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The opioid crisis demands a stronger response from emergency care and EMS is uniquely positioned to lead. The MN Bridge podcast explores how EMS systems across Minnesota and the country are stepping into this role. This series highlights innovative strategies, local successes, and the evolving responsibilities of emergency providers. It’s a place for honest conversations, practical insights, and stories from the front lines of overdose response.
Hello, everyone. Welcome to the Minveridge podcast series. My name is Tim Coomer. I am an emergency physician at Hennepin Healthcare and EMS medical director for Hennepin EMS.
Speaker 2:And I'm Holly Drone, pharmacist here at Hennepin Healthcare and Emergency Medicine and with Hennepin EMS.
Speaker 1:Hello, Holly.
Speaker 2:Hey, Tim. What a treat today.
Speaker 1:This is going to be great. So today we are talking to Alyssa Woodward. Alyssa is so wonderful. We've gotten to know her a little bit over the last maybe year or so. She is the associate medical director for substance use treatment at the Hennepin County Jail.
Speaker 1:And we knew we wanted to do an episode on this topic, kind of incarceration and the opioid crisis, because we know that patients who are incarcerated are at high risk of overdose, especially upon discharge. So we wanted to tap into her knowledge. So we reached out to her and said, hey. Do you wanna be on the podcast, and do you know any other cool people? And she did.
Speaker 1:She knew Dustin Newman. Dustin is the Detention Services Captain for Mille Lacs County Sheriff's Department. And I gather that that's his formal title, but he seems to be the kind of guy who just does whatever needs to be done.
Speaker 2:Which I so appreciate. He shared with me that he is on the rescue swim team. Wow. He, is a member of the SWAT team. So he's kind of got his hands in a lot of different buckets, which I think gives him a really well rounded experience.
Speaker 1:Totally. It's great to have someone who's on the SWAT team and also is working at the, the jail saying, hey. We need an MOUD program here because it's the right thing to do. I think that's that's fantastic. So this is gonna be fun.
Speaker 1:Please enjoy Alisa Woodward and Dustin Newman. So we are here with Alisa Woodward. Alisa Woodward is the associate medical director for substance use treatment at the Hennepin County Jail. Alyssa, hello.
Speaker 3:Hello. Thank you for having me.
Speaker 1:Thanks for being here. We also have Dustin Newman. Dustin is the detention services captain at Mille Lacs County Sheriff's Department. Dustin, thank you for being here.
Speaker 4:Appreciate you having me.
Speaker 1:And we are gonna talk I'm excited for where this goes. We're gonna talk the opiate crisis, and jail, and prison, and going into jail and prison, and coming out of jail and prison, and what it's like to be in jail and prison, and have opioid use disorder, substance use disorder. So we're gonna go all kinds of different directions, if that's cool. Okay. So I think it's important, because words are important, just so we can establish some terms, because I know I'm gonna use them wrong, can we talk briefly about like, the difference between jail and prison?
Speaker 4:With jail, that's when we get people, you know, freshly arrested straight off the street. We're holding people, you know, pre trial, pre sentence, all that kind of stuff. You know, prison, when you're talking prison, that's people who are already through the court process, people who have been convicted of crimes, and also too is, you know, prison is felons only, so they've been convicted of a felony crime and they're sentenced to longer than one year. That's another caveat to the To going to prison versus staying local. So Okay.
Speaker 4:Those are just kinda the the big differences there.
Speaker 1:And do you find the general public in general uses the terms interchangeably? Because I will slip up and do that.
Speaker 4:100%. Okay.
Speaker 1:100%. But they're different. It's important to it. I was a nurse in the Hennepin County Jail many careers ago, and that was my first learning of like, oh, didn't know those words actually meant something. But they are technically different, right?
Speaker 4:Yes.
Speaker 2:But how long can someone be in jail before they were to be sentenced, or released, etcetera etcetera?
Speaker 4:Well, that is another great question because a lot of people think that, you know, it's just your overnight, you know, DWI offenders come to jail, things like that. People sit for maybe a month and then they're, you know, changed out or whatever it is. But we find people, you know, two and a half, three years waiting to get through the court process. So even though, you know, like I say, people, once they get sentenced, they can only be in a county jail for less than a year, but going through the court process, they can be here for a year, two years, three years, sometimes even longer depending on how long the court process takes. So that's a good question.
Speaker 1:Wow.
Speaker 3:Yeah. We get everybody from the people who are overnight to to the long term people here at the Hennepin County Jail too. I think I was looking the other day, and our our median stay is, like, thirty nine days. So it's pretty common to to stay here for a bit.
Speaker 1:So let's just talk some logistics. If you are one of these folks who comes in for only, like, a a day or two, maybe it turns in to be longer. You don't really know. From a health care perspective, how do you handle that? I take medication x y and z, and now I'm in jail.
Speaker 1:I need my meds. Maybe I don't get them. Maybe I do. How do talk through just logistically so everyone has like because I I found when I worked as a nurse there, I was like, I'm so grateful for this job because I've never thought about this. I don't know what this looks like.
