Massachusetts County Demonstrates Shift in Thinking on Inmate Treatment

Hampden County, Massachusetts Sheriff Nicholas Cocchi comfortably talks treatment, in a manner that reflects the dramatic changes in how leaders in corrections are viewing the population of inmates with substance use disorders. One of seven sheriffs piloting a statewide effort to make available the approved medication treatments for opioid use disorder across the county jail system, Cocchi says he no longer sees his fellow sheriffs adhering to an abstinence-only mindset. Still, there is work to be done to achieve a full transformation in thinking.

“The lack of education is still there,” Cocchi tells Addiction Professional. He recalls being in the same position when he decided to run for sheriff in the western Massachusetts county and was advised by medical experts that the department needed a full implementation of medication-assisted treatment (MAT). “From a security perspective, this wasn't being embraced four or five years ago,” he says.

The progress that communities such as Hampden County have made in maintaining continuity of care and lessening inmates' chances of relapse and recidivism can be instructive for other jurisdictions that will be pushed in a more treatment-friendly direction. With a growing body of case law upholding inmates' right to receive medication treatment while in custody, “The writing is on the wall,” says Linda Hurley, president and CEO of Rhode Island-based CODAC Behavioral Healthcare, which is managing MAT services in the Hampden County system.

Hurley sees Hampden County's work as “assisting others who are going to be coerced into providing this care.”

Building on history

Hampden County's efforts in medication treatment did not happen overnight. Cocchi says pregnant women with opioid use disorders have been receiving methadone in the county jail system for about a decade. The injectable formulation of naltrexone came into the system a few years after that, and use of buprenorphine was ramped up a few years ago.

Why is access to all three of the available medications for opioid use disorder so important? “It saves lives,” Cocchi says. “There is no one-size-fits-all medication, treatment tool, or anything else.”

The corrections system's superintendent, Kevin Crowley, tells Addiction Professional that around 60 inmates are now receiving MAT in Hampden County. That number is expected to soar past 300 over the next several months. “We're refining [the program] better every day,” Crowley says.

Thomas Lincoln, MD, medical director for the county jail system, says it is critically important for any local corrections system to establish strong ties with community-based providers. Local jail stays can be so short and unpredictable that it is important to focus on an offender's continuity of care regardless of custody status.

The county's MAT effort covers individuals ranging from those held while awaiting trial to those serving sentences to others who have been committed to treatment under a controversial state statute allowing forced treatment of individuals judged to pose a threat to self or others. The Hampden sheriff's office operates a facility that has come under some criticism in the advocacy community as an inappropriate venue for treatment, but Cocchi has vigorously defended the operation, citing a dramatic effect that the initiative has had on reducing recidivist behavior and supporting sobriety.

“It's not a jail. It's not a prison. It's a rehabilitation center,” Cocchi says.

Strong commitment

CODAC's Hurley says her organization became involved with Hampden County after a business development professional who lives in Massachusetts and works with CODAC learned that Sheriff Cocchi wanted to have a significant impact in the area of MAT.

“He jumped in head first,” Hurley says of Cocchi. “I have so much respect for him and his staff. They're excited about this project.”

It can be encouraging for an addiction treatment professional to work with someone in law enforcement who routinely makes comments such as, “We believe there is no wrong door to treatment. Any door is the right door for you if it's working.”

Cocchi admits that the education process within the system hasn't always been easy. With buprenorphine products having been the main contraband threat in the jail system, it took some maneuvering to convince staff that they could work to keep the drug out of the black market while at the same time administering it appropriately to inmates in need of treatment for their addiction.

“Did some staff look at us like we had five heads? Yes, they did,” Cocchi says. Four sites and dozens of medication recipients later, MAT in the county jail is the new normal.