The Medication-Assisted Treatment (MAT) Bridges program was implemented in the Detention Center in 2021 to address individuals with opioid use disorders (OUD) through the use of medications in combination with counseling and behavioral therapies. The types of medications used in MAT for OUD work by attaching to the same receptors in the brain that to reduce cravings, treat withdrawals, and return patients to normal function. The goals of the program include:
- Treat those with opioid use disorder (OUD) utilizing effective MAT programs.
- Encourage participation in counseling and behavioral therapies.
- Build bridges between the Detention Center and community-based treatment providers.
- Reduce recidivism and reduce the return to opioid use within the first 90 days of exiting incarceration.
- Increase public safety.
In May of 2019, Lewis and Clark County was one of 15 counties selected from across the nation to participate in the Planning Initiative to Build Bridges Between Jail and Community-Based Treatment for Opioid Use Disorder program. This program, supported by Arnold Ventures and the U.S. Department of Justice, Bureau of Justice Assistance, was a 9-month planning project designed to help communities develop a comprehensive continuum of care model that targets the jail population and builds bridges between in-custody and community-based treatment. A multidisciplinary MAT Bridges team was formed to research evidence-based practices used in existing jail-based MAT programs across the country and develop a MAT program specific to the needs of Lewis and Clark County. The team included: a County Commissioner, the Criminal Justice Services Director and Behavioral Health Coordinator, Sherriff's Office Detention Center Captain, Physician, and Nurse Manager, and two Federally Qualified Health Centers' (FQHC) Behavioral Health Director and Behavioral Health Program Supervisor.
In 2020, CJS was awarded two three-year grants to assist with the implementation and support of the MAT Bridges program, including $142,000 from the Intergovernmental Institute of Research's (IIR) and Bureau of Justice Assistance's Building Bridges Between Jails and Community-Based Treatment and $600,000 from the Bureau of Justice Assistance's Comprehensive Opioid, Stimulant and Substance Abuse Program (COSSAP).
Since implementation, 86 individuals have participated in the MAT Program in the Detention Center. Low utilization can be attributed to a number of barriers, but none more so than the lack of an in-house physician in the Detention Center. Following State-wide and national labor shortage trends, the Detention Center has been without a consistent in-house physician since 2022. In-house nursing staff are available to administer MAT-medications for individuals booked into the Detention Center with an active prescription but may not diagnose or prescribe. As a solution, the Detention Center and CJS coordinated with PureView Health and Helena Indian Alliance-Leo Pocha Clinic to offer telehealth services for the Detention Center. While this expands access for eligible individuals, Medicaid restrictions on incarcerated people reduce incentives to seek treatment, by obligating individuals pay for the prescriptions and physician services that would otherwise be covered through CJS grant funding. In 2023, CJS will seek an amendment to the COSSAP grant to allow funds to cover MAT services and medications through telehealth.
Additional program access barriers that would not be resolved with an in-house physician include individuals who are released before eligibility determination and individuals whose disposition after conviction is Montana Department of Corrections (DOC). DOC does not currently offer a MAT program, and, while DOC does contract with a number of treatment facilities, they do not all allow for the continuance of a MAT program within their facility. Thus, to prevent the chance of an individual experiencing an abrupt discontinuation and withdrawal from their MAT OUD medication, these individuals are not eligible to being the MAT program within the Detention Center. In 2022, DOC was awarded a grant to address inmate opioid use through the Montana Board of Crime Control. Introduction of a MAT program is one possible option for how DOC may utilize these funds in the future.
Narcan Vending Machines
Three vending machines dispensing Narcan, an FDA-approved "miracle drug" with the ability to rapidly reverse an opioid overdose, have been made available at no-cost to the public, in an effort to increase community access to a life-saving medication. The vending machines can be found on the first floor of the Law and Justice Center, the Our Place Drop-In Center, and the CJS reception area. Narcan works by binding with opioid receptors in the brain and blocking the effects of opioids for 30 to 90 minutes, reversing respiratory depression. Narcan is considered safe, non-addictive and effective at restoring normal breathing. The machines were paid for through the IIR grant, and the Narcan is provided by the State of Montana Department of Public Health and Human Services.
"Our primary goal is to eliminate opioid use in our community. The unfortunate reality is, many of us have neighbors, family, or friends that are struggling with opioid addiction. My hope is that these machines will be a resource for people who are trying to avoid losing their loved ones to addiction." - Chief Brett Petty, Helena Police Department
In the first six months since the vending machines were introduced, 581 boxes of Narcan have been distributed.