By Elizabeth Thompson
Major Elijah Bazemore started working at the Durham County Sheriff’s office on April 11, 1988. Since then, there’s been a “paradigm shift,” he said.
“You want to help an individual be better when they get out of the facility than when they were when they were detained,” Bazemore said in an interview with NC Health News.
He’s been helping people detained at the Durham County Detention Center do just that through the jail’s medication-assisted treatment (MAT) program, where he is the jail’s program administrator.
This work saves lives, Bazemore said, and could also reduce recidivism. Bazemore’s work was recognized by Attorney General Josh Stein who awarded Bazemore the North Carolina Dogwood Award on Nov. 23.
The Dogwood Awards honor North Carolinians “who work to keep people safe, healthy, and happy in their communities,” according to the North Carolina Department of Justice.
“Major Bazemore puts people first,” Stein said in a statement. “He works to help those who are struggling with substance use disorder get treatment they need while they are incarcerated and find a path to recovery. With the opioid crisis devastating our state, I’m proud to honor Major Bazemore and Durham County’s work to help people have a chance at a healthier tomorrow.”
MAT in jails
MAT is the use of one of three drugs approved by the U.S. Food and Drug Administration — methadone, buprenorphine and naltrexone — to alleviate cravings for opioids such as heroin without a high. It is considered best practice to care for people with opioid use disorder.
Opioid use disorder directly affects much of the incarcerated population. Federal data show that as much as 85 percent of the prison population either has a substance use disorder or was arrested for crimes related to drug use.
The program at the Durham County Detention Center allows people with opioid use disorder on MAT to continue getting their medication while detained in the jail, and it also allows detainees to begin the treatment at the jail.
This is key for reducing opioid deaths, Eric Morse, an addiction psychiatrist who serves on the board of Morse Clinics, previously told North Carolina Health News.
Jails are already identifying people with opioid use disorder to put them on a detox protocol, Morse said. Instead of putting them on a path of withdrawal and relapse, introducing MAT to people in jail could help put them on the road to recovery.
The use of MAT in North Carolina’s jails is inconsistent at best, North Carolina Health News previously reported.
While some counties facilitate the use of MAT on jail property, others force people in recovery into withdrawal, which can be both painful and deadly. One study found that people leaving prison were 40 times more likely to overdose on opioids in their first two weeks after reentry.
“When you get back you think you can do the same amount that you did before you got locked up, and then you wind up having an overdose,” Bazemore said.
Expanding MAT in jails and prisons
Over the past five years, jail and prison use of buprenorphine, one drug that is used for MAT, has increased 224 percent, according to one recent study.
This is good news, said Ashish Thakrar, one of the study’s researchers, in an interview with North Carolina Health News. Still, only an estimated 3.6 percent of incarcerated people with opioid use disorder received buprenorphine.
“More than 95 percent of people struggling with opioid addiction who are incarcerated never get treatment with buprenorphine,” Thakrar said. “So you know, there’s good news and that we’re making progress, but we still have a really long way to go.”
Just because many jails and prisons haven’t invested in MAT programs yet doesn’t mean that they don’t care, Thakrar said.
Expanding the use of medication-assisted treatment in jails and prisons requires investment of both time and money that some facilities may not have the resources for right now. It also takes time to set up the infrastructure necessary for a functioning MAT program.
It can often be difficult for facilities to get approval to dispense methadone, Thakrar said, since methadone must be dispensed from a licensed opioid treatment program.
“That means jails or prisons have two options,” Thakrar said. “They either themselves can become licensed opioid treatment programs, although that process often takes months to years, or they can get methadone delivered from an opioid treatment program in the community.”
Durham’s MAT program was able to work with community and state stakeholders so it can offer both methadone and buprenorphine. It is currently working on creating a methadone dispensary clinic in its medical unit, Bazemore said.
Bazemore started working on introducing MAT to the jail in October 2018. Durham’s MAT program which allowed people detained in the jail to continue MAT only if they had already started the medication began in 2019. Only in November 2021 did it launch the second phase of the program — identifying and treating new patients.
The effectiveness of MAT programs in carceral settings also depends on whether people will be able to continue using MAT once they leave the jail or prison, Thakrar said.
“We need to… really work on coordinating community treatment too,” Thakrar said, “making sure that jails and prisons are partnering with organizations in the community.”
Durham’s jail-based MAT program works with several community partners to connect patients with care upon release, such as North Carolina Formerly Incarcerated Transition (NC FIT) program, Bazemore said.
North Carolina’s prison system was set to start a program that would allow people with substance use disorder to go on MAT, but that pilot was delayed due to the pandemic.
The Durham County Detention Center got support from multiple community stakeholders for its MAT program from the get-go, Bazemore said, such as the local health department, Duke University and the University of North Carolina at Chapel Hill, and it has been able to get grants to help fund the program.
It costs a lot of money to run a program like the one at Durham’s jail. The state budget allocates $2 million in recurring grants to sheriff’s offices to expand MAT as part of reentry programming.
Bazemore said, “but at the end of the day, it’s working.”
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However, as instances of the coronavirus continue to climb across the state, a lack of functional plumbing in any number of North Carolina households is becoming a more critical concern than ever before: hand-washing is difficult without flowing water or a working sink. It has received funds from Duke University and the University of North Carolina at Chapel Hill to assist support the program.