Road to Recovery at Ordnance Road Correctional Center

State: MD Type: Promising Practice Year: 2019

The Anne Arundel County Department of Health is the sole government agency responsible for improving the health of Anne Arundel County. The Department is located in Annapolis, Maryland and has a population of over 550,000.  The county is centrally located between Washington and Baltimore and surrounds the capital city of Annapolis.  The county borders over 533 miles of coastline with areas that are rural and suburban.  The county houses two detention facilities. The Jennifer Road Detention Center (JRDC) is located in Annapolis and the Ordnance Road Correctional Center (ORCC) is located in Glen Burnie.

Since 2012, the Anne Arundel County Department of Detention Facilities (AACDF) and the Anne Arundel County Department of Health (DOH) have collaborated to provide and manage the Road to Recovery Program (RTR) at ORCC. The primary objective is to reduce the recidivism rate of inmates who return to illegal drug use and criminal behavior after release from the detention center and to reduce the risk of overdose death.

Prior to the implementation of the program, DOH was providing assessment and referral information only to inmates in the facility.  During that time, only one inmate entered treatment upon release. National data also showed that few inmates (as low as 15%) actually entered treatment in the community upon release.  This prompted the decision to provide a full opioid treatment program for opiate-addicted male and female inmates incarcerated at the ORCC with referral to community medication assisted treatment programs upon release. This would allow medication to continue and allow for continuity of care by providing a seamless transition from the detention center to the DOH community methadone program or the home clinic.

Since then, there has been a continued sharp increase in overdoses.  The Maryland Department of Health and the Department of Public Safety and Correctional Services matched data on overdoses from 2007 to 2013 on individuals released from prison or the Baltimore City jail.  The analysis found that the risk of overdose was 8.8 times greater in the first week after release, compared to the period of three months to a year after release; a finding supported by other studies.  The increased risk was attributed to reduced drug tolerance following an incarceration period when drugs were largely unavailable, or events following release that involved the use of multiple drugs. In response, DOH and AACDF explored strategies that would mitigate this risk. 

The RTR programing expanded to include prioritizing pregnant women detained at JRDC, peer support services, overdose prevention training, and naloxone distribution.

Referrals to RTR come through case-management services, the peers or a self-referral from the individual.  An inmate detained at JRDC (intake and classification for all inmates in AACDF) who comes in on methadone will be guest dosed if a short stay or given a 21-day taper if likely to receive a lengthy sentence at a facility outside of Anne Arundel County.  If the individual sentenced to a stay at the ORCC, the inmate is eligible for admission to the RTR program.

Peer support services (PSS) began with one peer support specialist. As the need increased, another full time peer support specialist joined the team. PSS includes one female and one male peer who work within the male and female units.  The peers facilitate weekly resource groups and peer support groups, meet individually with inmates, activate and engage inmates in the recovery process, help set up needed resources upon release (funding, housing, treatment, legal) and connect inmates upon release to a community peer.

The Opioid Response Program (ORP) coordinator with DOH facilitates two sessions a month.  The peers provide one-on-one training to inmates unable to attend the group trainings.  Inmates receive a kit with two doses of Narcan. Kits are logged into property and given to inmates upon release. This is a novel approach as many programs in correctional facilities provide inmates with a certificate to redeem at the local health department. A practice that has not proven to be very successful. In addition to direct training of inmates, the ORP coordinator trains detention staff and supplies each unit a two doses for the first aid kits.

While the majority of the financial support for this project comes from outside the AACDF, this program exists because of the continued support and commitment of the Superintendent and the Warden.  Their leadership and vision have been instrumental in the development of this model program.

Public Health impact of the practice is to reduction of risk of overdose deaths of recently released inmates.

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Anne Arundel County has experienced a 171% increase in opioid related overdose deaths from 2014/2015 to 2017.   This increase has been attributed to the rise in fentanyl related overdoses. In 2017, 58% of the deaths were related to fentanyl or a fentanyl/heroin mix.  The demographics of the overdose population in Anne Arundel County is 75% male, 88% white and 45% between the ages of 25 and 34. This demographic is also reflected in the population served in the RTR program at ORCC with approximately 70% male, 30% female and a mean age of 32.3.

In four prison-based treatment trials, treatment entry rates one month after release was 85% for those who received treatment while incarcerated compared to 15% for those not treated.  At six months post release, 50% who received treated where still engaged in treatment opposed to 5% who had not received treatment. (Hedrich D. Addiction. 2011;107:501-517).

Between 2009 and 2010, over 450 inmates at ORCC with a history of opiate use received SUD assessments and counseling and written information about DOH's methadone client with immediate access to treatment upon release.  During that time, only one inmate presented for treatment.

An Australian study of 85,203 inmates followed after release showed 1,431 drug-related overdose deaths in men and 196 overdose deaths in women with the majority of overdose deaths occurring within 2 weeks post release (Kariminia A, Med J Aust. 2007. 187(7):387-390).  A Washington study of 30,237 released inmates that in the first 2 weeks after release, the risk of death was as great as 12.7 times that of other state residents and the leading cause of death was from drug overdose (Binswanger IA, New England Journal of Medicine. 2007. 356(2):157-165).

