What more could the federal government do to help Cheshire County fight the opioid epidemic and meet local health care needs? That was the topic Monday, as Congresswoman Ann M. Kuster stopped by the county jail and nursing home to meet with county leaders.
As part of the visit, Kuster and county officials discussed the jail’s expanded use of medication to treat inmates addicted to opioids.
Kuster, a New Hampshire Democrat whose district includes the Monadnock Region, applauded the program. She said she’s pushing legislation that would offer federal grants to jails and prisons with medication-assisted treatment programs.
“I kept coming up against this idea that people were getting incarcerated for drug-related crimes,” she said in an interview after the presentation, “but they weren’t getting the treatment — either the mental health treatment or the substance use treatment — that they needed to recover.”
Medication-assisted treatment, or MAT, refers to the use of prescription drugs to treat opioid addiction, in combination with other therapies. Medications like methadone and Suboxone can help a person recover by easing the physical effects of withdrawal.
In 2017, a presidential commission on the opioid crisis wrote that MAT reduces overdose deaths and helps keep people in treatment for longer. The commission’s report specifically recommends expanding the use of MAT in jails.
On Monday, Doug Iosue, the Cheshire County jail’s case manager, gave Kuster an overview of the program.
In fall 2017, the jail started allowing people who were already taking methadone or Suboxone to continue that treatment while incarcerated. Officials then expanded the program around the beginning of this year. Inmates who demonstrate a commitment to recovery can now start medication-assisted treatment in their last two weeks in the jail, with an eye toward continuing that treatment once back in the community.
Iosue said more than a dozen inmates have started MAT in 2019. Before people using these types of medications are released, an appointment is scheduled so they can continue treatment with a provider in the community. Nearly everyone shows up to those appointments, Iosue said.
“It’s not the whole answer, it’s not a magic pill, but along with other treatment and interventions,” it’s effective, Iosue said.
The people gathered Monday in the jail’s administrative wing — who included Cheshire County’s three commissioners, corrections Superintendent Richard Van Wickler, County Administrator Christopher C. Coates, N.H. Rep. Daniel A. Eaton, D-Stoddard, and members of the jail’s medical staff — also discussed the makeup of the jail population and the role mental health plays in the criminal justice system.
According to numbers presented by Iosue, about 90 percent of inmates have some substance-use issue, with heroin/fentanyl predominating. Two-thirds of inmates have a mental health problem, and almost 30 percent are homeless.
Kuster said those substance-use and mental-health issues often grow out of a past trauma.
“I do a lot with veterans, PTSD. It’s sexual assault in the military,” she said. “It’s domestic violence. It’s sexual assault as children. It’s all of these different things that happen to people.”
Barnes Peterson, the jail’s mental health clinician, said he has seen the same thing. “Trauma is at the root of many mental health disorders,” as well as substance use disorders, he said. “And in a correctional setting, (a) very high percentage of people have trauma.”
Speaking to reporters after the presentation, Kuster — who co-chairs a bipartisan Congressional task force on opioids and has described her brother’s struggle with prescription-painkiller misuse — mentioned two additional legislative efforts she is involved in. One, she said, would provide $25 billion over five years for a range of public-health responses to the opioid crisis.
The other change would allow Medicaid to cover people while they’re in jail or prison — something barred under federal law.
Kuster argued that’s a barrier to substance-use and mental-health treatment for inmates. She said she proposed getting rid of the provision known as the Medicaid Inmate Exclusion Policy after “hearing about it over and over.”
Monday was no exception. More than 90 percent of the jail population is Medicaid-eligible, Iosue said. But the county, rather than Medicaid, absorbs their medical costs.
The inmate exclusion policy, he added, also hurts nonprofit mental-health providers like Monadnock Family Services. When a client is arrested, Iosue said, “they’ll choose to try to stay involved, and doing the right thing, sending in the case manager or counselor during incarceration. But they can’t be reimbursed because the Medicaid’s suspended.”
Earlier, at the county-owned Maplewood Nursing Home in Westmoreland, Kuster and county officials discussed workforce shortages in the health-care field and “overburdensome government regulations” affecting the nursing home.
“We talked quite a bit about how I could be helpful to them if Cheshire County started a program around workforce development,” Kuster said.