This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Opioid overdoses killed 18 times more Michiganders in 2018 than they did in 1999, and putting addicts in jail isn't helping the problem. Studies have found that people released from incarceration are 129 times more likely to die of an overdose.

However, a new initiative of the Wayne State University Center for Behavioral Health and Justice (CBHJ) is working to change the cultural landscape around substance use disorder and decrease overdose deaths through prevention, treatment, harm reduction, and sustained recovery. CBHJ's six-county Opioid Treatment Ecosystem initiative creates community-based alliances including corrections and law enforcement agencies, behavioral health and medical providers, state of Michigan partners, philanthropic organizations, social workers, and individuals directly impacted by the opioid crisis. The initiative employs a holistic approach that seeks to help people with substance use disorders before, during, and after incarceration.

The Opioid Treatment Ecosystem initiative partners with Kent, Jackson, Monroe, Muskegon, Washtenaw, and Wayne counties. Eaton and Oakland counties have their own similar programs in place, and initiative organizers aspire to eventually partner with even more counties. CBHJ director Brad Ray proudly notes that Michigan’s programs are among a small number of similar endeavors that are leading the nation.

Brad Ray, director of the Wayne State University Center for Behavioral Health and Justice.

“The fact that we have many jails doing this work in Michigan is such a huge achievement,” Ray says. “People who crave opiates crave them regularly. They are consuming, for example, heroin a couple times a day. Individuals who have addictions go to jail and go through a very painful withdrawal that is sometimes life-threatening. In 99% of jails in the country, no treatment happens whatsoever.”

Ray sees jail as a “salient touchpoint” for intervention. Upon release from jail, people with substance use disorder often surrender to their cravings, unaware that their tolerance level has plummeted. The result is often death by overdose. This scenario is magnified if the person had been using methadone to overcome addiction before incarceration. And, because methadone withdrawal is particularly excruciating, they may reject going back on it as a way to overcome addiction. In addition, CBHJ data indicates that, since COVID-19, overdose deaths among people released from incarceration have increased by as much as another 40%.

“It's really important that an individual receive immediate help for their addiction upon intake within the jail because this may be the first time they've been without a substance for quite some time,” says Joshua McLenithan, a recovery coach with the Grand Rapids Red Project, one of the Opioid Treatment Ecosystem initiative's partners in Kent County. “If we start working with them right away and build a rapport and set goals for their release, this can help ensure success.”

EMTs as a first link to recovery

Often the first on the scene, emergency medical technicians (EMTs) working within the Opioid Treatment Ecosystem do more than administer naloxone, CPR, and ambulance transport. In Monroe County, Opioid Treatment Ecosystem initiative partner Emergent Health takes a team approach to overdose patients that includes law enforcement, medical providers, and mental health services.

“Unfortunately, opiate abuse is an addiction disease that’s a tough habit for people to overcome. We do see some people on a lot more frequent basis than we’d like,” says Karl Rock, vice president of south central operations for Emergent Health, which oversees Monroe Community Ambulance and Jackson Community Ambulance. “It is really [impacting] everybody, one of those diseases that spans all demographics, ages, race, economic status, everything.”

Karl Rock.

Because some overdose patients may refuse transportation to the hospital, Emergent’s EMTs step in to connect them to the help they need.

“In the event that we do respond to somebody treated with Narcan [brand naloxone] due to opioid overdose, we provide them contact information for community health as an access point for so many other services that help them see what led them to that path and correct the root cause of the problem. That leads to better outcomes,” Rock says. “It’s a team effort starting with the person calling 911, who makes the biggest impact on saving people’s lives.”

Transforming jail from risk factor to recovery support

In most jails and prisons across the U.S., people with substance use disorder receive no help for their disease. If they had been prescribed methadone or other medications, the correctional facility does not provide them their prescriptions. However, when new inmates arrive at Michigan jails that are partnering in the Opioid Treatment Ecosystem initiative, they are screened for opiate use disorder. They not only continue their prescribed medications, but also meet with a case manager and peer mentors who help them recover and plan for success after release.

Nikole Skipp, MI-REP 2 supervisor at the Kent County Correctional Facility, says the jail has a designated case manager who meets with inmates currently receiving medications for opiate use disorder. The case manager works with inmates for the duration of their stay, developing a release plan for them, referring them to community services, and giving them a "warm handoff" upon release to a peer support specialist from the Red Project.

Inmates engage in the program voluntarily and receive no court incentives for involvement. Skipp believes that continuing prescribed medications during incarceration is essential to inmates’ recovery.

“Withdrawal from methadone is really awful and jail is not a warm, fuzzy place where you want to go through that," she says. "More important, when they are being released back into the community, they are more likely to experience risk factors and to abuse heroin or another opioid and overdose.”

Continued support after release

Like other jails collaborating in the Opioid Treatment Ecosystem initiative, Kent County provides Narcan to inmates with substance use disorder when they are released. Before release, they receive training on how to use it.

“Having Narcan provided to the client when they are released from the facility is most important,” Skipp says. “If they were to do heroin and overdose, they would have that on their person. Or, if they go back into an environment where someone else is using and overdoses, they have it, administer it, and hopefully save a life.”

Karl Rock holds a syringe of naloxone.

Peer mentors are also an important part of the Opioid Treatment Ecosystem initiative's strategy, and they do much more than cheer from the sidelines. They provide transportation to meetings, therapy, and probation appointments. They may connect clients to community resources for housing, food, and employment. Most importantly, as people who have experienced addiction or incarceration themselves, they show that recovery is indeed possible.

“As a recovery coach, we meet people wherever they're at, whether that's active addiction or recovery. It's a non-judgmental approach that I find makes communication with an individual much easier,” says McLenithan, who has served time in prison himself. “I'm a peer, not an authority figure. ... When an individual knows someone is in their corner and advocating for them and wants to help, it could mean saving a life.”

And that's the Opioid Treatment Ecosystem initiative's overall goal: reducing opioid-related deaths through a more mindful and humane system that does more than just lock addicts up.

“Addiction is something that can happen to anybody. You never know when you’ll have a loved one or a neighbor fall into addiction,” Skipp says. “Helping people better themselves and make better choices by giving them that added layer of support overall reduces overdoses and deaths in our communities.”

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Karl Rock photos by Steve Koss. Brad Ray photos courtesy of Brad Ray.