Jailers at the Bernalillo County Metropolitan Detention Center are defending their decision to cancel the state’s only inmate methadone treatment program by the end of the year. They say the $10,000-a-month program, which has been treating opioid-addicted inmates since 2006, is better suited for community clinics outside the lockup.

“We reviewed all of our jail’s programs and determined this one is not well suited for our institution,” MDC Director Ramon Rustin told SFR today. “Our main concern in this situation is the health and safety of the inmates.”

Rustin said he is working closely with the medical team to develop a plan to detox inmates currently participating in the program.

But not everyone agrees with Rustin’s decision.

Recent Medical Director Anjali Taneja, who took over the program in August, said Rustin never consulted with her about discontinuing the program.

Now, Taneja said she plans to ask county commissioners to fire Rustin or ask him to resign.

But Rustin isn’t worried. He said his supervisors support his decision.

“With 33 years in the corrections field, they trust my advice,” he said.
Taneja said this isn’t the first attempt by the jail to curtail the six-year-old program started by Dr. Bruce Trigg, who resigned his position at the jail in July.

Taneja tells SFR that MDC’s Operation Manager James Zamora told her to begin detoxing patients on methadone treatment in August.

“I refused to do so, as it was not medically necessary and because they would not give justification for stopping the program,” Taneja said. ”Their real motive is to get everyone completely off methadone within a week; throw them into detox units and let them suffer.”

Taneja said she is worried some of her patients could suffer fatal consequences from a rapid detox.

“It’s inhumane and potentially very dangerous,” Taneja said.

But County Commissioner Wayne Johnson, a Republican, who supports Rustin’s decision, said it won’t be similar to quitting cold turkey.

“We’re not going to lock them up in a cell and not take care of them,” Johnson said. “Every inmate will have their vital signs checked every six hours by a trained nurse.”

Rustin says inmates will receive reduced amounts of methadone and prescription medication to control seizures and said he decided to allow pregnant women to continue their treatments while they are incarcerated.

The decision to end the methadone program at MDC comes three months after New Mexico’s own Medicaid program joined 30 other states that recognize methadone as an effective treatment for heroin addiction and authorized re-payment for outpatient treatment.

The Centers for Disease Control, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration, among others, have continually supported methadone as an effective treatment for opioid dependence that reduces overdose deaths.

“We are appalled at Bernalillo County’s decision,” Drug Policy Alliance State Director Emily Kaltenbach says.

“Up until now, Bernalillo County’s MDC Methadone Program has been a beacon of effective, physician-approved treatment. It has been a model for the rest of the state. This decision is not only unsound and counterproductive, but a step backward by reverting to a treatment model that does not work for everyone.”

Still, Rustin wants inmates to rid their system of all substances.

“It helps them think more rationally and enables them to make better decisions,” Rustin said.

He disputes claims from groups like the Drug Policy Alliance that the jail program reduces recidivism.

“Most of the 140 people in the program today are repeat offenders,” he said.

Johnson said alcoholics are not given beer in jail. Instead, he said they are allowed to detox and provided medication to reduce withdrawal symptoms.

Taneja said she’s heard from guards and inmate families that they worry that jail violence and contraband smuggling will increase after the program ceases.

“I am incensed and upset for the inmates, and sad that our progress in setting a model as a progressive state is being reversed in one swift decision,” Taneja says.

Trigg, who set up MDC’s methadone treatment program six years ago—and invited Clinton’s Drug Czar Gen. Barry McCaffrey and then New Mexico Department of Health Secretary Michelle Lujan Grisham, to the program’s inaugural launch—believes that Rustin “lacks a basic understanding of substance abuse and treatment.”

Trigg, who sent an email to program supporters today, said the program has always been seen as an important public health intervention.

“It’s proven to prevent transmission of infectious diseases, overdose deaths, relapse and recidivism and to encourage more people to enter evidence-based treatment for their heroin addiction,” Trigg wrote.

Kaltenbach insists treatments inside jails are key to reducing the state’s drug overdose epidemic.

In fact, a newly issued report on drug overdose deaths in the United States found New Mexico to have the highest overall overdose death rate of any state.

The DPA in New Mexico sent SFR a statement and claims treatment significantly reduces criminal activity during and after treatment.

Every dollar invested in substance misuse treatment saves taxpayers $7.46 in societal costs such as crime, violence, and loss of productivity. Averaging $5,000 a year, methadone maintenance therapy has proven to be a cost-effective way to break the cycle of incarceration, preventing the state from paying an upwards of $40,000 a year to incarcerate someone for their addiction.

Contrary to jailers, Dr. Trigg asserts the program has proven to reduce recidivism.

“Some of the repeat admissions are for minor probation violations,” Trigg wrote. “Such as being late for an appointment with a probation officer or a traffic ticket; not necessarily for heroin use.”

Trigg claims his data shows that 90 percent of inmates treated in jail report to their local methadone clinic following their release.

Most of the people on the program are awaiting a court date and have never even been convicted of any crime yet their potentially life-saving medication is going to be discontinued.

The program only enrolls people who are already in a community-based methadone program at the time of their arrest. Most receive their first methadone dose at the jail in a day or two after admission so they do not need to be observed in the special detox unit at the jail. They are also able to have their initial court hearing since those who are too sick may have to delay their hearing. Both of these save the jail money.

A number of the methadone patients are enrolled in the Gordon Bernell Charter School and the teachers and staff there have noted how well their students have done who in the methadone program compared with those with untreated addiction issues.

For now, Rustin says he’s convinced his decision will help inmates get back on their feet.

“In jail, you have to stay clean and sober,” Rustin said. “We don’t allow nicotine addicts to smoke.”
Rustin says he is not concerned about an increase in contraband. He says the county has purchased two body scan machines and they hope to catch drugs at the front door.