Medically Assisted Treatment (MAT) for Opiate Addiction - Experience Matters
In 2018, Senator Cindy Friedman wrote, “MAT reduces withdrawal symptoms, prevents overdoses, and helps many people stay in treatment. It improves a patient’s quality of life, level of functioning, and ability to handle stress. Long-term studies show that MAT, along with Narcan and counseling services, is the most effective treatment we have to save lives.”
More than a decade earlier:
A 2 Year Pilot Program from 2007-2009, the first of it’s kind in the United States: Alf recognized the influence of substance abuse addiction in causing crime and the difficulty offenders experienced when re-entering the community with an active substance abuse disorder. The program allowed offenders with a recognized abuse history to be treated by up to four different substance abuse programs in Berkshire County before they completed their probation requirements. Ten years later, in 2018, a pilot program among 7 Massachusetts Sheriff’s allowed for medically assisted treatment to facilitate treatment for substance abuse disorder while incarcerated.
In 2007, Alf Barbalunga, Chief Probation Officer, partnered with Berkshire Health Systems, and created and implemented the Berkshire Partnership in Care Pilot Program (BPICPP). This revolutionary program focused on combating opiate abuse, well before the May of 2019 Federal Court decision mandating inclusion of all components of the Medically Assisted Treatment (MAT) in prisons, and enforcing Massachusetts Senator Friedman’s 2019 opiate law.
Alf has recognized the critical importance of medically assisted treatment for opiate users and inmates for 15 years, and will continue that leadership of being a staunch MAT proponent if elected Sheriff in September.
In Contrast - Sheriff Bowler has been behind the times, putting the lives of Berkshire residents at risk of death.
When an inmate is released from prison in Massachusetts, their ability to re-enter society is being threatened by the opioid crisis. The risk of opioid-related death following release from incarceration is 50-120 times greater than for the general public. What’s more concerning is that the threat is immediate. Fatal overdoses during the first month after release are six times higher than for all other post-incarceration periods.
Among inmates who both were released and died between 2013 and 2014, opioid-related overdose was the cause of death for 40% of these people. Consider that as you read on…
In 2012, roughly 18 months after being sworn in as Sheriff, Thomas Bowler spoke at a forum hosted by the City of Pittsfield and Spectrum Health Systems regarding the opening of a methadone clinic to treat opiate addicts.
Sheriff Bowler attended and stated, "How are you going to schedule that, so we don't have a venue that has an enormous amount of lower-class people that are addicted hanging around those people's residential areas, or similar places?"
Many were embarassed and insulted.
Is this how an elected public servant should talk about our addicted population?
90% of the inmates at the Berkshire County House of Correction have Substance Abuse Issues.
How does Sheriff Bowler view the addicts in his care, custody and control?
Six years later, in 2018, Sheriff Bowler was interviewed by Josh Landes of WAMC about medically assisted treatment for opiate addicts.
Sheriff Bowler stated he believed in abstinence, the cold-turkey method. He said:
“Those who are out on the street, and they are on a maintenance program – medically assisted treatment program with suboxone or methadone – once they’re arrested and they come in here, we don’t provide the methadone or suboxone," said Bowler. "First of all, we don’t have a license to do that, for one reason. But at the same time, we’re firm believers in abstinence.”
Bowler went on to say that medically assisted treatment was "misguided," and he was upset that state lawmakers "were going to force this medically assisted treatment down our throats."
However, it was Sheriff Bowler who was misguided. The facts are that while abstinence may work for some, prisoners released from his abstinence program did overdose and die following release, because a prisoner relapsing after a “cold-turkey” abstinence program who obtains opiates on the street is at greater risk of opiate overdose, especially drugs tainted with fentanyl.
Sheriff Bowler knew about these deaths, and had he compiled his own data, he would have realized that his abstinence program wasn’t working; instead, he continued his program.
That same year, Sheriff Bowler was interviewed on TV about medically assisted treatment, where he claimed that his abstinence method was superior to medically assisted treatment, and again complained that MAT was being implemented by other Sheriff’s, and he felt that “a lot of it was being shoved down our throat”. The host of the show then reminded Sheriff Bowler that the Massachusetts Department of Health found that:
“The opioid overdose death rate is 120 times higher for those recently released from incarceration compared to the rest of the adult population.”
Additionally, Mass DPH found “in 2015, opioids accounted for almost 50% of all deaths among formerly incarcerated people. This is especially horrifying given that proven treatment methods for opioid use disorders exist — they just aren’t accessible to people in and recently released from prison.”
Fortunately, in 2018, the same year that Bowler was upset about MAT, Senator Cindy Friedman sponsored MA legislation (which passed in 2019) to increase access to medically assisted treatment for prisoners, creating a pilot program that was implemented by Hampden, Hampshire, Franklin, Middlesex, Norfolk and Suffolk county Sheriffs, while Sheriff Bowler watched from the sidelines.
Senator Friedman wrote, “In Massachusetts, nearly 1 out of every 11 individuals dying from opioid-related overdoses has a history of incarceration in state jails and prisons, and in 2015 alone, nearly 50% of all deaths among those released from incarceration were opioid-related. In response, this bill makes significant strides towards extending access to medication assisted treatment in correctional facilities.”
Members of the Massachusetts Sheriffs’ Association then launched what it called “a landmark initiative providing expanded medication-assisted treatment options to those with opioid-use disorder at correctional facilities in seven counties.”
“While we need to continue our efforts to end the criminalization of substance use disorder and mental illness, we must do everything we can to meet the needs of those who are currently incarcerated,” said Sen. Cindy F. Friedman (D-Arlington), who helped champion the 2018 comprehensive opioid treatment bill that established the pilot.
“The creation of this program is an important and ground-breaking step toward addressing substance use disorder within corrections so that people can get the medication they need and have the opportunity to recover.”
Meanwhile, improvement was slow in Berkshire County.
In 2019, following a Federal Court Case mandating MAT treatment in prisons, Sheriff Bowler finally began offering buprenorphine to treat Opiate Abuse Disorder, 8 years after he was sworn in.
In February 2021, the United States Attorney’s Office for the District of Massachusetts (USAO) opened a compliance review of Sheriff Bowler, under Title II of the Americans with Disabilities Act (the ADA), as part of a review of all Massachusetts county sheriffs’ offices that had not implemented a program offering all three forms of medications used to treat Opioid Use Disorder (OUD).
In November 2021, during an interview with the Berkshire Eagle, Sheriff Bowler stated that while he had doubted MAT,
“The jail and house of correction now offers Vivitrol, Suboxone and methadone”….
And, “While he previously expressed doubts with medically assisted treatment, Bowler said he later saw that treatment was “starting to assist people and their families.” Adopting medically assisted treatment has allowed the facility to obtain Department of Public Health licensing as a treatment facility, Bowler said, estimating that the facility has used Vivitrol and Suboxone for around two years.”
Tragically, during nearly ten years of resisting the data and advice to administer MAT, Berkshire residents lost their lives to opiate overdoses following their incarceration; these are lives the Sheriff was sworn to protect. This attitude against MAT will change if Alf Barbalunga is elected Sheriff this September. As someone who specializes in the care of prisoners after their release, Alf has been a leader and proponent of MAT treatment for more than 15 years.
