Thursday, July 25, 2024

Brunswick County approves ARROW program for in-prison addiction treatment

The Brunswick County Commissioners approved the funding and implementation of the ARROW program in the detention center, along with the 2025 budget, at their most recent meeting. (Port City Daily/Amy Passaretti)

BRUNSWICK COUNTY—- The Brunswick County Sheriff’s Office is implementing a drug abuse rehabilitation program after receiving approval from most commissioners Monday; however, one remains opposed to the idea.

READ MORE: Brunswick residents argue planning board has too much authority

At Monday’s commissioners meeting, the board voted to approve the Addiction Response and Rediscovering One’s Worth (ARROW) program, an in-prison addiction treatment initiative, part of a broader spending strategy for the county’s allocated opioid settlement funds. The vote was unanimous, although Commissioner Pat Sykes abstained.

“If I had to vote today, after thinking it over a little bit, I would definitely vote no,” she said later in an interview with Port City Daily on Wednesday. 

The program will offer treatment services such as individual counseling, support groups, and cognitive-behavioral therapy. And develop a transition plan for re-entry into the community. It is designed for patients to participate for 90 days, voluntarily or by referral.

According to Acacia Alston, licensed clinical social worker and addiction specialist, for the BCSO, the program is modeled after two similar initiatives at the Pitt County Detention Center: the Sheriff’s Heroin Addiction Recovery Program (SHARP) and the Women’s Empowerment and Recovery (WEAR) programs. Like ARROW, these are substance abuse rehabilitation initiatives that allow licensed therapists, counselors, and peer support specialists to work with individuals who suffer from substance abuse disorders. 

“The [Brunswick County] Sheriff’s Office members got to speak to participants that were active in SHARP and heard firsthand how the program has changed the trajectory of their life,” said Emily Flax, Public Information officer for the sheriff’s office, in an email with Port City Daily. 

However, Commissioner Sykes said ARROW needed a solid plan and supporting data from the program it was modeled after. She also thought the funds could be better allocated to other programs. 

It is estimated to cost $252,335.84 for 30 participants. The budget covers the salaries of two positions—a program coordinator and a jailer—as well as contracted services for psychological evaluations, EMDR, individual therapies, equipment, and commissary incentives.

Flax notes the personnel salaries and contracted services will be recurring expenses in the annual budget.

Sykes said it is important to use the settlement money where it is going to benefit the most. 

During an interview with Port City Daily Wednesday, she proposed the funds might be better allocated to providing transportation for individuals who have completed treatment court and are now seeking to maintain employment in the community, ensuring they have rides to work.

Alternatively, she suggested addressing the problem at its root by hiring investigators dedicated to identifying drug dealers.

“‘We do need to spend money to save lives.’ I agree with that, but using evidence and data to guide the spending is important,” she said, “We also need to make sure we’re understanding what our community needs and I just don’t think our program is where we need to go.” 

A logic model, used by the ARROW program, was included in the commissioners’ agenda packet. The model outlines the necessary resources, such as staff members, collaborations, and target audiences. It also details the activities participants will undergo, beginning with an initial eligibility evaluation, followed by a comprehensive clinical assessment, treatment plan development, and subsequent steps.

Sykes told Port City Daily in an interview Wednesday that she still doesn’t know what treatment entails, despite requesting more data about the Pitt County initiatives and its structure when it was first presented to the board at the June 3 commissioners’ meeting.

“[In the] goals, that it says treatment plan development,” she said. “So that means they have to develop the plan?” 

Treatment plan development involves creating a customized strategy for each participant based on consultations and initial screenings. During this phase, the type of therapy, such as Moral Reconation Therapy (MRT) or Eye Movement Desensitization and Reprocessing (EMDR), is decided upon.

Sykes also raised concerns during the presentation about the 90-day participation requirement, questioning how ARROW would operate if someone is not incarcerated for the full 90 days.

“She [Alston] says that this is gonna be a 90-day program; I just don’t see that many people in the jail that will be there 90 days,” said Sykes, as she relayed to PCD that, in her experience, drug dealers tended to remain incarcerated longer than drug users.

However, at the meeting, Alston said there are several intimates she sees daily that have been there for 90 days. When asked if she had supporting data for this comment, she did not have it on hand.

Another point of contention for Sykes was that the objectives of  ARROW closely align with other existing health-related initiatives, such as the county’s partnership with Wellpath, Brunswick County’s treatment court, the Anchor Initiative program; and treatments like Medication for Opioid Use Disorder (MOUD).

Currently, the county has a treatment court, a specialized session of a regular district or superior court. It focuses on monitoring adult and juvenile abuse, neglect, and dependency cases involving individuals with substance abuse disorders.

The Anchor Initiative was launched in 2018 and assists individuals struggling with substance abuse to get into treatment facilities and avoid criminal penalties. For example, an individual can reach out or be referred to the sheriff’s office, which will provide transportation and funds for treatment. 

Wellpath is the healthcare service provider used by the county for the detention center. 

