One by one, inmates at the Atlantic County Justice Facility made their way outside in a secured area on a recent Wednesday and stepped into a bus from the John Brooks Recovery Center for their daily dose of methadone.
The inmates are the first in the state to get methadone, a medication assisted treatment for opioid addiction, from a mobile service while behind bars. The jail and the recovery center teamed up for the state's pilot program in order to bridge the gap in services for incarcerated addicts.
"This is a cause near and dear to my heart," Geraldine Cohen, the jail warden, told The Press of Atlantic City. "My son has been in recovery for 13 years with help from methadone. He's now got a really good job, bought a house and is getting married. Hopefully, we can help more people like my son with this program."
The mobile methadone clinic, managed by the John Brooks Center and staffed with experts from the center, county jail and Jewish Family Service, aims to treat pregnant women abusing opioids or on methadone, any inmate already using methadone and addicted people with high risk of recidivism.
The program currently provides medication treatment for about 11 people. Alan Oberman, center director, expects to enroll up to 50 inmates at a time for the program in the near future.
"We know the program will reduce the chance of an overdose once they get out," Oberman said. "One of the most at-risk populations for overdoses is recently incarcerated people. Their tolerance for the drug drops after they are clean in jail for a period of time, so if they use when they get out, they are likely to overdose."
About 65 percent of all the 2.3 million U.S. inmates meet the medical criteria for substance abuse addiction, according to a report by the National Center on Addiction and Substance Abuse. However, it showed only about 11 percent actually receive treatment.
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Equally concerning for experts are the rising rates of overdose deaths. Drug overdose deaths in New Jersey increased more than 20 percent between 2014 and 2015, reaching 1,587 deaths. The majority involved heroin, according to the state Medical Examiner's Office.
National studies and experts say that medication assisted treatment for opioid addictions works, especially when linked with counseling and other services like 12-step programs. Success rates are why Oberman, Cohen and other county officials pushed for five years to start the program at the county jail.
"These individuals will be treated as if they were in John Brooks Center," Oberman said. "A doctor and nurse will see them, do evaluations and physicals, prescribe their methadone and get them linked to programs and continuing treatment services once they are discharged."
Methadone, an opioid agonist, reduces the painful symptoms of opioid withdrawal and blocks the euphoric effects of the drug. Oberman said he plans to also offer inmates naltrexone, commonly known as Vivitrol, which completely blocks the euphoric and sedative effects of opioids.
A third commonly used medication assisted treatment, buprenorphine, known as Suboxone, will not be offered through the program as Oberman said the risk for the medication to be abused is too great. The treatment needs more observation than can be provided at the mobile jail program, he said.
Some people are so dependent on methadone for treatment that the fear of going to prison, where there was previously no treatment, became heightened.
Jane Calabrese, inmate service supervisor, said one recent inmate worried so much about going off methadone in prison that he did not turn himself in on a warrant until he was guaranteed treatment. Out of the 11 program participants, three were new to medication assisted treatment.
The mobile methadone program was established in early August with $335,000 from the state Division of Mental Health and Addiction Services. The money was already awarded to the John Brooks Center for its previous mobile services in Atlantic City.
Dennis Levinson, county executive, said it made more sense to bring the methadone services to the inmates instead of transporting them to outside methadone clinics every day. He hopes the program not only benefits the inmates, but their friends, families and communities they return to.
"We've got them now, and so while we have them, instead of just releasing them without anything, we can now capitalize on treatment," he said. "The worse thing we could do is nothing."
Experts said they hope the program's success will lead to similar services at other jails across the state.
"Even if we can help just one person at a time, that's a success," Cohen said. "And when people share their stories about their addictions and recovery, it continues to take away the stigma."