The Tompkins County jail has been commended by a human rights group for its innovative treatment of opiate-addicted inmates.
A report by Human Rights Watch highlighted the jail's buprenorphine program as an example of the sort of medication-assisted drug addiction therapy that all jails in the state should be providing.
As part of the Tompkins program, started a few years ago by the facility's mental health director, Dr. John Bezirganian, opiate-dependent prisoners are started on buprenorphine approximately one month prior to their release date, given a 30-day supply as they leave and then linked with a licensed provider for continuing care. New inmates can also be given the drug to help with detoxification when they first arrive.
Tompkins County is the only jail outside of New York City to offer such medication-assisted therapy, and the only one in the state to use buprenorphine. Rikers Island in New York City also offers short-term detoxification using methadone.
Buprenorphine is not an addictive drug in itself - no matter how much you take you'll only get 20 to 30 percent of the effect of a full dose of heroin or morphine - and combined with another drug, it binds irreversibly to opiate receptors for two to three days, so that if someone shoots up heroin during that time, nothing will happen. And unlike methadone, which is only available locally at clinics in Binghamton and Syracuse, it does not have street value, and can be prescribed by a primary care physician.
Dr. Bezirganian appeared before members of the Tompkins County Legislature's Health and Human Services Committee last month to speak about the 52-page "Barred from Treatment" report, which was released in March.
He said he manages many of the buprenorphine cases himself, both in jail and in the community, and that it seems to be effective. Although not all inmates prescribed the treatment continue with it upon their release, a substantial number do, and Bezirganian said he believes it has saved more than one life.
"It's a highly risky time when people leave a jail. If they return to their environment, there is a high risk of accidental overdose, and relapse in general," Bezirganian said. "This way, at least they have a shot at choosing recovery."
At $5 per pill, the costs involved are relatively small compared to those that could mount down the road if the users continue on a course of addiction and crime, he added.
"You have to take a little bit of a chance, but I think we're ahead of the curve here," he said.
His initiative was praised by committee chair Frank Proto, R-Caroline and Danby.
"Sometimes things don't happen because of great policy decisions," he said. "Sometimes they just happen with personal initiatives like this."
Sheriff Peter Meskill said he believes the program, and Dr Bezirganian's increased presence delivering on-site mental health services at the facility, have led to better treatment overall at the jail.
In November 2006, the New York State Commission on Correction notified county sheriffs and jail administrators of new federal regulations permitting easier administration of buprenorphine, and said that safe and effective opioid withdrawal treatment in jail is part of the generally recognized standard of adequate medical care.
The Human Rights Watch report noted that medication-assisted therapy is widely available outside of prison, with 1,212 licensed buprenorphine providers in New York
"Tompkins County, however, is the only jail outside of New York City that provides medication-assisted therapy," the report stated. "Jails in the other 56 New York counties could correct this problem immediately."
The report also argued that punishment for drug use in New York State prisons is severe and out of proportion to the seriousness of the offense.
"Prisoners who may be drug dependent are punished for symptoms of a chronic, relapsing disease," it said. "Drug dependence treatment is withheld from prisoners who may need it as part of the disciplinary sanction."
The full report can be viewed online at
www.hrw.org.
payback is a bitch!