Speaker 1:It's just a thing that you hear about, but people need their medications, Pete. Right? And and we believe that's a right that they should have. So talk through just logistically what that looks like.
Speaker 3:So I think it's pretty different between here at the Hennepin County Jail and what they have in kind of more rural settings. So here at the Hennepin County Jail as part of, like, the booking process, people actually meet with a nurse down in our intake area who will ask the the detainee or the patient about their chronic medical conditions, what medications are you taking. They'll actually do a medication review through things like the PDMP or through through our electronic health record and then be able to either continue or restart some of those medications for patients on admission with a medication signed off by the provider after the review. Sure. But I think they do it quite differently in some rural settings, though.
Speaker 3:Don't they, Dustin?
Speaker 4:Yeah. We we still you know, for us in Mille Lacs County, you know, when we get somebody coming in off the street, that's one of the first things we do even at the squad car. I mean, granted if the person is compliant and and, you know, willing to talk to us, but we start medically triaging them out in the garage. So we're asking medical questions, we're trying to figure out what meds they take, or what medical conditions they have. And also two, unfortunately, is what substances they've also been using on top of that, to make sure that we're giving the best care we can.
Speaker 4:And then once we get them in and do the booking process, we ask them all their medical questions, go even further. And when people are driving their cars or out and about, they're not always carrying all their medications on them. So then, if they do have some sort of critical med, we give them phone calls, we work with them to try and contact family members, or just ways to get that medication to us. And then ultimately, if they don't have anybody who can bring them that medication, then our medical staff, which you know, being rural, we don't have twenty four hour medical coverage. I could go on a long rant about that, but.
Speaker 1:Go ahead. It's a podcast, Dustin. Rant away.
Speaker 4:Well, it just it's one of those things, right? It's battles we face. Well, I just I'll answer the question first, and then I'll go on a little bit of a rant, but So, then our medical staff will review the medications, make sure that person We'll do drug screens on them, and this is not a gotcha drug screen to give to their probation officer or anything else. This is a drug screen to make sure that we know what substances are in their body, so that we're not gonna give them something that's gonna adversely affect them and throw them into some sort of withdrawal or counteract with the medications they have. So we'll triage all that with our medical staff, and then from there, kinda order their meds and get them locally or whatever we gotta do so that, you know, they're getting taken care of properly.
Speaker 4:And then just to go on my side rant about it, part of it is jail healthcare, correctional healthcare is not cheap. And one of the battles that we face, and it's nothing against county boards and things like that, but to understand that even if you have a jail, and you're ADP, your average daily population is only 20 inmates, you still are dealing with such acute, you know, medical issues that, you know, if those things aren't getting taken care of, and if those things aren't, you know, being handled, now we have such, you know, major liability going on. So for it for us to have twenty four hour medical coverage, it shouldn't be out of the realm in these smaller facilities and things like that just because it is it's such a it's such a critical need on the on these folks that we're taking care of. One of the things that we changed over was we actually switched over from five day a week medical coverage to seven day a week. This was about three years ago.
Speaker 4:So now we seven day a week medical coverage for twelve hours a day, which for a facility like ours, you know, where we can house 148 inmates, that's kind of unheard of a little bit, but the acuteness of these medical conditions, of the opioid use and everything else, it's just so so necessary for us to give proper care.
Speaker 1:And not to mention this population that you have is like wildly under cared for in general already, right? So you're not bringing in our healthiest. Right? You're bringing in those who haven't had medical care potentially in years, and this is kind of their first crack at medical care. It's a, yeah, it's a huge need.
Speaker 1:I'm biased, but
Speaker 3:No. It's a huge need. We're seeing just like a ton a huge increase in, like, the acuity of the needs of our patients. Like, nutritionally, they're not eating the way they should, the substances that they're using in the community, and how that impacts their health plus the chronic medical conditions. Other things that they're coming in has really put them at higher risk out in the community, and then when they're coming into us for us to make sure that we're taking care of them in the best best way that we can.
Speaker 1:Okay. Let's move to opioid use disorder, MOUD, etcetera, in this topic. I was doing a little bit of review for this, and the numbers in terms of how incarceration impacts outcomes for people is like staggering to me. And I again, I I I think a lot about this stuff, and I I don't know and even I was very surprised. I don't know if the average person, but just talking about like how much higher your risk of mortality is or risk of death is in the immediate discharge from incarceration period is.
Speaker 1:I mean, I read is two weeks post release, you are 10 to 40 times higher risk of death compared to obviously the non. I mean that's that's huge. There was another one that talked about how patients who get medications for opioid use disorder, MOUD, while in custody are eighty five percent less likely to die of an overdose in the first month, a thirty two percent lower all cause mortality. I mean, that's huge. Right?
Speaker 1:And and patients get released from being incarcerated, and to the average person, think, great. Just pick up your life where you left off. It's not that hard. Not the case at all. So to even be making these dents in mortality is is tremendous.
