Isabel Byon: 0:00

The New York State Office of Addiction Services and Supports, or OASAS, provides this podcast as a public service. Thoughts and opinions expressed do not necessarily represent or reflect those of the agency or state. This is Addiction: The Next Step.

Jerry Gretzinger: 0:19

Hello there once again, Jerry Gretzinger, your host for Addiction: The Next Step, the podcast brought to you by the New York State Offices of Addiction Services and Supports, and thanks so much for checking us out in this episode.

Jerry Gretzinger: 0:31

You know, one of the things that OASAS has been really excited about is all the work that's been happening in the criminal justice system with addiction treatment, and that's because today we can tell you with great pride that all of the jails and the correctional facilities throughout the state of New York offer addiction treatment. It wasn't always the way, and I can also tell you we've looked at this recently across the nation, and New York is one of two states that can say that that every facility across its state provides addiction treatment the way that we do. The other, I believe, is Rhode Island, and they have one correctional facility statewide. So certainly a very big deal for New York to be able to say this, and today we're going to talk about the importance of that, why it's working well and we're going to focus on a place where it's working extremely well and we're going to go out to Cayuga County. We've got Sheriff Brian Schenck from Cayuga County with us and Mark Raymond, the clinic director at Farnham Family Services. Gentlemen, thanks so much for chatting with us today.

Brian Schenck : 1:35

Thank you

Brian Schenck : 1:36

Glad to be here.

Jerry Gretzinger: 1:37

So, yeah, I mean this is you know. Again, we talk about how, historically, this is not something that was always available. Okay, you know people you know who may have been incarcerated, you know, in the criminal justice system didn't have this necessarily guaranteed to them if they could benefit from it. But today it's a very different story that we're happy to tell, and our folks here who work with the criminal justice system say that what you two guys have done, your organizations have done, has really been like a good model for how well something can work together. So let's first of all I'm going to start with you, Mark, if you don't mind talk about the importance of having addiction treatment, the way it's being provided, available within the criminal justice system. What is it that we're providing and why is it so important?

Mark Raymond: 2:22

I would say the first thing that comes to my mind is the fact that upon release from prison, if somebody's in jail, well, let's just back up a little bit. What we have found with fatal opioid overdoses is that one of the key risk factors of a fatal overdose has been a period of incarceration prior to that fatal overdose. Because what happens is people who have opioid use disorder, they maybe commit a crime, they get incarcerated. While they're incarcerated they don't use opioids, so their tolerance goes down. And then when they get released because opioid use disorder is a medical condition and there's a very high rate of relapse when they are released, they eventually relapse and because their tolerance has gone down, they could use the same amount of opiates that they were using prior to incarceration, and now that amount could result in a fatal overdose.

Mark Raymond: 3:21

So by having a person who has opioid use disorder connected with the right treatment, including medication when they are discharged, if they do relapse, then there's much less likelihood A there's less likelihood that they're going to relapse if they're connected with treatment, which we have examples of that. But if they were to relapse, they'd be much safer and less chance of a fatal overdose, and that's the most extreme. I mean, there's less extreme, great reasons too. Just by having this connection, you know, I and Sheriff Schenck can speak likely to have as many problems while incarcerated and they're more likely to follow through with treatment upon release, which not just is that less likely of an overdose, but more likely to engage with their counselor, more likely to obtain employment, more likely to not commit another crime and end up back in jail. So I'll stop there. I mean those are the biggest reasons that come to my mind.

Jerry Gretzinger: 4:32

And Mark. So I just want to make sure I point out too, I've been saying addiction treatment, but we're talking primarily about you know, what's happening here is the administration of methadone, correct?

Mark Raymond: 4:42

Yes, I think you know well, they're using all the medications. You know, one of the great qualities of Cayuga County is their medical team is using buprenorphine. They're using methadone. They're trying to find the right medication for the right patient at the right time. Where we come in is because they can handle the buprenorphine within their structure. Where we come into play is to provide the methadone, but they're providing more than just methadone. But we help them when the patient needs methadone versus buprenorphine.

