King County Jail inmates may get methadone

Linda Drummond remembers the pain she felt withdrawing from heroin addiction while in jail more than 10 years ago.

The symptoms — bloody nose, diarrhea, vomiting, dizziness, sleeplessness — were often so severe she couldn't get out of bed and sometimes had difficulty physically functioning when called to court.

"They do nothing for you in the jail right now when you go through withdrawal," said Drummond, 56.

Once out of jail, Drummond was eventually able to kick her habit using methadone, a medicine that stabilizes an addict by acting like heroin without damaging the person's body or providing the euphoric highs often associated with the drug.

Methadone treatment may be available to King County Jail inmates under a pilot project being offered through Public Health — Seattle & King County. If approved, the Jail-based Opioid-Dependency Engagement and Treatment Program (JODET) would start in 2006 and would be only the second such program in the nation.

Mark Alstead, JODET's director, said there are normally between 300 and 400 people in the county's jails who are dependent on opioid substances like heroin. If their addictions are not treated, he said, they are likely to continue using and committing crimes once released.

"Many of those people return to jail, over and over again, and that's expensive," Alstead said. "In addition to the monetary savings there, the idea is to interrupt that cycle of people who are in and out of jail ... over and over again."

Alstead said the $350,000 pilot program, to be funded by local tax dollars as part of the county's criminal-justice initiatives, grew out of recommendations from former Seattle Mayor Paul Schell's Heroin Task Force. The program is subject to approval by two state and two federal drug-treatment agencies.

Task force's origins

The heroin task force was created in 1999, a year after deaths in King County from opioid addiction, including heroin and other drugs such as codeine or OxyContin, hit a high of 144. Alstead said if the county can get those who are addicted to heroin hooked on methadone while in prison, they will continue to use methadone once released and will not commit as many crimes in the community to sustain their former habit.

The only other methadone-treatment program for addicts entering correctional facilities started almost 20 years ago at the Rikers Island jail in New York. Alstead, who visited Rikers last year, said JODET is modeled after that program.

A 2001 report published in the Mount Sinai Journal of Medicine by researchers studying the Rikers Island program noted that "Patients are demonstrating a remarkably low rate of recidivism, given their long history of drug involvement."

Ron Jackson, who has been the executive director of the Evergreen Treatment Center, a King County methadone clinic, for 26 years, said the number of patients served at Evergreen in the past 10 years has skyrocketed from 200 to about 1,200.

"Punishment doesn't work," Jackson said. "One way to both save [inmates] as well as save the community a lot of burned-up resources is helping them get into treatment."

Once the program went into effect, addicts entering jail would be eligible for a 12-day methadone treatment to help them through withdrawal symptoms. After the 12 days, only those offenders convicted of a misdemeanor or low-level federal offense would be eligible for methadone treatment throughout their stay in jail.

Alstead said the pilot program hopes to accept between 50 and 100 inmates. After being released from jail, those in the program would receive vouchers for methadone at local clinics like Evergreen.

A social worker inside the jail would also help inmates in the program plan for life after incarceration, including assistance with housing and medical care.

Methadone treatment in Washington has been controversial particularly due to community concerns about locations of methadone clinics that critics say would attract crime and loitering. But Alstead said he has encountered little resistance to the jail program because it is not being placed in a community.

While forming JODET, Alstead and others consulted people like Drummond who have firsthand experience with the effects of heroin and the benefits of methadone.

"I think when you go into jail and get on the methadone when you're in jail, I think you have a lot better chance of making it and staying on methadone," Drummond said.

High failure rate

Ethan Nadelman, director of the Drug Policy Alliance based in New York, said that forcing people to go through withdrawal without continued methadone treatment causes an 80 to 90 percent relapse rate. "When people leave a jail or prison, it is among the most common times of people to overdose on heroin or opiates and die. [Or] they go back on the streets and [keep] using," Nadelman said.

Drug-treatment programs like JODET are slowly developing around the country, and some experts say they reflect a shift from punishment to rehabilitation in the nation's correctional facilities.

David Olson, a professor at Loyola University in Chicago, is closely monitoring a prison that opened in Illinois less than two years ago devoted solely to drug treatment, although it does not use methadone.

"There seems to be a pendulum swing back to rehabilitation and to provide services," Olson said. "[If offenders are] not receiving any type of treatment, they're getting released and rearrested. The program here was designed to break that cycle ... Seems to be if we don't do anything with them while they're incarcerated, they're going to come out just as bad if not worse."

Reena Szczepanski, director of the New Mexico Drug Policy Alliance, said she was able to use similar logic to help establish a program similar to JODET in Bernalillo County. The new policy provides methadone to those already on the medicine if they re-enter the county's jails. Unlike JODET, it does not provide treatment for addicts not on methadone.

It is illogical not to continue treatment for offenders if they are rearrested, Szczepanski said, because they will turn to illegal and contraband heroin while incarcerated and get hooked on the drug again. "Within the next five years it is going to be the standard of care if cities like Albuquerque and Seattle continue to take the lead and show that this is effective," she said.

International standard

Methadone treatment for those behind bars has become the standard of care in many other countries.

The medicine was introduced into the New South Wales corrections system in Australia in 1987 as a way to combat high rates of HIV in the correctional facilities because of needle sharing, said Kate Dolan, a senior lecturer with the National Drug and Alcohol Research Center at the University of New South Wales. Dolan said it has been so effective that the number of inmates with HIV is down to 20 out of about 8,000.

Drug-related treatments are greatly reducing the levels of HIV, Hepatitis B and C, and tuberculosis in many prisons across Europe, according to a report on substance abuse in prison published by the World Health Organization in May.

Inmates on methadone were also 70 percent less likely to return to prison eight months after their release, wrote Alex Wodak, director of alcohol and drug services at St. Vincent's Hospital in Australia.

Correctional facilities in the U.S. have a history of abstinence-only approaches to drug treatment, something Jim Thorsteinson of Vancouver Coastal Health, one of Canada's largest public health-care providers, said doesn't work.

Thorsteinson said methadone-treatment programs in Canadian correctional facilities have been beneficial in stabilizing addicts' lives and saving money for the community.

"It's a compassionate and pragmatic approach, rather than 'sink or swim,' " he said.

Ari Bloomekatz: 206-464-2540 or abloomekatz@seattletimes.com