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Early Release Precautions Can Mean Life Or Death For Those With SUDs
By Dr. Ernie Fletcher
Published: 05/10/2021

Prisoner walking in red jacket1 Many state prison administrators are implementing the selective early release of prisoners in response to the COVID-19 pandemic and an increase in infections among workers and inmates. This action alleviates overcrowding in prisons and is thought to reduce the risk of morbidity and mortality from COVID-19. But in reality the early release of those with a history of addiction can expose them to fatal overdose if they use drugs at previous levels without the tolerance lost while incarcerated.

Overdose is, in fact, the leading cause of death following release among prisoners with a history of substance abuse. A New York DOC study found that formerly incarcerated people were “eight times more likely to die of drug-related causes during the first two weeks after release than were non-incarcerated NYC residents in the same two-week period.” And a Washington State DOC study rated the risk even higher, concluding that overdose and re-use are nearly 13 times more likely during the two weeks following release than at any other time.

Make A Plan

Corrections personnel have plenty on their minds already, but following evidence-based precautions can do much to prevent tragedy. It all begins with an accurate “Risk Assessment” that takes into account both COVID-19 and substance use risks. The assessment should focus on five key factors:
  1. Vaccination—Every effort should be made to ensure those incarcerated get the COVID-19 vaccine. Knowing a person’s vaccination status is critical in forming an adequate plan for release that’s consistent with CDC guidelines.
  2. Transportation—All transportation should of course comply with CDC guidelines to prevent COVID-19 infection.
  3. Supportive Housing—This assessment should entail a clear definition of the living arrangement and how the individual will transition to the housing. Those released to non-supportive living arrangements should also be checked in on at least once a month to assess the client’s status and supportive services.
  4. Recovery Services—These should include peer support, clinical support, and treatment services that align with the client’s history, primary substance used, and the severity of their condition. In rural areas, this may include the use of Tele-Health technology to provide physical and mental/behavioral healthcare that may otherwise not be available. This would be particularly important for individuals needing access to MOUD resources.
  5. Meaningful Employment—This would include education, job training, “warm handoffs,” legal services to facilitate reintegration, and assistance in establishing eligibility and applying for public programs such as Medicaid, SNAP, and Section 8 housing. Keep in mind that the pandemic may create barriers to meeting benefit eligibility requirements. For example, governmental offices that issue photo identification may be closed and individuals without a fixed address may find it difficult to receive benefit cards or documentation that are normally received by mail.
There are other issues that require special attention such as Naloxone, MOUD, outcome assessments, and release status reports. Let’s take a brief look at each one by one.

Naloxone Training and Supply

Before release, all clients with a history of SUD should be given Naloxone and trained in its use. When appropriate, friends and family members should also be trained. And of course, recovery housing staff would need to be trained and have Naloxone available onsite as well.

MOUD

Plans should be made so that those who received Medications for Opioid Use Disorder (MOUD) while incarcerated can continue their treatments after release. Corrections officials should follow up with clients in accordance with the requirements of release, parole, or probation. And the recovery housing staff should regularly report on the client’s status in accordance with the transfer service agreement.

Outcome Assessments

Outcome assessments are essential to continuous quality improvement and may in fact be required by the terms of release. Outcomes should include the occurrence of fatal or non-fatal overdoses documented in collaboration with ED and a coroner or medical examiner. The outcome assessment would also include return to use data—either self-reported or from providers who have been given permission to do so by the client.

Release Status Reports

The Outcome Assessment will be referred to when it’s time to create a Release Status Report. A range of data is included such as re-arrest, fatal/non-fatal overdose rate, SUD reoccurrence, housing arrangements, employment, training and educational activities, completion of recovery housing programs, participation in ongoing treatment and peer support services, and an evaluation of factors affecting the outcomes such as gender, age, race/ethnicity, and geographic residence.

Summary

All of this requires considerable effort and diligence, but compliance with CDC guidelines regarding COVID-19 combined with an accurate risk assessment and wellinformed protocols will pay off, not only by lowering overdose and recidivism rates.

Best-practice re-entry will also help returning citizens complete their healthy transition back into society, thereby lowering corrections costs and jail overcrowding while improving overall public safety. For a much more detailed understanding of these practices and protocols, please refer to the links below. Don’t hesitate to contact us if our free Technical Assistance would be of help to you. And thank you to all corrections personnel for the hard work you do to ensure our nation’s safety and well-being.

LINKS
  • Access the White Paper from which this article is drawn at: https://www.fletchergroup.org/wp-content/uploads/2020/07/A-HOLISTICAPPROACH-TO-CORRECTIONS-EARLY-RELEASE-COVID-19-STRATEGIES.pdf
  • Access more information about the Fletcher Group Rural Center Of Excellence at: https://www.fletchergroup.org/
  • Obtain free Technical Assistance from the Fletcher Group RCOE by filling out a brief TA Request Form at: https://app.smartsheet.com/b/form/1c3042bb5e984fd6ac3898346fd77ef1


AUTHOR BIO
Dr. Ernie Fletcher
Fighter pilot, board-certified physician, statesman, and healthcare visionary, Ernie Fletcher was elected in 1998 to the first of three consecutive terms in the United States House of Representatives. In 2003 he was elected the 60th Governor of Kentucky. As Founder of the Fletcher Group, Ernie continues a legacy of innovative public service that seeks to extend the company's unique model of "Recovery Ecosystems" to rural communities across the nation.


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