So imagine you have finally taken the courage to begin treatment with methadone or Suboxone. You have mustered up the courage to walk in the door and say I have a problem, can you help me out? We get going on the methadone, we are increasing the dose, you are using less and less heroin every day. By day 14 you are completely off the air when and only taking your daily dose of methadone doing great, family life seems better, work life is getting better. Then, out of the blue you are arrested and back in jail. It was from a leftover warrant a year ago for something you did back then. Traditionally in jails there is no treatment of any kind. You go through severe withdrawals for two weeks, struggling, writhing. Then you are discharged from jail, maybe the withdrawals are slightly better at this time, you are thinking no problem maybe I will make it on the outside without treatment now. Does this sound reasonable?
The truth is most patients with substance use disorder that her discharge from jail will relapse within 24 to 48 hours. Why would we treat a diabetic who is in jail with insulin but not an addiction patient with methadone or Suboxone?
One of the great advances we are making here in Colorado is that my group is pushing strongly for treatment in the jail system. Some of this is already coming to fruition. If you look at states like Rhode Island their success rate is amazing because they simply continue the same treatment in jail is outside, patients are discharged in stable condition and follow-up with their clinic immediately afterwards. Remember one of the highest risks of overdose death is when someone is discharged from jail with a lower tolerance (because they have not used for a few weeks) and they relapse with a similar dose of opioid as before they went into jail. Their brains cannot handle the load and they simply die. I am happy to see that Colorado is moving in the direction of decreasing denial and increasing acceptance of medical condition that really deserves and needs treatment 24/7/365.
After all diabetics, heart attack patients, cholesterol patients, thyroid patients, Depression patients, anxiety patients and all other patients get the same 24/7/365 care right?
Stay aliveAndreas J. Edrich MD FASAM ADM MRO “the addiction doc”
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