Speaker 1:And I also read that the, you know, general population has about a two percent rate of people with opioid use disorder, and those who are incarceration are closer to ten percent. So it's also a huge percentage of those who are incarcerated. And the last point, and then I'm gonna let you two hold forth on these random stats that I pulled from the interwebs that I'm pretty sure are accurate. They are. I checked.
Speaker 1:It also just drops recidivism rates. And that, like, if we're talking about making our society better, right, doing these folks a service to get back into the world, dropping recidivism rate by fifteen percent if you have MOUD in your jail, like, what other conversation are we having? Right? Like, to me, that's that's the end of the talk. So as to say, I think it's really important.
Speaker 3:Yeah. Absolutely. We last let's see. I think it was in 2023, the Hennepin County Jail had 25,000 admissions over all. So that that's duplicate people.
Speaker 3:Right? People that do have that recidivism piece. However, of those 25,000 admissions, sixty two hundred folks identified that they were using just opioids in community. So that's not stimulants. That's not alcohol.
Speaker 3:That's not benzodiazepines. That's just opioid use and the folks that are referred to, like, MOUD program here. So the need is huge among the people that are coming into to the carceral system.
Speaker 4:Yeah. And it's no different, you know, out here in rural Minnesota. We're seeing the same things, seeing the same issues. And especially too, you know, what happens is as people, you know, they're using their certain amount of whatever their drug of choice is, you know, added in, and then they get incarcerated for eight months.
Speaker 1:Right.
Speaker 4:And then what do you think their tolerance is? But when they get out, they remember what amount they were using when they were, you know, before they got incarcerated, and then they get back to the community and immediately start, you know, a lot, try to use that amount again, and that's a fatal amount for them because they just don't have that tolerance built up anymore. Right. And that was one of those big changes for us. Well, I shouldn't say changes, but it was just one of those big eye openers for us when we started onboarding Suboxone program in rural Minnesota, because we were seeing that where people were getting back out into our community, and then we were starting to see the overdose deaths, and it's like, oh, they just got out of jail two weeks ago, or they just got out of jail a week ago.
Speaker 1:Right.
Speaker 4:Now this, you know, this wasn't something you were seeing on a weekly basis, but still, know, seeing that every six months, a death like that, you know, that was a big, big eye opener to realize we have to be doing better on the inside.
Speaker 2:And I think you can back that data up to like the general addiction medicine data shows pretty consistently that the highest period of mortality or unintentional overdose is after an unintended pause in whatever substance someone is using. Whether that's an ED stay, whether that's a loss of access to fentanyl or whatever someone is is using on a daily basis, and I think jail would fall right in that category.
Speaker 3:Yeah. I think something that I talk about with my patients as well is that not only is their tolerance lower, but, like, the substance that they are going back to when they leave jail has also changed. So these are not some pharmaceutical companies that are consistent in the product that they're putting out. Like, there's always changes in the drug supply. And so what they were using before they came in to jail and what they are returning to use when they leave, it can be very different as far as potency, as far as additives, all of those kinds of things.
Speaker 1:So when I'm in the hospital and I'm taking care of a patient, I will often use this idea that I'm a physician and this is a hospital. We are here for your health. That's why we want to know what you took. Right? And I know patients don't always aren't always forthcoming and that's okay, but I think often they are right because I can say I'm not here legally.
Speaker 1:I'm here to take care of you. That's a different environment for you two because you're actually in a jail or a prison, and you are surrounded by law enforcement. How do you get folks to open up, or how do you get the patient who's been in for three days and is diaphoretic and vomiting, and you as the provider are going, yeah. They're in opiate withdrawal. And they're going, no.
Speaker 1:It's just a GI bug I have. Like, how do you how do you gain that trust? That's hard.
Speaker 3:I think here at the Hennepin County Jail, we built it up over time. Sure. So our MOUD pro program has been running since, like, 2019. And it is I think I mean, word gets around jail, and word gets around this community of people who use drugs Mhmm. When they're not incarcerated that it's safe to share substance use information with the folks if you are gonna with your provider if you are gonna get incarcerated.
Speaker 3:And here at the jail, they know that that information is not gonna be shared with law enforcement. It's not gonna be shared with, the courts and impact how long they're gonna be with us at the jail. And so I think that it is a matter, a little bit of time, and building Sure. And knowing these people over the course of years.
Speaker 4:No. That's exactly spot on. It was the same thing here. You know, for many, many years, you know, for the twenty two years I've been in the business, it was always, you know, when we request UAs or something like that from people, they don't wanna give it up because they know it's gonna go to probation, they know it's gonna go to the courts, they know that they're gonna get in trouble. And you know, for us, it took that building building of trust amongst a few, and then the word spreads that no, this this UA we're asking for you is just so that we can properly take care of you, and take care of you to the best of our ability.
Speaker 4:And then my staff, especially differentiate. Yes, we do get those phone calls from probation that says, hey, we need this UA on this person, and we let them know, this is for probation, you know. This UA, this was for your your healthcare. This
Speaker 1:is And those are kept
Speaker 4:separate. Correct.
Speaker 1:So if I'm the patient and Dustin comes to me and says, hey, we wanna get a urine a urine drug screen on you. You're being told legally binding. This is for your health care record. This is for your parole. Yep.
