Mark Herz: Good morning. This is GBH’s Morning Edition. Overdoses in the opioid epidemic have claimed the lives of some 2,000 people in Massachusetts for eight years in a row through 2024. And one population that’s particularly vulnerable is those who have recently left prison or jail and are reentering society. But that’s also a specific group of people where some real progress has been made here. And joining me now to talk about this is an expert on the treatment of opioid use disorder, Dr. Andrew Kolodny. He’s the medical director for the Opioid Policy Research Collaborative at Heller School at Brandeis University. Dr. Kolodny, welcome.

Dr. Andrew Kolodny: Thanks for having me, Mark.

Herz: Great to have you. So let’s start with what we know: Facts and figures about the risks to people with opioid use disorder when they’re reentering their regular lives from a stint in prison or jail. There are studies that have laid this out and really underscore the urgency of doing something about it, right?

Kolodny: Yes, we’ve known for decades that discharge from jail or prison is one of the greatest risk factors for an opioid overdose death. And unfortunately, even though we’ve known this for many years, it took quite a while before we started to do a better job of reducing the risk of overdose after discharge.

Herz: But explain to us: Why is it particularly risky? And I believe it’s particularly risky, say, in the first few months when somebody gets out of a jail or prison. Why is that?

Kolodny: When someone is addicted to opioids and they’re using opioids regularly, they rapidly develop a tolerance — meaning that they need to take higher and higher doses to get the same effect. When somebody stops using opioids, they rapidly lose that tolerance. And if someone’s been incarcerated, or perhaps they’ve just recently been detoxed and their tolerance returns to normal, and then they go out into the community and they pick up again, and if they use anything close to what they were using before they had stopped, they’re at very high risk for death.

Herz: Yeah, that makes sense and it’s very troubling. But also, as I mentioned, up top, now things have changed significantly for the better in Massachusetts in particular. And you’ve told me when we’ve talked previously that one jail here that I visited, the Middlesex Jail and House of Correction in Billerica, is really an exemplar. And here’s the sheriff who runs the place, Peter Koutoujian.

Sheriff Peter Koutoujian, pre-recorded: We used to think of it in terms of recidivism and were we making gains based on recidivism. But it wasn’t very long before I realized the more important metric was: Were we keeping people alive?

Herz: Now, Dr. Kolodny, you’ve paid close attention to what Sheriff Koutoujian is doing up there in Billerica. Tell us what’s going on there and why he’s had that success that he’s talking about.

Kolodny: Peter Koutoujian was one of the first sheriffs in the country to see that inmates would be given a naltrexone injection before release from jail and into the community. And naltrexone is an opioid blocker, it’s one of the medicines that’s used for treating opioid use disorder. And if you have your opioid receptors blocked with naltrexone, that will certainly reduce the risk of an overdose while that drug is still in your system.

They sent inmates out the door with a naltrexone injection and then worked with folks while they were in the community, stayed involved with them to make sure that they would continue to get that injection. And a couple of years later, the sheriff modified his program by seeing that inmates would also have access to medications that really do work better for most people with opioid use disorder, buprenorphine — also called Suboxone — and methadone. And so now his program is offering all three medications to individuals before release. We do have good data that treating opioid use disorder with medication does reduce both overdose deaths and criminal recidivism.

Herz: One person I talked to there, a gentleman named Adam DeYoung: Before he was set to turn himself in for his sentence that he had to serve, you know, he was almost thinking of running away if he wasn’t going to get his methadone.

Adam DeYoung: They dose people now. And that was a huge weight off my shoulders. Like, that was the defining moment where I decided, “OK, now I don’t have to run.” It was very scary.

Herz: So treatment of proven medical therapy, wraparound services when people leave the community. Are there lessons there that legislators and other public officials in Massachusetts and around the country can draw from that approach?

Kolodny: Absolutely. Every prison, every jail in the country should be doing what we’re seeing Middlesex Sheriff’s Office do. We should be saying that individuals with the life-threatening condition of opioid use disorder should get treatment for it while they are incarcerated — and should be linked to treatment after they’re discharged.

It’s a no-brainer. It reduces criminal recidivism and it saves lives. And in prisons and jails where we see a disproportionate number of people with opioid use disorder, it’s a great place for us to see that people with this condition can access treatment.

