Medication Assisted Treatments (MATs) are a central component of Opioid Use Disorder (OUD) treatment, and are especially vital to the prison and jail populations who struggle with addiction at a disproportionately higher rate than the general population, according to a study called Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. by The Department of Health and Human Services.

“Correctional Facilities showed that 23% of state prisoners and 18% of federal prisoners report lifetime use of heroin and other opioids,” the study wrote.

Because people are forced to remain sober throughout their time in correctional facilities, their tolerance levels often increase and they are therefore more likely to overdose when they are released.

“Within two weeks of being released, former inmates overdose at rates nearly 130 times as high as the general population,” according to an article by Stat News.

Because of this, it is especially important that treatment is administered prior to their release.

MATs, in this study, is a term used in reference to methadone, buprenorphine, and naltrexone – three drugs used to counteract the effects of opioids. Methadone is one of the most widely used forms of opioid addiction treatment, and it is a full opioid agonist which reduces the symptoms of opioid withdrawal and increases treatment retention. Buprenorphine is a partial agonist which is effective in reducing illicit opioid use and addresses opioid withdrawal and cravings, similarly to methadone. Naltrexone is an antagonist that has not been thoroughly researched or approved by the U.S. Food and Drug Administration, but studies show that it also increases treatment retention and reduces illicit opioid use.

Despite the positive effects that MATs can have on a person’s battle with addiction, these treatments are rarely used in correctional facilities, depriving inmates of the opportunity to rehabilitate while incarcerated.

This study investigated the effects of MAT treatment during incarceration on inmate substance use and treatment initiation post-incarceration. Results showed that participants who used any of the aforementioned treatment drugs throughout incarceration were more likely to engage in community-based substance use treatments post-release, as compared to those who solely used methadone for detox purposes.

“Pooled effects from the meta-analysis suggest that inmates who received methadone during incarceration were more than 8 times as likely to engage in community-based substance use treatment compared to those who did not receive methadone during incarceration, and there was consistent support for engagement in treatment across observational studies.”

Studies examining the effects of buprenorphine and naltrexone found similar results. Participants on buprenorphine were more likely to engage in treatment post-incarceration compared to participants receiving methadone. Additionally, individuals with a naltrexone implant were more likely to participate in treatment six months post-release compared to a control group receiving methadone.

This is a method proven to be effective in reducing illicit opioid usage, and working to incorporate it into prison systems should be a leading priority for criminal justice officials.

Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: a meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43. https://doi.org/10.1016/j.jsat.2018.12.003

People who have a history or are currently dealing with addiction are especially vulnerable to relapse when faced with isolation, and this is especially worrisome given the intensity and duration of isolation associated with the COVID-19 crisis. With restrictions on travel and unusually stressful economic and social changes, people across the world are forced to find ways to pass time and to cope with stress. Substance use can be a maladaptive coping strategy that many people may fall back on during these difficult times.

A Forbes article noted that the sales of spirits spiked about 50% the week of March 21, a week when the onset of the pandemic began to overwhelm the United States.

“Nationally, tequila saw the biggest spike, up more than 75%, underscoring its status as the fastest growing spirits segment in the U.S,” said Forbes contributor, Joseph V Micallef. “It was followed closely by gin. Wine sales were up 66% and beer sales, in a reversal of the usual recession consumption pattern, lagged even though they still rose 42%.”

A study was conducted by the Pacific Neuroscience Institute (PNI) on the effects of stress and isolation on relapse. The results indicated that the effects of people who struggle with drug or alcohol use are at increased risk of relapse in isolation. “Preclinical studies show that animals kept in isolation are more likely to press a lever to receive a dose of drug or alcohol than animals able to interaction with other animals.”

The connection between isolation and an increased need for stress-relieving rewards is proven to be a chemical reaction. The PNI recommends that those who are struggling seek out regular social interactions with sober family members, friends or other people who can offer support. There are online platforms set-up to support individuals who are struggling and cannot receive in-person help during the pandemic.

AA and SMART Recovery are two recovery platforms that have online services including specialized group forums, peer support groups, meetings, and other events designed to create remote support systems for individuals in need.

