Lewis County Jail's Medical Clinic

Licensed Practical Nurse Kim Heberer checks the contents of a cabinet in the Lewis County Jail's medical clinic Wednesday afternoon in Chehalis.

Every inmate booked into the Lewis County Jail goes through a screening process that includes an assessment identifying health conditions and needs — it’s also the first step that may get an inmate into the jail’s Medication-Assisted Treatment (MAT) program, a recent initiative jail officials hope will take a bite out of the local opioid epidemic.

Lewis County Sheriff’s Office Corrections Chief Chris Sweet said, that while drafting a plan for their partnership with Cascade Pacific Action Alliance (CPAA), one of numerous milestones within their timeline was for 25 inmates to be brought into the program within its first quarter. Jail officials said they hit that goal within two weeks.

Two weeks ago, there were 34 people in the program.

MAT provides medication to curb the symptoms of opioid withdrawal and gets them into addiction-based counseling.

Lewis County Jail's Medical Clinic

Captain Chris Tawes, left, and Health Services Administrator John Ackerman, right, review an inmate information sheet in the Lewis County Jail's intake area Wednesday afternoon in Chehalis.

John Ackerman, health services administrator with NaphCare, said that when each inmate is screened, they’re asked about any active or previous drug abuse. If they show signs of being at risk for going through opiate withdrawal, they’re placed on a monitoring program.

That program involves a Clinical Opiate Withdrawal Scale (COWS), which rates the severity of withdrawal symptoms. Typically, said Ackerman, they’ll be monitored like this for about 24 hours. When the individual starts showing signs of active withdrawal, they meet with a professional that prescribes the medication Subutex — also known as buprenorphine — with a dosage that’s appropriate for that person’s level of drug use. The drug is designed to help treat opioid dependence.

After approximately 72 hours of staying on that “stabilizing dose,” the inmate begins meeting with a staff member from Medtriq through a HIPAA-compliant video conference program. Their dosage is adjusted as is appropriate, and they’ll meet at a frequency also dictated by the Medtriq staff member.

While incarcerated, the plan also sets the inmate up with a drug counselor.

Lewis County Jail's Medical Clinic

Medical staff work on computers while Health Services Administrator John Ackerman, center, changes the paper on a medical table in the Lewis County Jail's clinic Wednesday afternoon in Chehalis.

As the inmate nears his or her time of release, Ackerman said the Medtriq counselor will call ahead for a certain dosage of the drug Suboxone to be held for the person at a local pharmacy.

Suboxone, according to Medtriq’s website, “fills the brain’s opioid receptors without producing the ‘high’ that other opioids produce. Thus, the potential for abuse is much less. In the meantime, it provides excellent relief from withdrawal symptoms and cravings, making it very effective in getting off other opioids.”

Suboxone differs from subutex — which is taken within the jail — in that it makes relapse more difficult, said Ackerman.

In the roughly two months since MAT started in the Lewis County Jail, Sweet said one of a couple hiccups identified with the program involves stalled Medicaid insurance for outgoing inmates. It can take around 24 hours for the coverage to be reinstated, delaying the time the individual may be able to pick up their suboxone. The first couple of days after release prove for an inmate to be especially vulnerable to relapse.

Lewis County Jail's Medical Clinic

Captain Chris Tawes talks about they type of information they collect in the Lewis County Jail's intake area Wednesday afternoon in Chehalis.

“So if you create an artificial barrier that puts a wrench in the plans, that may divert them from our plan … back into their drug pattern. … So any artificial barrier that prevents immediate reintegration incentivizes relapse,” said Ackerman.

The jail is making up the difference currently by paying out of pocket from funds made available through CPAA. However, Ackerman said that’s not a long-term fix. Katie Strozyk, behavioral health program coordinator with Lewis County Public Health and Social Services, said CPAA and Healthcare Authorities from the state are aware of the issue and are looking at ways to mitigate the coverage gap. A meeting with state officials will be upcoming, she said.

While it may be considered too early to determe whether the program is considered a success — it was implemented in March — Ackerman said taking a look at how many former inmates are following up with their treatment and counseling six months down the road may be a way to quantify a success rate.

Strozyk said the program’s mere existence is a triumph.

“While it’s still too early to see actual metrics being met within the program — so, individuals who initiated suboxone, individuals who followed up with treatment afterwards — just the implementation of the program itself is a huge success — especially in a rural community who is historically underfunded and has huge service gaps, especially when looking at substance misuse. The fact that we’re able to offer Medication-Assisted Treatment in jail really reduces the stigma and creates a component that shows the individual is really cared about and we want people to enter recovery,” Strozyk said.

MAT was funded through a project with CPAA, a program created by the CHOICE Regional Health Network. CPAA is boosting the initial $90,000 in funding with an additional $176,000. 

Lewis County Jail's Medical Clinic

Health Services Administrator John Ackerman talks about the type of medications they keep on hand, Wednesday afternoon at the Lewis County Jail's medical clinic in Chehalis.

Strozyk said the funding comes through the Medication Transformation Demonstration. The program’s based on innovation and evidence-based findings, she said, meaning that it’s flexible and can be changed and updated to meet any needs that come along.

She said that recent studies show that around 10 percent of jails across the nation have programs in place that start inmates on opioid-curbing medication, much like the Lewis County Jail is doing now. More common are jails that will continue ongoing treatment of people booked, rather than initiate the treatment.

Lewis County Jail's Medical Clinic

Health Services Administrator John Ackerman pulls out a box of Narcan nasal spray, Wednesday afternoon at the Lewis County Jail's medical clinic in Chehalis.

Lewis County Jail's Medical Clinic

Licensed Practical Nurse Kim Heberer checks the contents of a cabinet in the Lewis County Jail's medical clinic Wednesday afternoon in Chehalis.

Lewis County Jail's Medical Clinic

Health Services Administrator John Ackerman, left, checks in with Licensed Practical Nurse Kim Heberer, right, as she checks the contents of a cabinet in the Lewis County Jail's medical clinic Wednesday afternoon in Chehalis.

Lewis County Jail's Medical Clinic

Health Services Administrator John Ackerman talks about inmate information on a test template on his computer in the Lewis County Jail's medical clinic Wednesday afternoon in Chehalis.

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