Jerry Gretzinger: 5:13

Yeah, I mean, and we've seen time and again, you know, studies that show, once people are receiving this medication, what a difference it can make as far as you know, going forward with the rest of their lives without having to, you know, go back to the reliance upon substances. So, yeah, let me switch over to the sheriff now. Brian talk to us too. I mean, he talked about how Mark indicated that when it comes to the methadone, you know they come in, they're able to help with that. What was the situation like before? I know it's been, since it's been a few years since there was a law passed requiring that such treatments are available in correctional facilities and jails across the state. There had to be something of a I would say at least a learning curve, if not a struggle to kind of come into compliance with that right.

Brian Schenck : 5:53

There certainly was and actually our program started at the end of 2022 when the state legislated the mandate that all correctional facilities would offer medication-assisted treatment in all forms in their facilities. So prior to that we didn't have a program for MAT. I'm really glad that that mandate came about. I know that it would have been somewhat challenging in our community to move this program forward if we didn't have that state legislative mandate and we've had our program up and running since then. But we did offer, you know, peer support and different forms of treatment absent the MAT within our facility prior. But we've really really seen a positive. You know, this has been a positive thing for our incarcerated population to be offering this rate in our facility and I'm really proud that we have this partnership with Farnham to be able to offer methadone and all of the other forms that we offer here, because I've really seen the positive results that do come from this when we offer that in our facility.

Jerry Gretzinger: 6:55

And Brian, I'm going to go back for a second. You said it would have been difficult to do this if it hadn't been for that requirement. I think I can kind of put the pieces together as to why, but so what would the difficulties have been?

Brian Schenck : 7:08

I think one of the primary challenges would have been just getting the local funding to make that happen if it were an optional program.

Brian Schenck : 7:16

And you know, I think part of that's due to some of the lack of understanding about the benefits of this program, of how these programs do benefit people that are that are, do benefit people that have substance use disorders. There's certain stigmas that we're trying to change and I've seen a really interesting shift in some of our own staff members here within our facility that initially, before we implemented this program here, that we're very reluctant, not understanding exactly how this could benefit those that we serve. But I've seen a shift in, you know, since we brought this in, people do see the benefits for the incarcerated and you know it's really it's great to see that happen. It's great to see people be successful, it's great to see our community start to understand the benefits of that. And you know we do have a long ways to go. But I am actually thankful for the mandate because I think it has been very positive for not only our facility but all facilities across the state.

Jerry Gretzinger: 8:12

And you know, I guess that's something too that can apply to so many things. Right, people are always, you know, something they don't understand, they don't know all the information about. They're a little apprehensive about it because they just don't know. But so this is great, that this has been in place now and you're saying that people are seeing how it works, the benefits of it, which now I'm going to jump back to Mark, if we can for a moment. And, Mark, you know we've tried in the past on some of our podcast episodes, to talk about how methadone, how buprenorphine work and try to bring it down to layman's terms, you know so people understand how it assists people who can benefit from it. But I want you to help us out with that. Talk a little bit about how these medications work, what they do to help people not feel like they need to have these substances.

Mark Raymond: 8:56

You know what a great question. That's such a key question actually. First, I'll start with what it's not doing. If it's done right, when medication-assisted treatment for opioid use disorder is done confidently, it shouldn't result in patients being sedated, impaired. And unfortunately that's one of the myths that is out. There is somebody on methadone or buprenorphine is nodding and is impaired. If the medication is provided in a competent way, the patient should have a normal state of mental status, allowing them to function like a quote-unquote normal person.

Mark Raymond: 9:43

And the reason why is what we understand about opioids is when somebody is addicted to opioids, if they're not using, basically they experience withdrawal and there's acute withdrawal and there's post-acute withdrawal, and they can be very sick in acute withdrawal and they can have ongoing symptoms with post-acute withdrawal. And so what happens is the opioid. All of us have opioid receptors in our brain and what happens is is if the opioid is not in that receptor of the brain and as it releases from the receptor in the brain, that's what causes people to experience that withdrawal and there's no known cure for this and that's that post acute withdrawal. So this uncomfortable medical condition can go on not just for days, but for very long periods of time, which is why there's such a high rate of relapse. And that's why, even if somebody is not incarcerated, some of our individuals who do very well maybe out of willpower, and they may do very well for months and they could also be the ones who are most at risk of a fatal overdose because they're doing so good that their tolerance went down, and so then when they do relapse, that's when again just like if somebody had a period of incarceration it can be extremely dangerous.

