Nowhere to Turn

Harris Silver remembers seeing his life flash before his eyes the day he almost died along an Arizona highway in 1986.

Silver was on vacation when the car he was riding in slammed into the back of a recreational vehicle. The violent impact sent his head crashing through the windshield.

After the accident, Silver, who by then had become the head and neck surgeon at Thomas Jefferson University Hospital in Philadelphia, spent months in and out of hospitals, enduring a series of painful surgeries to repair ruptured discs in his neck—a complication resulting from the accident. He admits it wasn't long before he was hooked on prescription pills and doctor shopping.

Silver successfully fought off his drug demons and has been a recovering addict for two decades. He decided to stop practicing medicine, and now volunteers as a drug policy analyst at the Robert Wood Johnson Foundation Center for Health Policy in Albuquerque. He spends his time and energy advocating for access to addiction treatment medications for patients—including drug-addicted prison inmates—around the state.

Suffice it to say that Silver is well-versed in the risks and challenges most addicts face. So when he learned, last week, that the Bernalillo County Metropolitan Detention Center was planning to shutter its six-year-old methadone treatment program, he was outraged.

New Mexico has a notorious problem with opioid drugs. According to a November 2011 report by the Centers for Disease Control and Prevention, in 2008, New Mexico had the highest rate of drug overdose deaths in the nation. Between 2001 and 2010, according to the New Mexico Department of Health, the overdose death rate increased by nearly 62 percent. Specifically, Bernalillo and Santa Fe Counties have some of the state's highest sales rates for oxycodone (a prescription opioid often sold as OxyContin), and Santa Fe County Public Safety Director Pablo Sedillo says 78 percent of inmates enter the system under the influence of drugs or alcohol.

Yet as the need for treatment grows, the options—particularly for inmates—seem to be narrowing.

Administering small doses of methadone "is the most effective treatment for opiate addiction," according to a 2002 CDC paper. Even New Mexico's Human Services Department recently began reimbursing Medicaid patients for methadone treatment. But Bernalillo County announced last week that it planned to halt its methadone treatment program. (More recently, the county backtracked, saying it would instead conduct a medical and legal audit of the program.) And in Santa Fe, Sedillo says he won't consider offering one.

To Silver, it's a worrisome trend.

"If I had it my way, I would love everyone to be abstinent," he says. "It's a great way to live, but it's not reality. These inmates' cravings won't go away and, after the pain they go through withdrawing, they probably won't head back to their community methadone clinic."

Instead, Silver believes many addicts will make the wrong choice and start using heroin or other opioid-based drugs again, which will lead to criminal behavior and, eventually, could land them back in jail.

Inside the Santa Fe County Adult Detention Facility, inmates face the scary prospect of detoxification protocols. Instead of being offered a methadone treatment program, they get some relief in the form of a "kick kit," a package of prescription and over-the-counter drugs designed to alleviate the symptoms of withdrawal.
Nicknamed Double K, the kits are as far as Sedillo will go.

"Our focus is on public safety," he says.

He believes the protocol designed by Nurse Administrator Lisa Leiding, who started her career in corrections across the street at the state penitentiary, are effective at reducing prisoners' withdrawal pains and anxiety.

"We don't expect them to quit cold-turkey," Sedillo tells SFR. "We realize their addictions are associated with a chronic disease and even mental illness. Our kick kits are used to help them through their symptoms while we develop a continuous care treatment plan."

The kick kits, which cost the county about $22 and last five days, are filled with Immodium, Bentyl, Robaxin, Clonidine, Vistaril and Phenergan. Together, the drugs are designed to ease the pain of withdrawal symptoms, which can include violent diarrhea, vomiting and muscle cramping. Other jails often include Ibuprofen and sedatives like Xanax or Valium to relieve inmates' anxiety.

Both Sedillo and Leiding are quick to mention the jail's partnership with Christus St. Vincent Regional Medical Center's behavioral health program. For inmates who don't have insurance, the hospital offers vouchers to help pay for substance abuse treatments such as acupuncture, massage, yoga and spiritual guidance, as well as bus passes and other services that support counseling once they are freed.

Citing his corrections experience, Sedillo says he's reluctant to bring a methadone program into the facility because inmates always find a creative way to share their medication.

"They can regurgitate it if it's in liquid form, or cheek it when it's in pill form," Sedillo says. "They use drugs to barter inside a jail, and I just don't want to jeopardize the safety of my staff and other prisoners."

During a press conference last week, Bernalillo County MDC Chief Ramon Rustin said his goal in reevaluating the county's methadone treatment program is to get his inmates clean and sober so they can think rationally. He told members of the county's Public Safety Advisory Board that the jail should not be considered a hospital or residential treatment program.

But methadone experts like Anjali Taneja are critical of Rustin's initial decision. She and Silver both say it's "inhumane."

"He is not a medical doctor, and he is making medical treatment decisions," Taneja says of Rustin.

Silver points out that it takes an addict's body weeks to withdraw from methadone and years of sobriety for a body's metabolism to completely adjust from opioid-based drugs.

He contends drug cravings don't stop in jail, and once inmates are freed they will start hunting down doctors for prescriptions or looking up friends who can supply them with black tar heroin.

From his own experience, Silver says, it's better to keep people in treatment. When they're not, even a needle from a flu shot could trigger their desire to start using again.

A simple internet search reveals that, at jails around the country, inmates have died from rapid detox off of methadone. 

"It's cruel," Silver said. "Really, it's torture. Patients, even inside prison, have a right to their medication."

Santa Fe Reporter