TITLE
Title
BUDGET AMENDMENT: FY25 MEDICATION-ASSISTED TREATMENT (MAT) GRANT FROM THE NC DEPARTMENT OF PUBLIC SAFETY (NCDPS)
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SPONSOR
Sponsor
Sheriff Danny H. Rogers (Captain Wes Mecham)
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BACKGROUND
Background
In 2022, North Carolina's average overdose death rate was 41.4 per 100,000 residents while Guilford County’s rate was 42.4 per 100,000 people. In 2023, the overdose emergency department visit rate in North Carolina was 161.4 out of 100,000 people while the rate in Guilford County was 191.2 per 100,000 residents. In 2022, the overdose death rate from illicit drug involvement in Guilford County was 80.7 per 100,000 overdose deaths, beating the state average of 78.9 per 100,000. This places Guilford County in the high range among North Carolina counties. According to the NCDHHS Division of Public Health, from 2017 through 2021 the statewide average for medication and drug overdose deaths was 27.6 per 100,000 residents, while Guilford County’s average was 29.6 per 100,000 residents.
The opioid epidemic continues to devastate North Carolina, where five (5) people die from opioid overdoses every day. Researchers examined rates of fatal drug overdose among justice-involved (currently incarcerated) individuals in North Carolina and found opioid overdose mortality rates more than 40 times higher than the general population. Those rates were highest during the first two (2) weeks following release from custody. The Medication-Assisted Treatment (MAT) Grant through the NC Department of Public Safety (NCDPS) was established to assist county Sheriff's Offices with combating this crisis in their detention centers.
The average daily population in the Greensboro Detention Center is 650, while the average in High Point is 250. On average, these combined sites have thirty (30) people a day on a Clinical Opioid Withdrawal protocol. Currently, at admission inmates are screened for medical, mental health, drug and alcohol use history. We work to ensure that inmates who are at risk of withdrawal are placed on proper monitoring protocols. Those who are at risk for opioid withdrawal are placed on the Clinical Opioid Withdrawal Scale (COWS). This screening ensures that patients are assessed and evaluated by nursing every eight (8) hours and that medication interventions are provided based upon the person’s needs. The MAT program involves the use of medications, alongside counseling and behavioral therapies, to treat substance use disorders. MAT provides a “whole-patient” approach to treat addiction to opioids such as heroin or prescription pain relievers. The Mental Health MAT Coordinator completes additional screening to see if these patients have an Opioid Use Disorder (OUD) and are interested in starting MAT treatment while incarcerated. The number of inmates interested in beginning the treatment is high.
In October 2023, we began our second phase of the program, the Induction Phase. We had 86 inmates sign up for this phase in October 2023. This part of the program involves helping inmates begin the process of switching from opioid misuse to a medically monitored buprenorphine regimen. The goal of this phase is to find the dosage of buprenorphine at which the patient discontinues or markedly diminishes use of other opioids, and experiences no withdrawal symptoms, and has minimal or no side effects, including no uncontrollable cravings for illicit opioids. We also offer naltrexone/vivitrol for patients who want to choose a narcotic free alternative to opioid addiction treatment.
MAT participants are offered counseling services that include group and individual counseling, as well as discharge services that comprise follow-up appointments with GCSTOP, ADS and New Season, and harm reduction to include Narcan at release. All participants will receive an initial set of labs as well as monthly random screenings completed by WellPath. In order to expand the MAT program we require additional resources. We are anticipating reaching a level of sixty (60) persons per day receiving the MAT treatment. Currently, we are unable to offer the MAT program, which includes the induction phase, at the High Point Detention Center due to a lack of detention and clinical staffing. Residents of the High Point Detention facility, who were previously inducted into a community MAT program, are moved to the Greensboro Detention facility to continue their treatment program.
One of the challenges of having two (2) Detention Centers in different cities in the county is that inmates from High Point who would continue in the program would have to be transferred to Greensboro for treatment. This means that the participants would have to be transported back and forth between High Point and Greensboro which have separate detention centers and courthouse locations (one in each city). With grant funding we will add two (2) contracted part-time Certified Peer Support Specialists with Substance Abuse experience. Each will work 29.5 hours per week and these positions will be contracted through a local mental health provider. These positions will be solely funded by the mental health provider and will not be county employees. The Peer Support Specialists will help participants with their coping skills, re-entry support to inmates being released, as well as developing relapse prevention plans, and completing discharge planning, which connects them to GCSTOP, ADS, or New Season for post-release care and monitoring. They will also follow-up for six (6) months following release to document the progress of these individuals. Adding these two (2) positions through the contracting process and having access to the additional resources budgeted for this grant will allow the Sheriff's Office to enhance its MAT program in the Greensboro Detention Center. This grant will enable the Sheriff's Office to provide substance use support to re-entering citizens leaving the detention facilities.
To be good partners in fighting the opioid epidemic, the Sheriff's Office has been and will continue to partner with GCSTOP, ADS, and the New Season Treatment Center. These three organizations support our MAT efforts and will accept our post-release referrals for continued care of our program participants.
The MAT Grant through NCDPS will provide peer support services to those individuals on detox protocols. Some of these individuals are ready inducted into the MAT program facilitated by WellPath, which includes those actually receiving medication assisted treatment (ie. buprenorphine). The other individuals on detox protocols but not receiving substance use clinical treatment will be provided this peer support opportunity. The peer support personnel will report to the Jail Diversion program.
The Sheriff's Office will be required to submit performance data quarterly and upon request, which includes:
• Unduplicated number of individuals served
• Aggregated demographic information, race, age, and gender identity of individuals served
• Type and number of doses of FDA approved drugs for the treatment of alcohol and/or opioid use disorder administered during incarceration
• Type and number of doses of FDA approved drugs for the treatment of alcohol and/or opioid use disorder administered after release
• Number of referrals to community-based MAT
• Explanation of expenditures
The Sheriff's Office applied for the MAT Grant and was awarded a total amount of $224,907 to be utilized over a three (3) year period. The first year will begin upon the signing of the memorandum of agreement (MOA). The second year will start on the same date 365 days later, and the third year will do likewise. The budget and subsequent expenditures are listed in an attached spreadsheet.
This grant does not require any matching county funds and does not obligate the county to continue funding a program after the grant funds are exhausted.
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BUDGET IMPACT
Budget Impact
NO ADDITIONAL COUNTY FUNDS REQUIRED
Grant Project Fund
FY25 Medication-Assisted Treatment (MAT) Grant
$224,907 appropriation to Grant Project
$224,907 in Federal/State Funds
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REQUESTED ACTION
Requested Action
Approve the Sheriff's Office to enter into a memorandum of understanding that allows the County to receive the awarded $224,907 funds from the FY25 Medication Assisted Treatment (MAT) Grant and adopt a grant project ordinance for FY25 Medication Assisted Treatment (MAT) Grant in the amount of $224,907, with $224,907 in Federal/State funds.
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