Doctors and mental health specialists are also accessible throughout this time and available to ensure that everyone has the resources they need during this global health crisis. Personal health is of the utmost priority during this time and is something we could all focus more time on.

Reach out to any people or organizations who can help you get through this difficult time, and don’t forget to make your support available to others as well. We’ll all get through this together.

As the coronavirus epidemic continues to affect the country, parents and children involved in the child welfare system face unprecedented challenges. These challenges include restricted visitations, lack of access to social and behavioral health services, and added stress for children who will age out of the system during a time of nationwide isolation.

The CARES Act, a $2 trillion stimulus plan for the American economy passed by Congress, will provide modest additional support to programs at the Administration for Children and Families, a division within the Department of Health and Human Services. The Chronicle of Social Change reports this support includes:

• $45 million for Child Welfare Services, about a 15% increase to the 2020 allocation for this program.
• $45 million for the Family Violence Prevention and Services program to help shelters and the National Domestic Violence Hotline, a 25% increase to the 2020 allocation.
• $25 million for immediate assistance to help programs in the Runaway and Homeless Youth Program.

While the additional funding will assist children and families so that their basic food and housing needs are met, child welfare advocates are requesting far more funding than what has already been allocated according to a separate report in The Chronicle of Social Change. Specifically, the Child Welfare and Mental Health Coalition is asking for more than $3 billion in the next stimulus. Their request includes:

• $1 billion for Community-Based Child Abuse Prevention, to support maltreatment prevention efforts including abuse and neglect hotlines, home visiting programs, and family resource centers.
• $1 billion is being requested for Promoting Safe and Stable Families, a part of the Title IV-B program that supports family preservation, reunification and supports for adoptive and guardianship parents.
• $500 million for the Child Abuse Prevention and Treatment Act to mitigate disruptions in the system that will likely occur as social distancing measures continue to exist.
• $500 million increase the Chafee Independent Living Program to offer rapid transitional housing for current and former foster youth.
• Additional funding to raise the reimbursement in foster care prevention in the Family First Prevention Services Act from 50 percent to the state-by-state Federal Medical Assistance Percentage rate, which may remain at 50% or increase to above 70% for states with the lowest per-capita incomes.

Stay up to date with changes in child welfare funding throughout the COVID-19 outbreak on The Chronicle of Social Change website.

Children in foster care are highly at risk

The approach to treating substance use disorder (SUD) has been changing to be more recovery-oriented. There is a shift from treatment and control of symptoms to treatment focused on approaches that empower the client to maintain long-term recovery.  Peer recovery supporters (PRS), trained individuals with their own recovery experience, are thought to provide significant advocacy and support for individuals struggling with addiction. PRS support and advocate for their clients as they navigate the successes and setbacks of the recovery process.

Some of the advantages of using PRS are that clients paired with PRS:

• Formed better relationships with their treatment providers and greater utilization of social supports
• Stayed in treatment longer and reported higher satisfaction with treatment
• Had reduced substance use and were less likely to relapse

Peer Recovery Supporters, in turn, express that having the opportunity to share their lived experience with addiction and recovery with others helps them to:

• gain better insight into their own symptoms
• increase social engagement and
• improve their sense of life satisfaction

The use of PRS as a component of a recovery-oriented treatment model is showing promise for promoting long-term recovery. It is expected that the use of PRS in SUD recovery will continue to grow, and agencies may need to make additional adjustments to support PRS. Cultivating agency culture to embrace and promote the inclusion of peers in SUD treatment is vital to having a successful PRS program. Further, agencies should consider the expansion of peer occupational growth opportunities as well as professional development efforts that allow PRS to qualify for advanced positions. Considering the PRS as a valued professional member of the SUD treatment team will help maximize their ability to help clients engage in treatment and work toward long-term sobriety.

