SOUTH SALT LAKE — Salt Lake County has a new strategy to combat the opioid crisis from inside the county’s jail.

Speaking at the sheriff’s office on Wednesday, Salt Lake County Mayor Jenny Wilson announced the expansion of the jail’s medication assisted treatment program. The new approach seeks to address the opioid epidemic by administering medication designed to treat addiction and providing patients with substance abuse counseling while they are in jail custody.

“Not only is this intervention the compassionate thing to do, it’s the cost-effective thing to do,” said Wilson, who hopes the expansion will curb recidivism rates for individuals struggling with substance abuse.

According to Brent Kelsey, assistant director of the Utah Division of Substance Abuse and Mental Health, 75% of people released from jail with an opioid addiction relapse within 90 days, sometimes fatally. Roughly 400 Utahns will die from opioid overdoses this year.

“Getting people through and out of our jail, making our jail experience a one-time stop … is so important to our bottom line,” Wilson said.

Inmates who are booked in the Salt Lake County Jail are now evaluated by a medical team to see if they need treatment. Anyone experiencing withdrawals can meet with a counselor, who assesses the patient’s needs and puts together a medication plan. Weekly substance abuse counseling is then provided over the course of the patient’s treatment.

With three nurses, three substance abuse counselors, an office coordinator and a program manager, the program’s current capacity is 100 patients. The medications used in treatment vary between methadone, buprenorphine and Vivitrol.

When the inmates are released, Salt Lake County provides them with the overdose-reversing drug naloxone and a bus token. If possible, transportation is arranged to a treatment center.

The county began expanding the program in June, and has since served over 200 people. Over those seven months, only 3% of the program’s participants returned to jail.

“We’re very proud of the program we have,” said Salt Lake County Sheriff Rosie Rivera. “It’s an effective program and it’s helping those who are in our community struggling with addiction.”

Integral to this expansion is Project Reality, a nonprofit that supports medication-assisted treatment services across Utah. Project Reality is one of several nonprofits that partner with the Salt Lake County Jail and help administer methadone treatments.

“Salt Lake County has one of the best systems I’ve ever seen,” said Linda Moore, executive director of Project Reality. “It’s an excellent system run by very forward-thinking people.”

Moore has been with Project Reality for 35 years and has seen a recent shift in the way jails address substance abuse. “The biggest change is the stigma,” she said, adding that state-funded programs give legitimacy to treatments like methadone, which are still subject to controversy.

“Methadone is the most highly evidence-based medication that exists, it’s highly proven. But people don’t trust that.”

With locations in Salt Lake, Utah and Carbon counties, Project Reality hopes the new treatment program can be a model for other Utah jails. Moore says patients are often shocked by the compassion and level of care received at the Salt Lake County Jail.

“Our theme here at the jail is the instillation of hope,” said Jimmie Long, the clinical services director for the Salt Lake County Jail. “We feel like mental health is extremely important.”

Long has worked at the jail for 13 years and is excited to see the county continue to prioritize treatment.

“It’s no longer a kind of black hole. It’s a receiving center and we provide lots of care.”

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Project Reality partners with other organizations in our service spaces. These organizations include funding stakeholders, program and services partners, and resources that provide valuable substance use disorder, mental health, and medical information.

• Utah Naloxone http://www.utahnaloxone.org/
• Utah Support Advocates for Recovery Awareness (USARA) https://www.myusara.com/
• Volunteers of America – Assertive Community Treatment (VOA ACT) https://www.voaut.org/act
• Utah Department of Health and Human Services https://dhhs.utah.gov/
• Salt Lake County http://www.slco.org/
• Salt Lake County Jail https://www.ksl.com/article/46708053/salt-lake-county-program-aims-to-combat-the-opioid-crisis-from-inside-jail
• YWCA https://www.ywcautah.org/
• American Society of Addiction Medicine (ASAM) https://www.asam.org/
• American Association of the Treatment of Opioid Dependency (AATOD) http://www.aatod.org/
• National Institute of Health (NIH) https://www.nih.gov/
• National Institute on Drug Abuse (NIDA) https://www.drugabuse.gov/

How to spot an Opiate Overdose

MEDICATION TREATMENT FOR OPIOID ADDICTION

What is opioid addiction?
Opioid addiction is a long-term treatable medical condition that causes changes in the brain.
These changes lead to a loss of control over opioid use, even when this is causing serious harm.
Opioids include some prescribed pain pills, heroin, fentanyl and other drugs. The medical term
for opioid addiction is Opioid Use Disorder (OUD for short). There are risk factors that increase
the chance of becoming addicted, including if it runs in a person’s family.

Why use medications for opioid addiction?
Most people with opioid addiction who are treated without medication return to using drugs.
Over 80,000 Americans died in 2021 from opioid overdoses. People who are taking a stable dose
of medication for opioid addiction are half as likely to die as those who are not. On average,
people who receive treatment with methadone or buprenorphine are less likely to use dangerous
drugs, get HIV or hepatitis or commit suicide, and are more likely to be employed, have an
improved quality of life and live longer compared to people who do not use these medicines.
These benefits are more likely with longer periods of medication treatment.

What medications are helpful?
Methadone and buprenorphine are opioid medications that are important tools to help people
regain control over drug use. They allow people to feel normal and to function normally, without
withdrawal symptoms, cravings or feeling high. And medications don’t get in the way of
working, taking care of family or other responsibilities. People on methadone or buprenorphine
can have essentially any job, including many that involve driving. Reaction time is not affected.
On the right dose, drowsiness does not occur unless other drugs are also taken.

Injectable naltrexone (brand name: Vivitrol) is a non-opioid used to treat opioid addiction.
Unlike methadone or buprenorphine, naltrexone has not been shown to reduce overdose or
death. With less evidence of effectiveness, it is considered by many to be a second-line option,
compared to first-line methadone or buprenorphine, for most individuals with moderate or
severe OUD. However, injectable naltrexone is an important option that may be preferred in
some circumstances.

Is medication for opioid addiction just “trading one addiction for another”?
NO. Methadone and buprenorphine are opioids, and if you stop taking them suddenly, you do
have withdrawal symptoms. The medical term for this is “physical dependence.” But addiction
is much more than just withdrawal symptoms. There are long-term changes in the brain and
psychological cravings for more and more of a drug even when this is causing serious harms.
Patients on methadone and buprenorphine can be free of cravings and can regain control.

How long should these medications be used?
People should typically remain on medication until they are in long-term recovery for at least several years because of the very high risk of relapse. Some people come off slowly after several
years and do well. But many or most people who do well stay on medication for many years or
decades. People have the right to gradually come off of medication even if the doctor
recommends against it. People are not congratulated for coming off of medication; the goal of
treatment is recovery with whatever tools a person chooses.

What are risks of taking these medications long term?
Opioids including methadone, if used with alcohol or sedatives, can cause drowsiness or
overdose. A methadone overdose could occur if it is increased too quickly. Any opioids,
including methadone, can cause or worsen sleep apnea, and can be more risky with certain
medical conditions. Any opioids could potentially reduce testosterone in men, which can cause
sexual problems. Low testosterone could also cause low bone density, especially with other risk
factors such as tobacco or alcohol use, HIV or poor nutrition. As a precaution, an EKG is done at
certain doses of methadone, to see if there is any risk of a very rare irregular heart rhythm. All of
these risks are lower with buprenorphine compared with methadone or other opioids.
Otherwise, there are no significant long-term health risks from methadone or buprenorphine.

SOURCE: Stop Stigma Now (www.stopstigmanow.org)