Speaker 1:That's really really interesting. So can you two each talk a little bit about you've built up, what you currently have, what that process was like? This is your chance to to not be Minnesotan and shine and brag about how far you've come. Because I I I want people to hear. You just said, right?
Speaker 1:Word-of-mouth, things being spread. That's so hold forth. Tell us what you're doing.
Speaker 3:I'll go first. So our program started was started by doctor Winkelman, doctor Tyler Winkelman, and doctor Rachel Silva, who is the medical director here at the time. In 2019. I think they initially started prescribing buprenorphine for pregnant individuals during their stay here at the jail. And then it started they got some funding through a state opioid response grant and then we're able to expand that care to anybody who has a diagnosis of opioid use disorder and is interested in starting a medication for opioid use disorder here at the jail.
Speaker 3:Over time, I mean, the fentanyl crisis has worsened, so the number of people needing this treatment here at the jail has definitely increased. But I think also the our openness to listening to our patients to of kindness and caring and compassion for individuals that are struggling with substance use disorders has has gotten around. And we have quite a bit of willingness to start this medication with us. And not only to start it and take it while they're here at the jail, sometimes just to, like, help them through their opioid withdrawal symptoms, but maybe considering taking it long term. So taking it when they leave back to the community, taking it when they're heading out to treatment because they're in drug court, and continuing it even beyond there.
Speaker 3:I think we do a really great job here of patient teaching, of talking about what is opioid use disorder, talking about it as a medical condition rather than a moral failing, and talking about what medication does in people's brains and bodies as far as helping with cravings, helping with withdrawal symptoms, and helping people to walk that recovery journey, whatever they want that to look like. So, yeah, I think our our program has really grown and expanded over the course of years and been a a really great way to listen to our patients and let have them let us know what they need as far as care goes.
Speaker 1:Do you do methadone?
Speaker 3:Do we are not an OTP, so we cannot start methadone here at the jail.
Speaker 1:Yeah.
Speaker 3:But we are able through a guest dosing program with the HCMC Addiction Medicine Clinic
Speaker 4:Mhmm.
Speaker 3:To continue methadone for folks if they are admitted to the jail.
Speaker 1:Okay.
Speaker 3:If they're beyond methadone in the community, they can continue it with us. There's a time limit on that for some of the some of the patients that come in here, but we are able to continue it.
Speaker 4:Okay. For us, we have let's see. It was 2022. So for the last three years, we've been working on we've been having a Suboxone program inside of our jail. It was a long time, or it took a while to get it kind of up and running just because, you know, whether it's getting our facility medical providers on board and nursing staff on board and just getting staff, our staff comfortable with everything that we got going on when we're administering these medications and things like that.
Speaker 4:And now, for us to be able to use that to help people get through withdrawal, to get people educated, so now they have the information if they wanna do this long term or not. And it's been just very, it's been very good and very helpful. We also had to do some changes just within the way we operate. So, the way we operate within the jail itself. I changed over a position two and a half years ago, to create what's called a program counselor.
Speaker 4:And this person is Their specific job is to help people, whether it's navigate just getting applied and getting on healthcare, to also navigate chemical use assessments, to navigate treatments and what their treatment options are, and maybe what's best fit for them. And also a sort of release planning as well, is kinda part of that. And that's where now we've started to see so much success. We've seen a lot of people, rather than the, well, I'm gonna go to treatment two weeks after I get out of jail, it's a door to door transfer. Right.
Speaker 4:And you know, that's where you see the most success. If it's a door to door transfer, where they're going straight out to the treatment facility and things like that, plus if they're already set up on a program that they can continue once they're in the community, or continue that program once they get to treatment. So we've been really hard at it, and like I say, it's relatively new for us over the last three years, but we've just seen so much success with that program. So I'm pretty proud on how that's progressed for us.
Speaker 2:Kudos to both of you because I I think that this this like, the gap in care is like one of the highest risks areas. Like, if your access to your substance is much lower than your access to continuing on the path that you've started on among all of the other social things that occur when you leave a facility. I can't imagine overcoming that. So kudos to both programs for trying to reduce that barrier.
Speaker 1:Totally. Alisa, you mentioned you had a provider who just started prescribing for patients who are pregnant and had OUD. And then there was grant funding in there. I'm guessing that went towards provider time?
Speaker 3:It did. Yes. Okay. So they hired actually me as an advanced practice provider to be seeing patients and starting people on MOUD. And then you're right.
Speaker 3:So that fund that SOAR funding, after that was ending, the sheriff's office took it up as part of their annual budget.
Speaker 1:Okay.
Speaker 3:And so now the MOUD program is funded by the sheriff's office.
Speaker 1:Okay. And Dustin, you know, so one of the things we hear from folks on the EMS side is like, oh, we don't have any money for that. We don't have there's this, like, intimidation of start up costs. Right? And it's you gotta get all this money lined up.
Speaker 1:And our argument is like, well, you don't really, like, it's just like a half hour of training and then add a medication. Dustin, did you have a grant, some sort of funding or was this just people adding to what they did?
