have fewer treatment providers available to drug users looking to get sober.
Buy-in and close collaboration among many local partners – judges, the sheriff's department, city prosecutors, social services agencies, addiction treatment providers and local health departments – are required to establish a courthouse treatment model, Gurwin says, as is a determination to counter stigma around addiction and the idea that medication-assisted treatment is merely substituting one drug for another.
It's a tall order, Gurwin says, but the program's success in Columbus makes her confident it's possible elsewhere.
"The courthouse is becoming a place of safety and a place to get help, rather than this big scary thing to run away from," she says. "People are confronting their problems head-on, rather than just running."
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