Mark Raymond: 11:10

So what these medications do, when done correctly, is they actually occupy that opioid receptor in the brain and if they're on the right dose of the right medication, they're not getting high from it, they're not getting intoxicated and they're also not uncomfortable in any type of withdrawal. So therefore they can function in this normal state and, plus these medications, they're longer acting opioids than, like what illicit opioids the heroin, fentanyl those are shorter acting opioids. People need to use them multiple times per day to either get high or even try to achieve their own sort of steady state Methadone and buprenorphine medications they can last like 24 hours, so you can provide the medication to the patient one time a day and they can remain in this normal range once they're at a therapeutic dose. So it's so important for their well-being while they're incarcerated and it's so important for their well-being when they're outside of being incarcerated. So the medication and I do believe they should have the wraparound services as well, like counseling, medical services, mental health services but the medication is key in being able to benefit from all those other additional services.

Mark Raymond: 12:19

Imagine if you're feeling very uncomfortable in withdrawal and trying to talk about your problems or obtain employment or go to the doctors. It's not going to be your number one concern if you're sick. So, in layman's terms, I guess that's the best I can explain it, unless you have some follow-up questions, I could try to do more.

Jerry Gretzinger: 12:39

Yeah, my next thought was we talk about and thank you for explaining it that way, because I think hopefully that will help people realize how it works and why it works and the importance of it. Certainly we talk about people having this benefit of this service, of this treatment now in the correctional facilities and the jails across the state of New York. So I guess the next question and we may have already alluded to it a little bit, though upon release from these facilities, what's the program there, what's the plan there to maintain that treatment? Because, as you said, this is not something that just goes away. It can last for a long time and their need for treatment likely extends beyond the time of their incarceration.

Brian Schenck : 13:23

So I can speak initially on that and you can elaborate, Mark. But so for us, for any individuals that we're releasing that are on certain medications, we do release them with some of those medications so they can continue their dose. But if it's methadone and they need to, you know, have a provider to provide that for them, you know, the next day after they're released. We're fortunate that we have Mark and Farnham Family Services right here in our community and they can report right there the following day to get their dose and continue that follow-up. And that's the program here. It seems to be working well and I think we're very fortunate that we have them here so that that can continue.

Mark Raymond: 14:01

And I would piggyback right there. You know, and this actually starts much sooner than their discharge, and I'm not just saying this to be nice because the sheriff's in the room, but this is such a key difference is, you know, since the day I met Sheriff Schenck and his team, like they've been very interested in this and they've wanted to work with us in terms of trying to figure out ways to be able to do this from the beginning to the time of discharge, to the best of our ability and with respect to each other's roles and responsibilities. We talked about some of the challenges in the beginning and some of the other challenges is the jails have other responsibilities. They have the inmates, they have the safety of staff, they have things that they're used to.

Mark Raymond: 14:42

And you know, medication assisted treatment with methadone is actually kind of complicated. It's not just come up with a dose and give it to a patient. It's actually really complicated care. We do it with medical doctors, medical providers, nurses, counselors. It's evidence-based, like there's a lot that goes into it. There's, you know, ekgs, medical examinations. So we take it very seriously and it starts right in the beginning and you know Sheriff Schenck and his team and Dr Duckett and their nurses, like we start from the beginning and talking together and we they actually bring the patients to us. I know there's some flexibility. That doesn't need to happen like that, but our medical doctor wants to see the patient. Their team wants the patient to come over here.

Mark Raymond: 15:26

It's a little extra work, but the patient comes in and they see our medical provider, they get a medical examination, we start them on medication and they know who we are and that's very key. It's not just about preference. Now they know where they're coming when they do get released. They've met a counselor, they've met their medical provider. So it's really worth that upfront work.

Mark Raymond: 15:47

And then they go back to the jail and our medical teams communicate with each other and, by the way, the deputies that bring the individuals over are wonderful. They're very kind and they just do their part. We let them do their part, but they don't make other people feel uncomfortable. It's done very collaboratively. And then throughout the course of incarceration, our medical teams work together to try to adjust their medication. You know, we've learned how to use cows, clinical opioid withdrawal scales, communicate between physicians if we need to see them over, if our medical provider wants to see them over the teleconference, they only need to come once in person. The rest we take care of through teleconference. We do medication pickups on at least a weekly basis to provide adjustments, and that whole process starts in the beginning so that when they do, get released.