Speaker 4:For us, we did try to do some grant partnerships And we did we we had a few of those and they only lasted like six months.
Speaker 1:Right.
Speaker 4:But it was good enough to get our nurses and provider trained on what what it was all about. And then in turn, we just, as the sheriff's office, I just absorbed it as part of my budget, just because I It's one of those things where a lot of times with grants, right, we want grants to kinda help us get going. Right. But ultimately, if we see success, we have to sustain it. And it's gonna be sustained one way or another.
Speaker 4:And you know, there's that always that chance that the grant money runs out, or a grant runs out in general.
Speaker 1:Right.
Speaker 4:We just committed to it as an office that we were gonna take on those costs. And like I say, it's to me, it was a no brainer.
Speaker 3:I think sometimes, like, the grant funding can, show especially this system that we're trying to do this work in, show the system that it's possible, that it's helpful, that it makes caring for individuals who are incarcerated actually maybe a little easier because they're not suffering as much through opioid withdrawal and the irritability of cravings and the anxiety that goes with that. And then so demonstrating that it's beneficial and then have getting that buy in to make it part of the permanent budget.
Speaker 1:And did you get feedback, Alisa, when your grant was winding down? What was do you know what the selling point was? Was it kind of a consolation of what you just mentioned? Or was they did you have outcomes that made the Tannenpa County Sheriff's Office go, Oh, yeah. This is totally worth it.
Speaker 1:Because I will add that as I was researching this, I think the state put out like a a guideline for MOUD in jails, and one of their points was for every dollar spent linking someone to MOUD yields a basically 4 to $10 social benefit. So cost effective wise, it is very worthwhile, but that can sometimes be hard to prove.
Speaker 3:Yeah. I think I don't know entirely for sure. I would guess that if we wanted really some numbers, we could talk to Tyler Winkleman. But I think the movement, especially during COVID, was toward providing MOUD care to individuals as part of routine medical care and not seeing it as, like, a separate thing that we are providing to folks. I mean, they got rid of the, what was it called, the x waiver and all of those pieces around the same time.
Speaker 3:And so it was like providing, I don't know, lisinopril for hypertension. Of course, you're going to provide a medication for somebody that has opioid use disorder because it's another chronic medical problem that we need to treat. So there is a movement in that direction, I think, as well.
Speaker 1:Sure. So what are the answers to the questions? What did you do to turn the tide of your giant ships that you work for? This enables patients. This isn't our job.
Speaker 1:They're just gonna divert it. They're just gonna sell it. Why is this our problem? All of those lines that we all hear. What are the lines?
Speaker 1:What worked? How did you slowly change your culture? Because I know part of your answer is gonna be it takes time. Right? But somebody also has to take that first step, and that first step can be tough when every door you knock on every meeting you go to, the answer is, This isn't our job.
Speaker 1:We shouldn't be doing it. They're junkies, etcetera, etcetera. What are the things that you've learned? What are the tricks you can share with those who might listen to this and go, it's time for us to change what we do?
Speaker 4:From our perspective, within the sheriff's office, it it was a big shift. I mean, we went from, you know, when I started my career in the early two thousands, you know, and meth was the big thing, you know, we would just get the people who came off their, you know, week long, two week long benders and things like that, and our medical staff might give them a couple Benadryl to help them sleep it off, and kinda move on. Well then, as the years progressed, and the the drugs changed, the concoctions of them changed, and just the amount of withdrawal, and just everything that was going on with it really started to change the tides for us. Because it boils down to is seeing people and seeing our inmates in that kind of crisis, the effect it had on my staff, and for them to see people suffering that way, it honestly didn't take a long time to change the culture for us to just say, like, this is why we have to do better. And just realizing too, right, part of it is when I got into administration in 2020, when we train new staff, that was the big thing is we tell them, you know, ninety nine point nine percent of these people get back out and they come back into our communities.
Speaker 4:So how we want them to be when they get back to the community? Do we want them to have a time in incarceration where they suffered, where they felt the worst they ever felt? Or do we wanna show empathy, compassion, and say that we want these people to be better because they're our neighbors, right? These are the people that we're still gonna see at the grocery store and everything else, and yeah, they're going through something, but how do we want them? So the change in culture from training, then some of the internal changes amongst our staff, just seeing these people and seeing how much they suffer, it didn't take too long, it took some time, because you still do have those people who think that, well, you earned your way to jail, so part of it is jail's not easy, so deal with it.
Speaker 4:Don't come to jail if you don't wanna deal with it, you know? But, yeah, that that was a big big culture change for us. But, you know, the staff buying in buying into it is huge. And it, like I say, you know, you work you work two weeks up in our intake, and your mind will be changed.
Speaker 1:Man, if we could play that on record over and over, like, it's because it's the right thing to do. That's what I'm hearing. It's the right thing to do, and they're coming back to our society. And I think what you alluded to a little bit was some of what tipped our scale in 2122, which is the moral injury that we're putting on our staff to say, go take care of these patients. Oh, wait.
