Pathway Advocacy and Alliances for Community Treatment (PA2CT)
In 2012 the Kentucky General Assembly passed House Bill 1 (HB1) that focused on combatting the prescription drug abuse problem by close regulation of pain management clinics and the development of new standards for those who prescribe and dispense controlled substances. As the prescription medications became harder and harder to obtain, other opiate based drugs became easier and cheaper to get. The passage of HB1 fueled the unintended consequence of driving the heroin epidemic that was about to hit Kentucky, Louisville Metro was no exception.
Louisville Metro Department of Corrections (LMDC) began experiencing a significant influx of high-needs individuals among the jail population. LMDC, like the Metro Louisville community, was suddenly faced with an issue, the growth in opiate use, especially heroin, like it had never seen before. Heroin related arrests had skyrocketed from 120 arrests in 2010 to 1,501 arrests in 2014. In 2015, Jefferson County had the most overdose deaths of any Kentucky County with 268, and the most heroin-related overdose deaths with 131. In 2016 LMDC was selected to receive Senate Bill 192 (SB192 Heroin Bill) funding to expand in-jail substance abuse treatment programs and medication assisted treatment (MAT) using Vivitrol, for eligible opiate addicts returning to the community. Vivitrol is an opiate blocker that blocks the opiate receptors in the brain. It will block any alcohol or opiate based drugs from being absorbed, causing the user to experience no euphoria. It also reduces the cravings to use alcohol and opiates.
In the spring of 2016, LMDC started developing the MAT program, Pathway Advocacy and Alliances to Community Treatment (PA2CT), by partnering with Correct Care Solutions (CCS), now known as Wellpath, the contracted medical/mental health provider for LMDC. Training for medical staff was provided by Alkermez, the Vivitrol provider. LMDC has partnered with the courts and prosecutors to refer offenders who were interested in Vivitrol treatment, and would get released to continue treatment in the community. Senior Social Worker/Coordinator for the MAT program has established contacts with community providers that are committed to taking on the task of the continuum care of the MAT program participants.
Once an inmate has volunteered and is identified as a potential participant for MAT who will be released from LDMC custody within a month, program coordinator requests liver enzyme labs (hepatic function panel) to be collected by medical. Once lab results return, the doctor or nurse practitioner clears or denies Vivitrol administration based on the lab results. If denied, the referral source and the inmate are notified. The inmate will still be assisted with a discharge plan to other resources for substance use treatment. If cleared, then approximately one week before potential release date the program coordinator conducts drug screen and has consent to treat and release of information forms signed by the inmate. At that time medical is informed that the inmate is ready to receive Vivitrol. The nurse administers the Naltrexone (pill), and after observing the inmate for possible side effects, 1st Vivitrol injection gets administered. Program coordinator forwards the lab results and signed ROI to the community provider, receives appointment for follow up care.
"LMDC has partnered with the courts and prosecutors to refer offenders who were interested in Vivitrol treatment, and would get released to continue treatment in the community"
PA2CT participant data was provided for the following data points relevant to analysis: inmate number (unique identifier), release date, housing placement (data was provided from 3/2016 – 12/2017):
47% of the population had “complete success” (zero arrests after release from PA2CT Program).
96% of the population had fewer or equal number of arrests after release from the PA2CT Program.