Mark Raymond: 16:39

That patient feels much more comfortable following through.

Mark Raymond: 16:44

They're on a mode of care that's worked for them. They feel more appreciative. I imagine maybe this is anecdotal on my part, but our experience is when they come in they feel cared about by the jail staff, that they took the time and effort to do this for them, and here they are feeling better and they don't need to go right out and and use to feel normal and instead they can show up at a place they've been and start talking with their counselor. I mean, we've got examples where we have people who've been discharged and released from incarceration, who have not went back to jail, who started treatment with us, who are rebuilding connections with their families, who have obtained employment, who are seeing their counselors, and I don't know what's going to happen for everybody or the future, but these are extremely impressive success stories. So I know that's a long-winded answer, but I think it starts from the beginning and it ends at the discharge. It's not just when they're released, but they're in a much better place when they're released, when we're doing it this way.

Jerry Gretzinger: 17:46

Yeah, I mean, if those are some of the results that you're seeing, you can't argue with those. Like you said, reconnecting with family, you know I hear stories about people then you know going and holding a job and being able to get their own places and it really is making a tremendous difference in lives. You know the medication and certainly making it available throughout the criminal justice system. You know, as we get to wrap up here, I just want to ask this question too. I know it's been rolling out all across the state of New York and, as I've mentioned a couple of times, it is available in all facilities. Now, if there are some facilities or providers who are struggling because you both talked about the great collaboration that you have together what are some of the challenges that you faced or you imagine people face, and what have been the ways you overcame those that you might want to recommend as a suggestion to those still struggling to make it work as well as it seems to be working out there?

Brian Schenck : 18:46

I think for me I would suggest making sure that you understand the benefits of the program and how it can be successful. I know there's a lot of stigma surrounding some of these topics and it still exists today, not only in our communities but within our criminal justice system and potentially with some of our providers. But you know, learn about the potential benefits, learn about some of the success stories that we're seeing in other communities and, you know, work on those collaborations because they are key. You know, not only having Farnham and MAT available in our jail but having the peer support embedded within our facility is huge. You know, understand the value of having good peers in your facility and building these partnerships. But these partnerships are critical for success. If your community doesn't have them, it's just not possible to see the results that we see. So you know you've got to be willing to partner.

Mark Raymond: 19:35

Sheriff Schenck and his team. They actually came over to our facility, they looked at it, they sat down with us, they spoke with us. We just had this great meeting and started our talking and we had a learning curve. There was a lot that we needed to learn and figure out and compromise and adjust, but we had a common goal. They respect that. We have rules and we have to follow FDA I mean DEA, SAMHSA, OASAS rules. They have their rules and just a lot of respect for each other's roles and responsibilities and then working together and talking, communicating. And so I would just add to Sheriff Schenck's suggestions just to meet and to talk and to not think that you need to do it perfect, to start somewhere and then build on it. It's just going to get better and better and you'll love the results.

Jerry Gretzinger: 20:24

Yeah, I mean again, you've both talked about some of the results that you see, and that's the endgame we're all going for, right? That's why we want this to be available. That's why we want everyone to succeed with these programs. Brian Mark, I want to thank you both for sitting down and talking to us today. We are so thrilled with how well this partnership is working out out there and we hope that others hearing this today, if they are struggling, if they have questions, maybe we've answered a few for them. So again, thank you so much for sitting down and sharing your experiences and your stories.

Brian Schenck : 20:55

Thank you. I appreciate being here, the opportunity and certainly all the support we get from Oasis. Thank you.

Mark Raymond: 21:01

Thank you as well.

Mark Raymond: 21:01

Same. Thing.

Jerry Gretzinger: 21:02

All right, appreciate it, guys. Thanks again, and we'll have you back at some point to maybe talk about more of the good work that's being done. I'm Jerry Gretzinger, your host for Addiction: The Next Step. Thanks for checking us out this time. We'll see you again for another episode soon and until then, be well.