Speaker 1:You don't actually have the right tools to take care of them? So good luck. And and we're sitting here just adding to the moral injury when there is a perfectly reasonable medication available that will actually care for these folks. So let's get it to them. Right?
Speaker 4:Exactly right.
Speaker 3:Absolutely. I think we are kind of continually working on some of this change here at our jail. And it's that, like, one on one education so that it's that relationship that our nurses or the provider and that has with our deputy staff and, like, answering those questions and being able to hear some pretty blunt questions and some really honest feedback about what they think and then being able to provide some of the evidence and maybe even some of a little bit of, like, the stories of the folks that come into jail and start this medication and how it can make a difference when they're leaving. Because, yeah, Dustin's right. Like, these people are not living at jail.
Speaker 3:These people who are people who use drugs and people who are incarcerated who use drugs do not live at jail. They live in our communities. And we I think as a person who lives in the community as well, like, I have relatives who have problems with substance use disorders. And I think most of us do. And so to kind of make that human connection that we all know someone who struggles with this stuff, maybe we should start providing some of this really great axe this really great care.
Speaker 3:Provide access to that care in a place where these people are going anyway could be really, really beneficial.
Speaker 1:What are the really blunt questions slash feedback that you got? Can we go non Minnesotan here? And because this is important. Right? Like, this is so important.
Speaker 3:Yeah. Aren't we just trading one substance for another? Yeah. Like, how is this any different how is buprenorphine, how is methadone any different than just giving people fentanyl here in the jail?
Speaker 1:Give them the answer.
Speaker 2:We
Speaker 1:Tell us tell us the answer.
Speaker 3:Oh, the answer is so many reasons. It's so different. One, it doesn't get people high. I think that's actually a pretty sincere concern from a lot of the a lot of our staff here is that and I, as a provider, I'm not really don't wanna provide euphoria to my patients on a regular basis either. Right?
Speaker 3:But letting them know that buprenorphine really can't provide a high. And then talking about I often talk about my grandma, actually. So my grandma's got diabetes. Right? And she's got problems with her body's ability to, like, use insulin and all, right, produce insulin, all these things.
Speaker 3:And so we give her insulin to treat that medical problem that she has. And our patients here have problems with their opioid receptors and other changes in their brain from their fentanyl use, and we are giving them a medicine to treat that physical problem inside their bodies. Right? And so they are not addicted to buprenorphine the same way my grandmother is not addicted to insulin. Right?
Speaker 1:A funny way to think about insulin, though. That insulin addict. That insulin head.
Speaker 3:I know. Well, just like but everybody's grandma has has diabetes. Right? And so we're just giving a medication for opioid use disorder that does the same thing that my grandma's medications for her chronic conditions do. It helps people to live longer, happier, healthier lives in both cases.
Speaker 3:And why would we not do that?
Speaker 1:Dustin, what do you say to your colleagues who say we're just swapping out one addiction for another?
Speaker 4:Well, sometimes, I mean, let's be honest, harm reduction, you know? If we can if we can try and give somebody a different way to, you know, do you know, like I say, it's it's not an addictive chemical we're giving them, but it's something that maybe reduces the cravings, it gives them a clearer mind, it helps them get through the worst of the worst, and you know, still, people have to make the decision for themselves. This isn't a brag, but I mean, working at this sheriff's office as long as I have, I sent one person to treatment 32 times, and they've never completed a program. And that doesn't mean that if I send them for the thirty third time, it might be the time. So it's about not giving up, and it's also just about, we have to do better by people.
Speaker 4:And like I say, it didn't take too long for us. We still get some of those questions on just saying, all you're doing is enabling these people, and suffering is part of what's gonna get them to stop doing what they're doing, and that's that's just not the case. You know, suffering is what gets people to make rash decisions and harm themselves or, you know, kill themselves, and that's that's not what we're about. If we're about harm reduction overall, we we just have to do better by these people, and you know, sometimes it's just a longer conversation with somebody to get them to maybe think and look at things through a different lens. Totally.
Speaker 3:I get that suffering one, that suffering question quite a bit from staff here. Like, if if we let them suffer through their withdrawal, maybe they'll learn their lesson and they won't go back to using. And what I think about then is, like, this patient has had, like, 11 overdoses. Right. Right?
Speaker 3:They've almost died 11 times and still are not stopping. I don't think one five day period of really severe opioid withdrawal is gonna change their mind about going back to fentanyl use.
Speaker 1:And that's something, you know, we had Doctor. Brian Gruhan on one of these episodes to talk about kind of the actual brain changes that occur with addiction, and it's fascinating. And one of the things that he always talks about is, you know, so if medics for us, medics go to a home, for you, it's someone who's in your custody, and they've had an overdose and the first responders lecture them, this is the third time this month we've been here for your overdose. Guess what? The patient knows that too.
Speaker 1:They're already aware of that, And they don't like it either, but the brain changes and the ability to cope with stress, and I'm not sure I can think of a more stressful environment than being in custody, to be able to think through and manage stress the way the unaddicted brain may function is just not the same thing and we we can't understand it because you have a different brain functioning than someone who's in that moment of crisis. So the elephant in the room is that they also know that they have overdosed again. They're aware of that. They are looking for some help. And yes, three days of suffering isn't gonna be the light bulb moment to go, You know what, doc?