References:

Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., … Kelly, J. F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10(JUN), 1–12. doi:10.3389/fpsyg.2019.01052

Ahmed, A. O., Hunter, K. M., Mabe, A. P., Tucker, S. J., & Buckley, P. F. (2015). The Professional Experiences of Peer Specialists in the Georgia Mental Health Consumer Network. Community Mental Health Journal, 51(4), 424–436. doi:10.1007/s10597-015-9854-8

Chapman, S. A., Blash, L. K., Mayer, K., & Spetz, J. (2018). Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders. American Journal of Preventive Medicine, 54(6S3), S267–S274. doi:10.1016/j.amepre.2018.02.019

Research from the U.S. Census Bureau has found that states with higher opioid prescribing rates have higher numbers of grandparents raising grandchildren, even after taking into account other socio-economic factors such as poverty. Data from the 2012-2016 American Community Survey allowed researchers to study the relationship between opioid prescription rates at the state and county level and the number of grandparents raising grandchildren. The study found that opioid misuse was involved in 46% of cases where grandparents are caring for grandchildren in rural areas, compared to 32% in urban areas. Nationally, 32% of children in foster care are being raised by relatives with many more are being raised by relatives outside of the foster care system. Currently, 2.7 million grandparents are raising grandchildren. According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio.

Ohio is making progress in reducing its opioid prescribing rates, but rates are still high. Since 2010, Ohio’s overall opioid prescribing rate has dropped from 102.4 to 63.5 per 100 persons, which is still higher than the national rate of 58.7. Cuyahoga is the only urban county, at 50.1 per 100 persons, have an opioid prescribing rate lower than the national rate. In rural counties, the prescribing rate ranges from Nobel the lowest (17.8) to Jackson the highest (112.5). Ohio continues to be challenged by the misuse of opioids with the second-highest opioid overdose death rate of 39.2 deaths per 100,000 persons.

Grandparents raising grandchildren face many special challenges including mental health concerns for themselves and their grandchildren due to the death or temporary loss of their grandchild’s parent (their son or daughter), financial obligations, navigating the school system, and building networks of social and other supports. To respond to the impact of the opioid crisis on grandparents, the federal government enacted The Supporting Grandparents Raising Grandchildren Act in July of 2019. The act created a federal task force to identify and share information to help grandparents raising grandchildren.

Anderson, L. (2019). The opioid prescribing rate and grandparents raising grandchildren: State and county-level analysis. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-04.pdf

Centers for Disease Control and Prevention. (2017). U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. Retrieved May 31, 2019, from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Cole, P. E., Clausen, K. A., Cook, L., Johanson, M., Cunliffe, J., Associate, R., Rostan, M. (2016). 2016 state of poverty: A portrait of Ohio families. Retrieved from www.oacaa.orgwww.researchpartners.org

National Institute on Drug Abuse (NIDA). (2019). Opioid summaries by state. Retrieved May 31, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

Good Samaritan laws are meant to protect someone from legal liability when providing help to a person in distress. Ohio has had a Good Samaritan Law since 1977 to protect people from malpractice lawsuits when providing emergency medical and non-medical care to someone in need. This protection is not just for off-duty medical professionals but also for any citizen. This law does not protect someone who deliberately acts in a way that they know can cause further harm, or who accepts money, gifts, or any form or payment for helping.

Do you have to help someone in distress? Ohio does have a “duty to rescue” rule and requires you to help someone in distress if:

• You are responsible for the welfare of a child. This includes parents, guardians, teachers, and any adult responsible for the child.
• Your actions caused the danger.
• You started to help – you must continue to help unless the situation changes to put you in danger.

In 2016, Ohio revised its Good Samaritan laws (Ohio Revised Code Section 2925.11) to encourage people to call 911 when they see someone who overdoses. What this law does is provide immunity for minor drug possession, amounts considered to be a misdemeanor or fifth-degree felony, to individuals who seek emergency help for themselves or another person during a drug overdose. The 911 operator receiving the overdose call can help explain this immunity if asked. You cannot be arrested or prosecuted if:

• Law enforcement found the drugs as a result of seeking medical assistance for a drug overdose.
• The person has a drug test and receives a referral for treatment from an accredited addiction treatment program or professional within 30 days.
• The person provides documentation, when requested by a prosecutor, verifying the date and time of the drug test and receiving the referral.

This immunity can be used twice and people on parole or probation are not eligible. The immunity is limited to possession of controlled substances. House Bill 205 is currently in the Ohio Legislature and, if approved, it will expand immunity to include drug paraphernalia.