While the RTR program at ORCC is not necessarily a new practice in the field of public health, it is the only Maryland jail based program and one of a handful in the nation that initiates and maintains inmates on medication.  In order to broaden the reach of the program and afford more inmates the opportunity for treatment, there have been several changes and new service implementations.  The detention facility at JRDC has recently added SBIRT to the intake process to help identify inmates at risk of a substance use disorder. Those inmates identified at risk are referred to a SBIRT Peer (DOH Employee) who will then meet with the inmate while incarcerated with the goal of engagement and activation in the treatment and recovery process within the jail and upon release. 

Additionally, practices within the RTR program were looked at under the lens of a recovery-oriented system of care approach with the focus on supporting sobriety and progress towards overall health as well as promoting positive community reintegration upon release.  Practices that limited eligibility and access were either replaced or modified to include evidenced based practices that fostered participation and commitment in treatment.   Programming changes included no longer administratively tapering an inmate who tested positive for an illegal substance while incarcerated, admitting inmates with residences outside Anne Arundel County, and starting medication on inmates with shorter stays (with an adequate community plan in place).

Medication assisted treatment (methadone and naltrexone) has been widely considered an evidence-based approach to opioid use treatment (National Institute of Drug Abuse https: //  Recovery Support Services has been shown to reinforce gains made in treatment and extend the reach of treatment beyond the clinical setting to increase success in sustained recovery (  Overdose prevention education and naloxone distribution is a widely accepted strategy to combat fatal overdoses.

The initial planning for the RTR Program began in 2010 with extensive collaboration with county Detention Facility Administration and staff, County Detention Facility medical and psychiatric services (external vendor), SAMHSA, DEA and the Maryland Department of Health. This was a two-year process with the program eventually opening in June of 2012.  This level of collaboration was essential, as the program would be housed within the facility. In addition, the program would need to meet State and Federal OTP standards in order to be licensed as an OTP as well as meet the safety standards and regulations of the detention center.  The program needed designed to be efficient and sill manage lockdowns, work release schedules, conflicting guard duties impacting transport of patients to appointments, inmate work assignments and Education/GED and other classes. The medical vendor's support and cooperation would be instrumental in assisting with guest dosing of inmates housed at JRDC.  Of critical importance was the buy-in from correctional officers and staff in order for the program to be successful.  Education on misconceptions around methadone was a key element. 

As this program is hosted within the correctional facility, there are monthly meetings that includes the leadership of AACDF and the Behavioral Health Bureau within DOH as well as RTR and ORCC involved staff to review stats, identify challenges, share successes and look for additional ways to enhance the service.  Weekly stats are also submitted to DOH and AACDF leadership that include the number of inmates served, the number discharges and the percentage that are linked to community programs upon release.

The goal was to open a full-service substance use disorder clinic located with the Ordnance Road Correctional Center.  The objectives were to reduce recidivism and overdose deaths post release.

Eligible participants include inmates with an opioid use disorder (OUD), pregnant inmates with an OUD, inmates incarcerated while active in a community based methadone clinic, and those serving 18 months or less at ORCC.  

This project receives the majority of its funding through the State of Maryland.  The County provides in-kind support and the Anne Arundel County Detention Facilities provided financial support for a part time nurse.  The estimated annual cost is $700,000.

Implementing a full service medication assisted treatment program within the detention center proved extremely successful in transitioning inmates to community programs (FY18: 70.77%)

Additional program impacts were reported during focus groups held with detention center staff.  Those impacts included fewer inmates experiencing withdrawal symptoms requiring medical observation and treatment; a noticeable reduction in fighting and conflict among the inmates, and an increase in inmate participation and attendance in educational programs offered by the facility.

Mid 2017, an analysis using data from the RTR enrollment records and the police overdose files was completed.  Between January 1, 2014 and December 31, 2016, 1,810 overdoses made by 1,499 unique individuals were recorded in the police data file.  Of the 1,499 persons with overdoses, 55% had a prior history with the Anne Arundel County Department of Detention Facilities system.  

There were 485 unique individuals discharged from RTR between January 1, 2014 and December 31, 2016. Fifty-nine RTR participants were matched in the police overdose file.  Most were male (86%) with an average age of 31.5 at the time of first recorded overdose.  Twenty-eight of the matches were person that recorded his/her first overdose in the police file after his/her documented discharge in RTR.  The first subsequent overdose, for those 28 RTR participants, occurred an average of about a year (369 days) after initial RTR discharge.

This analysis is a descriptive summary of this matched population.  It does not reflect the estimated risk of overdose for RTR participants, as there was no adequate comparison group (e.g., inmates with a history of opioid abuse not enrolled in RTR).  Nonetheless, an overwhelming majority of RTR participants (88%) had no known overdoses since discharge from the program and release from the detention center.

The implementation of SBIRT at intake will provide a control group to use in future analyses.  We are also excited about the possibility of working with a research entity in Baltimore who has offered to provide a statistical analysis using tools that would take in to account the lack of controls.

The RTR program is a successful due to the strong partnership between the Anne Arundel County Department of Health and the Anne County Department of Detention Facilities.  Without the support of the leadership of AACDF, the ability to maintain inmates on medication and the distribution of naloxone kits within the facility would not be possible.  This support continues from leadership and program funders due to the proven success in linking inmates to community based MAT post release.  This commitment is tantamount to the continuation and expansion of the program as services are not reimbursable by insurance while a participant is incarcerated.

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