Speaker 1:You're right. That is not how this process works. But I think these conversations and call I I really try to just name all of these stereotypes as much as possible because what I don't want people to think is that we're naive with our heads in the sand going, this is so great. Everything's rosy. No.
Speaker 1:It's complicated and it's messy and it takes 32, 33, 34 times sending someone to treatment. But our job is to continuously be there for people. I mean, Holly and I just got an email last week that I can't read on a recorded podcast because of what's in it. But our job is to be there and to answer those questions honestly and not hide from that pushback, I think.
Speaker 4:The other part too is, you know, like for us on the inside, you know, we also realize that, you know, drug use, right, it stems from, you know, trauma and other things like that, right? So, for us, it's like, we're not just firing medications at people, we're also running programming inside our facility.
Speaker 1:Sure.
Speaker 4:We're doing like the ACES program, you know, and things like that, you know, because people are dealing with all these different kinds of trauma. So for us, it also goes back to, you know, we're not just over medicating these people and then trying to get them out of custody. We're actually trying to help them better their lives overall, deal with the trauma, get set up with counseling, get your GED, get those things done, because hopefully that, in turn, helps with not using. Helps with the reason why they got arrested on a theft to support their drug habit, the reason they got arrested on the burglary to support the drug habit. That's what we're trying to change as an overall.
Speaker 4:We're not just throwing medications at people and just saying, look, we're doing the best. You know, It's it's not that just that.
Speaker 3:I think medications is like such a huge piece of this, but I think a lot of our programs, and I think Dustin and I connected with over this before, is that we're moving into other areas of evidence based practice for helping people to in recovery. Right? So here at the Hennepin County Jail, we've been bringing in peer recovery specialists to meet with people and do visits here at the jail. And then those same peer recovery specialists are available out in the community for that patient to connect with once they're leaving and get resources and support and connection to to MOUD out there. And so I think a lot of the programs are realizing that it does have to be this, like, whole person care rather than medication only or rather than programming only.
Speaker 3:Like, it really does need to be looking at the entire entire individual and what they're what they're needing.
Speaker 1:Right. Alright. I wanna be mindful of time. We're starting to wind down, but I wanna make sure we cover a really important part, which is discharge. Right?
Speaker 1:So how and I think this is where EDs and EMS can sometimes get more involved. Obviously, there's things while they're they're at jail or prison, but I think we see them often, when they're just immediately out. What does it take? How do you set people up for success when they are leaving the jail?
Speaker 3:I think jail is sometimes a little bit difficult. I think Mille Lacs may do a little a better job of than Hennepin does, but trying to figure out when someone is leaving.
Speaker 1:Sure.
Speaker 3:The jail is often difficult. That court system Right. And court process can be somewhat of a mystery even to me having worked here almost six years. But providing patients with the resources, those walk in hours at certain clinics, the EMS bridge team, like, super helpful as far as being able to, like, go out to the patient and reach out to them, which is essentially what we do here at the jail too. Right?
Speaker 3:We will we go out to that patient's housing unit if they don't come to clinic for visits and and all of those pieces. So it's really that the patient doesn't need to initiate it as much. And so that's what I think is really wonderful about some of these programs, that are willing to go out to the patients and and touch base with them where they're at.
Speaker 1:If you get started on MOUD and you're in the Hennepin County Jail and you get released, how might one get medications if you're on Suboxone?
Speaker 3:So we provide a two week bridge script for people that are released to the community. That medication goes over to a specific pharmacy at HCMC Hospital called the Red Discharge Pharmacy. We like it because it's open twenty four hours a day, and sometimes our patients are getting released at 1AM and wanna pick up their medications at that time. The sheriff's office actually pays for that medication. So a lot of times when people come in most of the time, when people come into a carceral facility, and they are on Medicaid, their insurance actually gets suspended, for the time period that they are incarcerated.
Speaker 3:And there can be a delay when someone of getting that insurance, restarted when that person is, released to the community. And so it's we are very grateful to our sheriff's office that they are able to, like, provide that or pay for that medication when someone is leaving so they don't have to use their health insurance. So they'll have two weeks of Suboxone from us. And then during that time, they are encouraged to, like, connect with one of the community resources that we talk about at length and try and connect with on a regular basis, our team does, so they know that they that they might be receiving some patients from jail, and here's here's what that looks like in in custody and then what they can expect outside. Our we do give our patient direct numbers actually to our jail nurse team.
Speaker 3:So our jail nurses discharge and our MOUDRN have cell phones, and we give out those direct numbers to patients so that in case they are finding any barriers to getting care or they go need a little medication beyond those two weeks, that we can be a resource for them and helping them to connect when they need it.
Speaker 1:Dustin, how about you? Someone's leaving your system. How do you what do you do to try to set them up for success?
Speaker 4:Yeah. I we we still, you know, battle the same deals. Right? You know, people are in our custody for six hours because they just get arrested. They go to court and they get out.
