PROVIDENCE, RI - A new study by researchers from Brown University and UNC-Chapel Hill has found that an addiction treatment program for inmates that Governor Gina M. Raimondo launched in 2016 is linked to a 61 percent drop in post-incarceration overdose deaths. The study, which compared the first six months of the new program with the six months prior to implementation, was published today in the Journal of the American Medical Association (JAMA) Psychiatry.
Governor Raimondo announced the findings of the study at a meeting of the Rhode Island Overdose Prevention and Intervention Task Force.
"Our number-one goal in fighting the opioid overdose crisis is simple: save lives," Governor Raimondo said. "But to do that, we have to use every tool in our toolbox. Our data told us that too many Rhode Islanders leave prison and overdose. So, we took action, and created this program with the Department of Corrections. Now, we are beginning to see results. We still have a lot of work to do, but this study lets us know that we are starting to move in the right direction."
In 2016, Governor Raimondo included $2 million in new funding to launch the nation's first comprehensive program that screens all Rhode Island inmates for opioid use disorder and provides access to medication-assisted treatment (MAT) to inmates at the Adult Correctional Institute (ACI) in need of treatment. The ACI program was part of a comprehensive set of initiatives launched in 2016 that were designed to combat Rhode Island's addiction and overdose epidemic. Other initiatives included new funding to support the creation of nine 'Centers of Excellence' treatment centers (with two satellite locations).
Governor Raimondo's FY19 budget proposal continues funding for these programs. In addition, the Governor has proposed funding for a new apprenticeship and job training program for Rhode Islanders in recovery.
The administration of MAT at RIDOC is a major component of the treatment strategy in Governor Raimondo's Overdose Prevention and Intervention Action Plan. Incarcerated and formerly incarcerated people are one of the groups at the highest risk for overdose. People who use opioids build up a tolerance, which then diminishes during periods of incarceration when they are not using opioids. The other focuses of the Action Plan are prevention, rescue and recovery.
The implementation of the MAT program at RIDOC was overseen by Dr. Jennifer Clarke, Medical Programs Director at RIDOC. She was also a co-author of the study.
"While comprehensive treatment for opiate use disorders has not been the traditional role of correctional facilities, we have shown that it is feasible," said Dr. Clarke. "Providing treatment saves lives and helps people become productive members of society, positively engages them with their communities and families which makes for healthier and safer communities."
The number of recently incarcerated people who died from overdoses dropped from 26 in the first half of 2016, before the program started, to nine in the first half of 2017, after the program had been implemented. That decrease contributed to an overall 12 percent reduction in overdose deaths throughout Rhode Island during the same first six months of 2017, compared to the first six months of 2016. Through the first 10 months of 2017, there has been an overall seven percent reduction in overdose deaths compared to the first 10 months of 2016. (The 2017 overdose numbers are not yet finalized.)
The study will be published in JAMA Psychiatry on February 14th. The lead author of the study was Traci Green, PhD, MSc, an Adjunct Associate Professor of Emergency Medicine and Epidemiology at Brown University, a senior researcher at Rhode Island Hospital, and an Expert Advisor to Governor Raimondo's Overdose Prevention and Intervention Task Force. The other authors included two of the chairs of the Task Force: Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health (RIDOH), and Rebecca Boss, MA, Director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH).
"People have been searching for some way to stop overdose deaths," said Traci Green, PhD, MSc. "Here we have a program that's shown to work and it's absolutely replicable in other places. Not only do we see that a statewide program treating people using medications for addiction treatment is possible and reduces deaths, but also this approach intervenes on the opioid epidemic at its most lethal and socially disrupting point-incarceration-to give hope and heal communities."
MAT is administered at the RIDOC by CODAC Behavioral Health. Upon release, former inmates can continue their treatment without interruption at CODAC, with primary care providers, or at a Center of Excellence. Patients are also assisted with enrolling or re-enrolling in health insurance to make sure they are covered when they return to the community.
While a handful of programs elsewhere in the nation provide one MAT drug or another to certain segments of incarcerated populations, Rhode Island's is the only one that makes the full suite of MAT available to every individual coming in or leaving the correctional system.
"We knew that Medication Assisted Treatment was the 'gold standard' for treating opioid use disorders," said BHDDH Director Rebecca Boss. "This collaborative effort between DOC and CODAC has been significant in proving that MAT not only saves lives but helps both the individual and the community to which they are returning."
"Dr. Clarke's leadership and vision at RIDOC have been instrumental to the success of this cutting-edge, national treatment model," said Dr. Alexander-Scott. "As we continue to work to prevent overdoses and save lives throughout Rhode Island, we must use data to identify differences in health outcomes and be sure that treatment and care are in place when and where they are needed most. Addiction is a disease, and recovery is absolutely possible because of life-saving treatment programs like the one at RIDOC."
Other co-authors of the published study were Josiah Rich, MD, MPH, a Professor of Medicine and Epidemiology at Brown University, Director of the Center for Prisoner Health and Human Rights at The Miriam Hospital and an Expert Advisor to Governor Raimondo's Overdose Prevention and Intervention Task Force; Brandon Marshall, PhD, an Associate Professor, Department of Epidemiology, Brown University School of Public Health; and Lauren Brinkley-Rubenstein, PhD, from the University of North Carolina, Chapel Hill.
During today's meeting, Governor Raimondo also formally introduced Tom Coderre as a new co-chair of the Task Force. Coderre, a senior advisor in the Governor's office, was an appointee in the Obama Administration serving as Chief of Staff and Senior Advisor to the Assistant Secretary at the Substance Abuse and Mental Health Services Administration (SAMHSA) from 2014 until January 2017. While at SAMHSA, Coderre led the team that produced Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. He is the former national field director of Faces & Voices of Recovery and former board chair of Rhode Island Communities for Addiction Recovery Efforts (RICAREs). Coderre served as a member of the Rhode Island Senate from Pawtucket from 1995 to 2003 and as Chief of Staff to the Senate President from 2009 to 2014.
"I'm proud to be back in my home state on the front lines of crafting our ongoing response to the overdose epidemic," Coderre said. "As someone who has experienced addiction and has 14 years in recovery, I know the gravity of the opioid crisis firsthand. The disease of addiction affects all of us in one way or another and demands our urgent attention. I am honored to be joining this distinguished group of health professionals as we continue to implement an all-hands-on-deck approach."
"By addressing addiction, in many cases, we are addressing the root cause of criminal conduct, and offering the hope that we can break the cycle of incarceration," said OHHS Secretary Eric J. Beane. "This collaboration with our community partners demonstrates what government should be doing – breaking down silos to make an impact."