Are Ohio heroin laws helping?

COLUMBUS – Heroin addicts leaving Ohio’s prisons will soon receive the gold standard of treatment — a combination of counseling and medication. But the state’s largest detox centers, county jails, receive little money for medication, and law-and-order legislation proposed by Southwest Ohio lawmakers would lock them up longer.

State lawmakers’ reaction to the heroin epidemic has been bipolar. Some changes treat addicts like victims of a brain disease, while others punish them as a scourge on society. Meanwhile, thousands of Ohioans are dying of drug overdoses.

Prisons director Gary Mohr wants lawmakers to stop adding stricter penalties while he and other professionals review Ohio’s criminal laws, which are littered with gut reactions to terrible circumstances, he said.

“The accumulative effect over decades is misdemeanors have become felonies, felonies have become mandatory sentences, and judges have lost some discretion,” Mohr said.

The effect is too many people who have never physically hurt anyone are sent to prison, Mohr said. The prison population has ballooned to about 50,000 prisoners, with at least 80 percent of them addicted to drugs. That was too much work for the 120 counselors employed by the state prisons.

Only 4,500 of the 30,000 prisoners struggling with addiction received treatment in 2013. Thousands of prisoners spent fewer than seven months in prison for charges like drug possession, leaving little time for treatment and making them much more likely to return, Mohr said.

“Quite frankly, we did little with them at all,” he said.

Gold standard for treatment

But more money in the state budget signed June 30 will pay for another 60 counselors to work with prisoners, in an attempt to improve the transition from behind bars to home. Paperwork on prisoners’ counseling while incarcerated rarely transfers to providers when they go home, said Tracy Plouck, who directs Ohio’s Department of Mental Health and Addiction Services that is taking over prisoner treatment.

That also means signing up more prisoners for Medicaid just before they’re released. Medicaid will pay for the combination of medication-assisted treatment and counseling that addiction specialists find most effective. While abstinence-only treatment ends in relapse about 95 percent of the time, researchers say medication-assisted treatment – such as Suboxone, methadone and Vivitrol – eventually will succeed, under optimal conditions, 50 percent to 65 percent of the time.

“Most addiction people feel it’s the gold standard for treatment now,” said Dr. Steven Matson, president of the Ohio chapter of the American Society of Addiction Medicine.

Starting as early as January, prisoners will receive a pill or shot immediately before leaving and continue treatment at home, Plouck said. Medicaid won’t pay for treatment while people are incarcerated, but many people leaving prison are eligible.

However, the state’s prisons have been slow to sign prisoners up for Medicaid, adding only 737 people since September while about 20,000 eligible people leave prison each year. Staff at four of 27 prisons are trained to enroll prisoners in the low-income health insurance; the goal is to have all prisons enrolling prisoners by the end of 2016.

Mohr said he’s not disappointed in the progress, which should ramp up quickly. The prison director said he supports use of medication-assisted treatment as long as medical providers are selecting the correct drug.

Many judges and law enforcement officials reject medication-assisted treatment, saying addicts are swapping one drug for another. Suboxone and methadone are powerful drugs and sometimes are sold illegally. That hesitance is one reason medication isn’t widely used in prisons and county jails, which have become the largest detox centers in the state.

But addiction specialists worldwide say medicine and counseling are the best tools for treating heroin addiction.

“We’re not treating a drug with a drug. We’re treating a disease with a drug,” said Matson, who works at Nationwide Children’s Hospital in Columbus.

Money in the budget, $11 million over two years, helps 15 counties provide medication-assisted treatment to jail inmates involved in specialized drug courts. Another $3.3 million is available for mental health or drug addiction programs, which could include medication for treatment. That helps, but won’t make medicine accessible to all inmates.

Another $58 million will go toward ideas to keep low-level, drug offenders out of prison. That might mean more beds at a halfway house or counseling. Mohr called the money a much-needed boost for local judges, jails and law enforcement trying to treat addiction. Lawmakers also asked Mohr’s office to look at converting a prison into a substance abuse facility, putting the addicts in one place to focus treatment resources.

Another addition allows county health departments to set up needle-exchange programs, where drug users can swap dirty needles for clean ones to reduce the spread of Hepatitis C and HIV. Those who drop off needles aren’t prosecuted but often receive information about drug treatment. An early needle exchange in Cincinnati set off a firestorm from opponents last fall.

Doling out punishment

But most of those changes, including adding medication-assisted treatment and coordinating counseling with the department of mental health and addiction services, were pitched by Gov. John Kasich and his administration, rather than by lawmakers.

“We’ve not left anybody behind. If you are drug addicted, we’re going to help you. We have been able to treat the drug addicted in our prisons,” Kasich told reporters before signing the budget.

Meanwhile, lawmakers are proposing law-and-order legislation and incremental tweaks. A bill sponsored by Rep. Jonathan Dever, R-Madiera, and Rep. Bill Blessing, R-Colerain Township, would increase the penalty for people selling large amounts of heroin — the kind of increased penalty Mohr warned against. Dever and Blessing’s bill passed the House before summer break. Another proposal from Dever would make it easier to prosecute drug dealers who provide narcotics used in fatal overdoses.

Dever said his bills focus on punishing people who supply the drug. Others, such as a Republican-sponsored proposal that would make it easier for people to access an overdose antidote, address demand. Rep. Robert Sprague, R-Findlay, and Rep. Denise Driehaus, D-Clifton Heights, have reintroduced a Good Samaritan law that would protect people, who call 911 to help a friend who overdosed, from facing prosecution for drug possession themselves.

Kentucky has a Good Samaritan law, but Ohio lawmakers dismissed it last year, fearing it would enable drug use.

“There’s so many different ways of dealing with this. One bill isn’t going to fix everything,” Dever said.

But threats and punishment alone don’t work, addiction specialists say, because addicts want heroin more than anything else. Many heroin addicts, who are criminals in the eyes of the law, steal to feed their habits. They aren’t making money off the drug, and throwing them in jail does little to solve the problem, Matson said.

Put another way: “People that we’re afraid of ought to be locked up in prison. People that we’re mad at might not have to be,” Mohr said.

jbalmert@gannett.com

Twitter: @jbalmert