Herz: I also wonder about overdose prevention centers, previously known or alternately known as supervised injection sites. There’s one operating successfully in New York City. There’s one on its way to opening in Rhode Island. And there was a big push for overdose prevention centers here in Massachusetts in the last legislative session on Beacon Hill. Now, in your opinion, what part can they play for people reentering from prison or jail who are trying to avoid overdosing?

Kolodny: Overdose prevention sites are places where individuals can, for example, inject an opioid in a safer setting, a place where someone has naloxone on hand or oxygen support should they overdose. And these are interventions that, in my opinion, make good sense in urban areas — particularly urban areas with large numbers of homeless, injection-drug users. Because I think in those areas, people will use those services, and they can save lives, and they can also be places that get people connected to treatment — which is really, in the long run, the best way to prevent an overdose.

Herz: Dr. Andrew Kolodny, the medical director for the Opioid Policy Research Collaborative at the Heller School at Brandeis University. Thank you for joining us.

Kolodny: Thanks for having me.

Herz: This is GBH.

Opioid overdoses have claimed the lives of some 2,000 people in Massachusetts for eight years in a row, a trend that’s continuing in 2024. And one population that’s particularly vulnerable is those who have recently left prison or jail and are reentering society.

But medications approved for treating opioid use disorder — Suboxone, naltrexone and methadone — have made it possible to see progress in preventing overdoses among people reentering free society, said Dr. Andrew Kolodny, medical director for the Opioid Policy Research Collaborative at Brandeis University’s Heller School.

“We’ve known for decades that discharge from jail or prison is one of the greatest risk factors for an opioid overdose death,” Kolodny told GBH’s Morning Edition.

People who regularly use opioids — like heroin, fentanyl or OxyContin — develop a tolerance to them and need higher doses to feel the same effects, Kolodny said. If they go to jail, prison, or a detox facility and stop using, their tolerance gets lower.

“Then they go out into the community and they pick up again, and if they use anything close to what they were using before they had stopped, they’re at very high risk for death,” he said. “And unfortunately, even though we’ve known this for many years, it took quite a while before we started to do a better job of reducing the risk of overdose after discharge.”

In Billerica, people being released from the Middlesex Jail and House of Correction can access one of three medications: Suboxone, naltrexone or methadone.

Several Massachusetts county jails have followed suit in the last several years by offering proven medical treatment for opioid use disorder. But Kolodny says, in Billerica, Middlesex Sheriff Peter Koutoujian was “one of the first sheriffs in the country to see that inmates would be given a naltrexone injection before release from jail and into the community.”

“If you have your opioid receptors blocked with naltrexone, that will certainly reduce the risk of an overdose while that drug is still in your system,” Kolodny said. “We do have good data that treating opioid use disorder with medication does reduce both overdose deaths and criminal recidivism.”

It was part of a broader change in how jail officials measured how effective their programs are, Koutoujian said.

“We used to think of it in terms of recidivism and were we making gains based on recidivism,” Koutoujian said. “But it wasn’t very long before I realized the more important metric was: Were we keeping people alive?”

For many years, he says there was persistent bias against treating opioid use disorder with medication among those who administered criminal justice programs. Many saw the treatments as “just substituting one drug for another,” Kolodny said.

“I do think that the Middlesex sheriff’s office has been setting a national example in their jail,” he said.

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It’s a factor for people who are going into the prison system, too. People in the jail also have access to the medication as they wait for trial or serve out their sentences. Adam DeYoung, who was incarcerated at the Middlesex jail, said knowing he could get access to methadone in jail was a deciding factor in his decision to turn himself in.

“That was a huge weight off my shoulders. Like, that was the defining moment where I decided, ‘OK, now I don’t have to run,’” DeYoung said.

Kolodny said such treatments should be an option everywhere.

“Every prison, every jail in the country should be doing what we’re seeing Middlesex sheriff’s office do,” Kolodny said. “We should be saying that individuals with the life-threatening condition of opioid use disorder should get treatment for it while they are incarcerated and should be linked to treatment after they they’re discharged.”

He called it “a no-brainer.”

“It reduces criminal recidivism and it saves lives,” Kolodny said. “And in prisons and jails where we see a disproportionate number of people with opioid use disorder, it’s a great place for us to see that people with this condition can access treatment.”