The Anne Arundel County Department of Health is the sole government agency responsible for improving the health of Anne Arundel County. The Department is located in Annapolis, Maryland and has a population of over 550,000. The county is centrally located between Washington and Baltimore and surrounds the capital city of Annapolis. The county borders over 533 miles of coastline with areas that are rural and suburban. The county houses two detention facilities. The Jennifer Road Detention Center (JRDC) is located in Annapolis and the Ordnance Road Correctional Center (ORCC) is located in Glen Burnie.
Since 2012, the Anne Arundel County Department of Detention Facilities (AACDF) and the Anne Arundel County Department of Health (DOH) have collaborated to provide and manage the Road to Recovery Program (RTR) at ORCC. The primary objective is to reduce the recidivism rate of inmates who return to illegal drug use and criminal behavior after release from the detention center and to reduce the risk of overdose death.
Prior to the implementation of the program, DOH was providing assessment and referral information only to inmates in the facility. During that time, only one inmate entered treatment upon release. National data also showed that few inmates (as low as 15%) actually entered treatment in the community upon release. This prompted the decision to provide a full opioid treatment program for opiate-addicted male and female inmates incarcerated at the ORCC with referral to community medication assisted treatment programs upon release. This would allow medication to continue and allow for continuity of care by providing a seamless transition from the detention center to the DOH community methadone program or the home clinic.
Since then, there has been a continued sharp increase in overdoses. The Maryland Department of Health and the Department of Public Safety and Correctional Services matched data on overdoses from 2007 to 2013 on individuals released from prison or the Baltimore City jail. The analysis found that the risk of overdose was 8.8 times greater in the first week after release, compared to the period of three months to a year after release; a finding supported by other studies. The increased risk was attributed to reduced drug tolerance following an incarceration period when drugs were largely unavailable, or events following release that involved the use of multiple drugs. In response, DOH and AACDF explored strategies that would mitigate this risk.
The RTR programing expanded to include prioritizing pregnant women detained at JRDC, peer support services, overdose prevention training, and naloxone distribution.
Referrals to RTR come through case-management services, the peers or a self-referral from the individual. An inmate detained at JRDC (intake and classification for all inmates in AACDF) who comes in on methadone will be guest dosed if a short stay or given a 21-day taper if likely to receive a lengthy sentence at a facility outside of Anne Arundel County. If the individual sentenced to a stay at the ORCC, the inmate is eligible for admission to the RTR program.
Peer support services (PSS) began with one peer support specialist. As the need increased, another full time peer support specialist joined the team. PSS includes one female and one male peer who work within the male and female units. The peers facilitate weekly resource groups and peer support groups, meet individually with inmates, activate and engage inmates in the recovery process, help set up needed resources upon release (funding, housing, treatment, legal) and connect inmates upon release to a community peer.
The Opioid Response Program (ORP) coordinator with DOH facilitates two sessions a month. The peers provide one-on-one training to inmates unable to attend the group trainings. Inmates receive a kit with two doses of Narcan. Kits are logged into property and given to inmates upon release. This is a novel approach as many programs in correctional facilities provide inmates with a certificate to redeem at the local health department. A practice that has not proven to be very successful. In addition to direct training of inmates, the ORP coordinator trains detention staff and supplies each unit a two doses for the first aid kits.
While the majority of the financial support for this project comes from outside the AACDF, this program exists because of the continued support and commitment of the Superintendent and the Warden. Their leadership and vision have been instrumental in the development of this model program.
Public Health impact of the practice is to reduction of risk of overdose deaths of recently released inmates.
LHD website - www.aahealth.org