Speaker 4:Those are the tough ones to deal with. But for the most part, if we have any kind of heads up, you know, even a week's notice or a few days notice, we get them set up with our, between our program coordinator and our program counselor that we have employed inside the jail, they'll get people set up on their healthcare and things like that, get all those applications done and ready. We'll release them. Same thing too, they'll have a couple weeks supply of Suboxone when they walk out the door. And then we also try to make sure that we have their next appointment in the community set up.
Speaker 4:So one of our program staff will set them up with their next appointment so that they already have that on the books. Because the challenges we face is, here you go, best of luck, make sure you schedule that appointment. Well, a lot better success when you say, here's your next appointment. We do that, but we still face many challenges just because people are in custody for six hours, twelve hours, eighteen hours, and our hands kinda get tied because now it's time to release them to the street, we haven't had a lot of interaction with them.
Speaker 1:Right. I want to thank you both for not only being on this Here podcast, but for the work that you're doing and kind of leading the way for our patients. It's so wildly important, especially when we think about how, dangerous coming in and leaving incarceration can be for patients in terms of overdoses. So thank you both very very much for the work that you are doing and for enlightening all of us. What did I miss?
Speaker 1:Anything I missed? Any key points that you wanted to make sure we covered that I failed to bring up?
Speaker 3:I guess I just wanna say that it's an honor to serve these patients. Right? Like, I really do feel honored that my patients would be willing to tell me about something that might bring them a lot of shame in the community, especially when they're here at the jail and willing to trust us with that and and start this care. So I really enjoy working with my patients every single day, and I'm very thankful that that they're letting me into this part of their lives.
Speaker 1:That's amazing.
Speaker 4:And I guess for me, it just goes back to, right, I mean, I work in law enforcement. It's about community safety and things like that. And the more we can do for these folks when they're in here, the better to set them up for when they get back out to our communities. That's what we're trying to do. That's the sheriff's office as a whole.
Speaker 4:We're trying to promote that public safety overall. And if we can do better by people, by helping them out in the jail and getting them set up on better programs, that's what, you know, that's what we should be doing. That's not, you know, if we have the resources, or if we have this or that. This is what we should be doing to make our community better and safer.
Speaker 3:And I so appreciate that, like, law enforcement and medical can, like, come together in this effort to, like, meet patients where they're at and and figure out what's what's gonna be best for that individual patient. And then beyond that, like, their family and the community through this type of care. It's huge.
Speaker 1:It is. It's pretty powerful. Alright. Well, thank you both for your time. We appreciate it.
Speaker 2:Thank you, Dustin. Thank you, Alisa.
Speaker 4:Thank you.
Speaker 3:Thank you.
Speaker 1:Well, Holly, that was a very fun conversation.
Speaker 2:And yet another one that we could have continued with for another thirty five minutes or an hour.
Speaker 1:Keep going. Keep going. Six, eight. We should do a series. I was actually thinking while talking to him.
Speaker 1:I think there's so much there. It's such like an an under talked about aspect of this crisis.
Speaker 2:Oh, it absolutely is. I mean, and one that I didn't, honestly, before meeting Alisa and even kind of meeting Dustin and doing this podcast that I was unaware of the process and how complex it is, how much, you know, energy has to go into building a program like this. But both of them, you know, separately have built programs that are, like, very sustainable and I think very, what's the word I'm looking for? Duplicatable.
Speaker 1:Duplicatable. You could do it again. You could you could do it yourself.
Speaker 2:Someone could model, you know, and make a program themselves.
Speaker 1:This is an afternoon episode. We're both, fading here. I no. I totally agree. It's very practical.
Speaker 1:It is I think kind of one of our missions with Minbridge, which is like, this can be so complicated and cost a ton of money if you want it to. Or it can actually be pretty doable and the first step is actually pretty small. I so appreciated I think Dustin first brought it up and then Alisa talked about it as well. Like, this is our community. Right?
Speaker 1:This isn't people who are in jail and then we all live here. These are this is our community who's just spending some time in this place and then they're coming back to the community. And, you know, his pitch is, I'm law enforcement. My job is to make my community safer. Getting patients MOUD makes my community safer.
Speaker 1:And I thought that was just such a tremendous point.
Speaker 2:Well, I think that's also relatable to EMS. Right? Like, even if you're with someone for five minutes, an hour, two hours, however long it is, whether they're traveling through, whether they're a resident of your city or town or county, like, this is your point at which a touch point at which you can improve the community. And that can be, like, as simple as the way you talk to somebody and relationships you build. So I thought that that point was was very important too.
Speaker 1:Totally. I agree. Alright. Well, as always, check us out, minbridge.org. Listen to the podcast on Spotify or Apple Podcast, or you can stream it on the interwebs if you will.
Speaker 1:Email us if you have questions. Reach out if there is something on the website that we are missing, or if you have interesting people we should talk to because we are always looking for new and interesting folks to talk to. So please reach out and give us some ideas because we're looking for them. Talk to you later, Holly.
Speaker 3:Bye.