As recent court rulings and substance abuse treatment advocates build momentum for some jail inmates to receive opioid-based medication, the Santa Fe County jail’s refusal to allow such methods is drawing interest from county commissioners.
Though no policy changes are on the horizon, commissioners are asking jail officials to brief them on the issue.
“We’re trying to encourage the jail to do what they need to do, consistent with the other programs that they have,” Commissioner Anna Hamilton said. “We’re trying to be supportive, but we’re also trying to get more information.”
Other county commissioners also said they needed more information on the issue, but the jail’s policy of banning opioid-based medication to treat inmates with substance-use disorder was met with criticism recently by members of a county health care advisory board.
“It’s just the national standard of care,” said Dr. Laura Brown, a member of the Santa Fe County Health Policy and Planning Commission who treats addiction patients at University of New Mexico Alcohol and Substance Abuse program clinic in Albuquerque.
The policy and planning commission is an advisory panel to the County Commission.
Brown, who also serves as chairwoman of the New Mexico Medical Cannabis Advisory Board, spoke after a recent commission briefing on the jail’s behavioral health treatment program, in which Brown and other commissioners as well as community advocates called for the use of buprenorphine — better known by the brand name Suboxone — and methadone in the treatment of inmates with opioid addiction.
Both medications are opioid-based but have proved effective at treating patients addicted to heroin and opioid painkillers, such as oxycodone. Instead of these medications, the Santa Fe County jail offers naltrexone, a nonopioid medication shown to decrease cravings for opioids. It is administered only after patients undergo a painful and potentially dangerous period of withdrawal.
Even inmates who have been prescribed methadone or Suboxone before their incarceration are not given access to the medication after their incarceration.
County spokeswoman Tessa Jo Mascareñas said the jail does allow pregnant women in the jail to receive opioid-based treatment if they need it.
The jail policy has drawn interest against the backdrop of a federal judge’s ruling in Massachusetts in November that a man must be allowed to continue using his prescribed methadone while held in jail in that state on an unrelated charge.
The ruling, in the ongoing case, is expected to have implications nationwide.
In late April, a federal appeals court in Boston upheld a decision by a lower-court judge to allow a Maine woman to keep using her prescribed Suboxone to keep her opioid-use disorder in remission.
Emily Kaltenbach, director of the New Mexico office of the Drug Policy Alliance, said she thought the issue would continue to come up as other states have caught up with and even passed New Mexico’s high rates of opioid overdose deaths.
“We are forcing people to withdraw off medication which has made them able to productively live,” Kaltenbach said. “Who wants to withdraw in jail? It’s inhumane.”
The Santa Fe County jail’s response to the inmate treatment trend troubles Brown, who said other facilities’ methods are superior in terms of saving inmates’ lives, reducing health care costs and achieving better rates of recovery.
“They’re not providing appropriate medication-assisted treatment with methadone and/or buprenorphine for the treatment of opioid-use disorder, in the face of an opioid overdose epidemic,” she said.
The Metropolitan Detention Center in Albuquerque has been using methadone treatment for opioid-dependent inmates for years.
Hamilton said the issue was complex for a jail of Santa Fe County’s size. There are problems with jail contraband. Adequate resources and medical staffing also may be concerns.
Hamilton said she would ask for a briefing from the Health Policy and Planning Commission.
Barry Cooney, a new member of the policy and planning commission, told jail officials at the hearing: “You’re falling behind a standard curve of established treatment for people with substance and addictive behaviors.
“That doesn’t at all denigrate your intention to do good,” he added. “It’s just you’re part of a system that’s dysfunctional and probably causing more recidivism than it needs to.”
Mascareñas said the current jail policy is based on the fact that medications that are not addictive, like naltrexone, have no street value. Jail officials have said significant quantities of Suboxone are smuggled into the jail and then distributed among inmates.
Laurie Glaze, the policy and planning commission’s chairwoman, said she’d like to gather more information about the issue, backed with statistics, budget information and best practices before the commission makes a recommendation to county commissioners.
Kaltenbach acknowledged funding and local treatment resources may be holding jails back from adopting opioid-based treatment programs and called for both sides to work together.
“We need to figure out how to chart a way forward,” Kaltenbach said.
Correction: This story has been amended to reflect the following correction. A previous version of this story incorrectly reported Dr. Laura Brown treats addiction patients at University of New Mexico Hospital. She treats addiction patients at the University of New Mexico Alcohol and Substance Abuse program clinic in Albuquerque.