“You know, we have Wellpath, whose part of their job is to make sure they take care of the inmates,” she said. “So why are we paying somebody else to come in and do this same thing that they’re supposed to be doing? Yeah. It’s just, there’s some duplicate stuff here.” 

The county entered into a contract with Wellpath in 2010, formerly known at the time as Correct Care. The contract was recently renewed at a meeting on March 18, a decision opposed by Sykes due to concerns over inadequate operations at Wellpath’s other facilities. 

In 2014, Jennifer Schuler, a pregnant inmate at the Forsyth County Jail died after a severe heart attack and lack of oxygen to the brain. Her family eventually reached an agreement with Wellpath—Correct Care at the time— and the lawsuit was dropped. In 2017, Michele Smiley, an inmate at Buncombe County Jails died after a methamphetamine overdose. Smiley allegedly swallowed the drugs in order to avoid prosecution. The lawsuit stated that EMS was called more than an hour after the inmate began to overdose. A $2 million settlement with the victim’s family was reached. 

Most recently, Devin Haley committed suicide in a Mecklenburg County Jail, whose healthcare is also provided by Wellpath. The currently pending case, states that Wellpath knew the state of Haley’s mental health, and never distributed the medication he requested. 

According to the Wellpath contract, the company oversees all healthcare services at the Brunsick Detention Center ranging from health screenings and assessments to body cavity searches, dental care, ambulance and hospital arrangements, and mental health services.

Wellpath was not involved in the creation of the ARROW, according to Alston, who emphasized the latter focuses on addressing addiction and mental health issues directly associated with substance abuse— while Wellpath addresses mental health in general. She also noted oftentimes, participants do not qualify for the Anchor Initiative program. 

“Although the Anchor program does operate within the detention center, there are more times than not that the individual doesn’t qualify just due to the nature of their charges or the level of offender status that they are,” Alston said at the May meeting. “Essentially, the ARROW program would close that gap and offer services for those that are waiting for their criminal cases to be handled in the detention center that normally wouldn’t have any access to treatment.”

Sykes told Port City Daily the MOUD model may be a better option, and it is backed by the North Carolina Commissioners Association. 

“We have several [NC Commissioners Association members] that have children that have OD’d so they’re pushing to do whatever they can to help,” she said. “So I think that’s why they’re pushing this program—the MOUD. And the ADA requires it. And we’re not doing it yet. So why wouldn’t we do a program that’s required first?”

Sykes is correct in that the ADA requires detention centers to provide MOUD upon request of an inmate. However, the BCSO does provide the service through Wellpath. 

MOUD is a treatment approach involving FDA-approved medications to treat opioid addiction, help ease withdrawal symptoms, decrease cravings, and block the effects of opioids. MOUD is often used in combination with counseling and behavioral therapies, which then makes it Medicated–Assisted Treatment (MAT). 

The ARROW program differs from MAT and MOUND because it does not administer any medication. Alston said Wellpath can administer MOUD at the detention center, but the sheriff’s office is not pursuing those treatment methods at this time. 

Sykes mentioned a letter written by the Disability Rights North Carolina, a federal protection and advocacy agency, was sent to commissioners via the North Carolina Commissioners Association. 

The letter urges sheriffs across the county to implement MOUD treatments, regardless of request. It is supported by the American Disabilities Act. It references research showing MOUD treatments can significantly reduce the risk of overdose-related deaths and relapse by curbing the cravings experienced by substance abuse addicts, which often impede their progress.

As of April 2022, the Department of Justice states that it is a violation of ADA rights to discontinue medication for an individual using MAT or MOUD. Denying MOUD or MAT to someone with a substance use disorder is considered discriminatory and illegal.

ARROW is funded by the Opioid Settlement Fund, in which North Carolina received $750 million in the first wave and $600 million in the second wave. Of this total, 85% was allocated to be distributed across North Carolina counties. The funds will be distributed over the next 15 to 18 years, with Brunswick County receiving $5.5 million thus far. In total, the county should receive over $24 million in funds by 2038. 

Brunswick’s remaining opioid settlement funds are intended to fund social service clinicians, residential recovery services to Brunswick County residents from contracted providers, The Healing Place and CRCI, a health educator to support and coordinate the county’s substance use prevention and recovery efforts, and a community paramedicine program to support post-overdose responses by providing connection to treatment services. 

The rest of the 2025 budget was also approved by commissioners at the June 17 meeting; no increases will be made to the property tax, keeping it at 34. 2 cents for $100 of valuation. 

Highlights of the  $392 million budget include 62 new positions within the county and funding for a new combined Emergency Operations Center and Health and Human Services building. The new Emergency Operations Center and Health and Human Services building are being allocated a $30,000,000 bond that comes from an increase in debt services. The project is estimated to cost $70.2 million. 

The district school system has an agreement with the county to receive 36.5% of the revenue generated from property taxes for its operational needs. This year’s budget allocates $57.5 million to Brunswick County Schools, representing a 3.6% increase, or nearly $2 million more than the previous year. Additionally, the schools are projected to receive approximately $9.7 million more. from local sales tax revenue to support their operations.

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