18 Q&A WITH DR. JONATHAN GIFTOS Preventing Opioid Relapse and Overdose

A Q&A WITH DR. JONATHAN GIFTOS PREVENTING OPIOID RELAPSE AND OVERDOSE

DR. JONATHAN GIFTOS Former Clinical Director of Substance Use Treatment for NYC Health + Hospitals, Division of Correctional Health Services at Rikers Island

In response to the prevalence of opioid use disorder among people with justice involvement, jails and prisons are starting to change how they address it. One treatment that has increasingly gained traction is Medication Assisted Treatment (MAT), an intervention becoming known for its affordability, effectiveness, and uniquely holistic approach. Through a combination of medications (i.e. methadone, buprenorphine, and naltrexone), counseling, and behavioral therapy, it not only reduces withdrawal symptoms, but addresses underlying issues driving substance use.

Dr. Jonathan Giftos, former Clinical Director of Substance Use Treatment for NYC Health + Hospitals/ Correctional Health Services, is one expert who has seen MAT’s effectiveness in helping patients with justice involvement avoid opioid relapse and overdose. In the following Q&A, he shares key information about MAT and advice for people who are incarcerated in jails and prisons that offer it.

What are the most important things for incarcerated people to know about MAT?

Medications such as methadone or buprenorphine (e.g, Suboxone) are effective treatments for opioid use disorder (i.e, opioid addiction: addiction to heroin or prescription pain killers). They have been shown to reduce opioid use and complications such as HIV infection. Most importantly, these medications reduce risk of death. They can be complemented by other services such as counseling or recovery groups if patients are interested. The most important thing to know is that these medications are most effective when taken every day (i.e, as maintenance medications), and not when used simply to wean one’s self from opioids (i.e, “detox”). For people in correctional settings, taking methadone or buprenorphine has been associated with an 85% reduction in risk of death from overdose during the first few weeks that one returns to the community.

What advice do you have for each of the following groups of people?

Incarcerated people who do have access to MAT, but are ambivalent about using it

Ambivalence is normal for people with addiction. And this is especially true regarding treatments like methadone or buprenorphine. Some may think they are “trading one addiction for another.” I usually tell people that there is a difference between physical dependence — which simply means that you must take a medication daily or you will feel withdrawal symptoms — and addiction, which is the compulsive and often escalating use of a substance despite negative consequences. Untreated addiction can lead to people’s lives getting worse. Medication like methadone or buprenorphine often lead to people’s lives improving. They feel better, they can engage other needed health care services, they can save money, and more.

People who are being transferred from a correctional facility with MAT access to one without MAT access

Some patients may be transferred from a setting with medication access to a setting with more limited medication access. If a patient worries that this may happen to them, they can discuss that concern with health care staff. There is no one answer in these cases, but coordination and counseling can sometimes help patients feel better about the process.

Incarcerated people who have used MAT and are about to be released. Additionally, are there any followup steps that those specifically being released from Rikers should take?

All patients who began using medication for opioid use disorder in the jail are offered a community referral. They are also tracked through discharge. The reentry process is very challenging with lots of competing pressures. Additionally, Medicaid may still be suspended due to incarceration, complicating access to medication or services.

Any recently released patient in New York City who has questions about their release plan should call our Point of Reentry & Transition (PORT) line at 646-614-1000 for assistance. 

FINDING HEALTH SERVICES AND SUPPORT AT THE COMING HOME PROGRAM

BY JESUS ROBLES Program Coordinator The Coming Home Program

Successful reentry into society after justice involvement is key to improving the personal and emotional well-being of individuals, as well as reducing social and financial costs to the community and criminal justice system. A crucial part of reentry is access to health services. To promote positive health outcomes and equity, establishing connections and support networks with community partners is essential. One initiative that does so is the Coming Home Program (CHP) at the Morningside Clinic at Mount Sinai St. Luke’s Hospital, which provides medical care, as well as mental health and social services for individuals who are recently released or have a history of incarceration.

CHP staff support network and resource building by creating referral streams with community-based organizations and local government agencies including courts, divisions of probation and parole, federal halfway houses, and reentry taskforces. Since outreach efforts began in November 2018, CHP has built key partnerships that are responsive to the needs of various stakeholders.

Outreach occurs within the individual organizations and across agencies at taskforce meetings and community forums. Every person referred to CHP is connected to a staff member who facilitates early engagement with the patient and sets up a timely appointment with a social worker and primary care physician, often within days of the referral. Staff members regularly reach out to CHP patients to foster retention for those who have missed appointments or may need more support. CHP patients have access to an extensive array of services, including the Addictions Institute, Health Home, Care Coordination, accompaniments, and support groups addressing anger management, substance use, and others. Patients also provide feedback as stakeholders in Morningside’s Consumer Advisory Board.

In order to address the psychosocial needs of each patient, CHP patients complete a comprehensive assessment which includes mental health and substance use screening. A majority of CHP staff have lived experience in the justice system. The lived experience helps the team better connect with patients while providing care that places the patients’ needs front and center with a high level of understanding. All staff at the

Morningside Clinic have been trained in providing trauma-informed care; the mental health and social work teams have extensive training and experience in providing services to individuals with a substance use disorder and cooccurring mental health disorders.

The Coming Home Program can help you transition back into the community with care, compassion, and understanding. By being part of the program, you will have access to state-of-the art services within the Mount Sinai Health System. Reentry can be difficult, but you do not have to do it alone.

Upon your release you can call either 212-523-6500 / 917-697-8563 or email ComingHome@mountsinai. org to schedule an intake appointment with the Social Worker. If you are working with an organization, you can also ask your case manager to reach out and schedule the appointment. 