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Parents involved with child welfare that have substance use (SUD) are often engaged with multiple systems including child welfare, SUD treatment, and the courts. To help families navigate these services and requirements, they can be assigned a Family Peer Mentor (FPMs). What is an FPM, what do they do, and are they helping families with parental SUD stay together?

An FPM is someone in long-term SUD recovery¹ who also has experience with the child welfare system. They also complete a certification training program¹ to learn how to apply their own experiences to help other families. The FPM is the family advocate, connecting the family to needed services and as emotional support promoting sober parenting. The relationship between the FPM and the family is collaborative with the shared goal of achieving parental sobriety and family safety and stability. FPMs are uniquely positioned not only to help families navigate the child welfare system, but also to provide the hope and motivation needed to achieve and maintain sobriety.

To better understand how FPMs help child welfare involved families, a study² was conducted of the services and outcomes of 28 FPMs involved in the Sobriety Treatment and Recovery Teams (START) in Kentucky. Each FPM was partnered with one child welfare caseworker, and this FPM/caseworker team served 12-15 families. This study shows the importance of FPMs in promoting family unification and parent sobriety:

The study also highlights the importance of supporting FPMs’ own sobriety as they transition from child welfare client to an employee supporting families through a very stressful situation. Of the 28 FPMs, 10 had a relapse or other ethical/policy violation that resulted in their removal; however, the remaining 18 FPMs realized stability and growth either with the child welfare agency or with other, more advanced positions.

With the goal of parental sobriety and family unification, the use of FPMs shows excellent promise. Kentucky START and programs using FPMs or peer supporters are not only helping families; these programs are keeping more children from entering out-of-home care while also giving individuals in recovery an opportunity for steady, full-time employment that appreciates their child welfare and SUD experience to help others.

¹Click here for more information on The Ohio Department of Mental Health and Addiction Services (OhioMHAS) certification for Peer Recovery Supporters in Ohio: (https://workforce.mha.ohio.gov/Workforce-Development/Job-Seekers/Peer-Supporter-Certification).

²Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (2018). Peer mentoring services opportunities and outcomes Huebner 2018.pdf. Children & Society, 84, 239–246.

Family Treatment Drug Courts (FTDC) have shown such promise in the US, that they are utilized at an international level.  In England, Family Drug and Alcohol Courts (FDAC) use an integrated approach similar to FTDCs in the US, where the same judge oversees both the care proceedings and the treatment intervention. In contrast to some American FTDCs, if parents don’t follow their FPAC plan, the case goes back to being public law care proceedings where authorities still must prove the child is at risk and the FDAC has no further involvement.

The London FDAC was evaluated for long-term outcomes before FDAC was implemented in other regions in England. All London FDAC cases from January 2008 to  August 2012 were tracked for up to five years after the intervention. The cohort was compared to cases that weren’t provided FDAC. Thirty-six percent of FDAC mothers had previously removed children,  37% had mental health problems, and 71% had experienced domestic violence. The majority of children (87%) of the cases were brought because of neglect, 25% had emotional and behavioral difficulties, and 41% had physical health problems.

Overall, FDAC mothers had better outcomes than comparison mothers. Forty-six percent of FDAC mothers stopped misusing substances, compared to only 30% of the comparison mothers ceased. Thirty-seven percent of FDAC families either continued to live together or were reunited vs. 25% of comparison familiesFifty-eight percent of FDAC mothers sustained the reunification compared to only 24% of the comparison mothers. However, there was no difference in the amount of time it took for the child to be permanently placed. The study also found that the first two years after the reunification was especially risky for mothers. However, about a fifth of all children (both FDAC and comparison) were estimated to change placements after they had received their permanent placement. This study shows evidence of positive, long-lasting effects from FDAC. Additional support for the first two years following FDAC may need to be offered, as this study showed that it is a vulnerable time for families.

Harwin J, Alrouh B, Broadhurst K, McQuarrie T, Golding L, Ryan M. 2018. Child and parent outcomes in the London Family Drug and Alcohol Court five years on: building on international evidence. International Journal of Law, Policy and the Family 32(2): 140–169. https://doi.org/10.1093/lawfam/eby006.