BOURNE – Imagine that from the time you wake up, until the time you go to sleep you are craving a
substance that, if it doesn’t kill you, it will ruin your life. A craving so strong, you will steal from those
you love, you will steal from strangers, you will risk going to jail, you will risk death just to satisfy it. It
consumes you, it motivates every decision you make. . . it owns you!
The Diagnostic Statistics Manual, a dictionary of sorts that defines psychiatric conditions, defines
these cravings as Addiction. Addiction is a chronic relapsing brain disease characterized by the
compulsive use and seeking of a substance despite its harmful consequences.
Fighting not to satisfy this
craving is rewarded with nausea, vomiting, diarrhea, anxiety, a runny nose, profuse sweating and
irritability. Thus pain is the daily life of an opioid dependent person. But addiction isn’t simply a physical addiction to a substance, it encompasses the whole person; it is psychological, behavioral and physical.
The opioid epidemic that is rampant across Cape Cod and the country has proven to be costly to
both human lives and law enforcement. Fortunately there is treatment which is beneficial to both the
individual and to society. Treatment can return a person to a “normal functioning life,” increases safety in the community, and decreases the cost to tax payers in the form of fewer people being incarcerated.
Medication assisted treatment includes the use of buprenorphine (Suboxone), Methadone or
injectable Naltrexone (Vivitrol).
The best treatment options considers a person’s individual circumstances and risk factors that predict the likelihood of a person‘s ability to stay in and sustain treatment. All of these treatments are only one aspect of a comprehensive treatment plan that includes psychosocial supports. Treatment isn’t a one size fits all proposition. Like treatment for any disease, treatment must be right for the individual.
Many in the community are working with the state legislature to move away from incarceration
and toward community based treatment for those convicted on drug related crimes. Jail can be a good
place to begin the recovery process. For some parents, when their child is incarcerated, they are relieved
because they know that their child is safe perhaps for the first time in a long time.
For those of us that work in corrections, we see it as an opportunity to provide intervention and treatment. Under the leadership of Sheriff James M Cummings, at Barnstable County House of Correction (BCCF) we offer Vivitrol as our MAT. For those who are sentenced or referred by the courts, BCCF offers treatment work groups, counseling and many other classes that are necessary for a person to sustain sobriety, including treatment with the medication Vivitrol. Vivitrol is an antagonist medication given once monthly as an injection. Vivitrol works by blocking the receptors that opioids bind to in the brain, thereby blocking the high and the cravings. Vivitrol, unlike agonist and partial agonist medications such as methadone and buprenorphine is not physically addicting, has no street value or secondary gain, making it a great choice for incarcerated individuals. For all of these reasons, Vivitrol is the right choice for a correctional setting.
Not experiencing cravings is vital to successful treatment; it allows a person to focus their mental
energy on developing new skills and tools to stay sober. When a person is admitted to the facility and are
experiencing withdrawal, the symptoms are treated with medication to minimize the discomfort.
Beginning the treatment process after the withdrawal process is completed is ideal.
The relapse rate for someone leaving jail is around 85-95% (National Association of Drug Court
Professional). An inmate is more than 50 times likely to overdose after having been in jail due to their
tolerance returning to a normal level. This of course is of huge concern to anyone working in a
correctional setting or in the treatment field, and is certainly something any treatment provider or
correctional facility wishes to mitigate. Since we started using Vivitrol in 2012, our recidivism statistics
for those addicted are very encouraging with 65% of those receiving treatment remaining crime free.
Treatment helps to protect against this risk and medically assisted treatment, including antagonist
medication such as injectable naltrexone (Vivitrol), further reduces the risk by blocking the insatiable
cravings associated with drug addiction. Because of injectable naltrexone’s non-addictive properties, lack of secondary gain, and lack of street value, it is the right choice for those incarcerated.
Remember. . . “The right treatment for the right person at the right time!”
Guest columnist Gail Dufault is a nurse case manager and coordinator of the Sheriff’s Heroin and Opioid Crime Reduction Program
