NaphCare Perspectives: An Innovative Approach to Addiction Medicine
January 30, 2025NaphCare is pleased to share a conversation with Dr. Scott Bell, our Corporate Medical Director and Addiction Medicine Specialist. In this role, he uses his expertise in the field of addiction medicine to provide critical oversight and training for our healthcare staff, ensuring compliance with national and community healthcare standards.
In our conversation, Dr. Bell spoke about NaphCare’s addiction medicine program and shared his thoughts regarding the need for and potential impact of increased substance use treatment in correctional healthcare.
What is NaphCare’s approach to addiction medicine, and how is it unique?
Substance use disorder (SUD), especially opioid use disorder (OUD), is unfortunately very prominent in the correctional population, but NaphCare’s role is to treat it in a nonjudgmental, all-inclusive way, consistent with national guidelines and community standards of care. We approach addiction medicine like any other medical condition and train our healthcare staff to handle OUD with the same attention they would hypertension or diabetes – as a treatable condition that requires specific medication. Our patients deserve that attention and care.
Buprenorphine: a medication used to treat opioid use withdrawal. Gradually reducing the dose decreases the danger of overdose and relieves symptoms.
NaphCare is unique because we focus so heavily on being proactive with our approach to addiction. At booking, we screen every patient who comes into the jail for risk of withdrawal, and we start those patients on comfort medications immediately. For opioid withdrawal, this includes evaluating all patients and starting buprenorphine within 24 hours to assist in managing the patient’s withdrawal symptoms.
NaphCare was also among the first in the correctional healthcare industry to offer Medication Assisted Treatment (MAT) programs in jails and prisons. Today, we’re providing some form of MAT in 100% of our partner facilities.
In the summer of 2024, NaphCare piloted a new approach to safely managing opioid withdrawal, in which we treat more patients earlier. What successes have we seen as we’ve rolled this out to all partner sites?
Our approach is to screen everyone at booking to make sure there is no delay in treatment for any patient at risk of withdrawal or in withdrawal. We’re really focusing on identifying OUD, because it’s so crucial for preventing overdoses.
The former way to treat withdrawal, in jails and in the community, was to wait for patients to show symptoms and assess their need for treatment. Now, we intervene early to prevent negative outcomes
With our new approach, we start buprenorphine on all patients who report opioid use, once it is clinically safe to administer. For the majority of patients, this is at 24 hours from booking or sooner. This early administration has resulted in much better outcomes (e.g., lower rates of overdose) at our piloted sites. And, we have seen far fewer complications from withdrawal – so much so that we have now implemented this early intervention at all facilities.
How does substance use disorder treatment differ in the correctional setting versus the community?
The medication and approach to treatment are the same since our goal is to provide care that aligns with community standards. The concerns, however, do differ in the correctional setting. We’re focusing particularly on OUD because of the immediate overdose and withdrawal risk it poses. About 10% of our patients come into the facility with fentanyl in their systems, which is very potent and very dangerous. It’s our goal to prevent adverse outcomes, so we’re treating everyone at risk. Historically, many community providers wouldn’t provide OUD treatment if a patient wasn’t completely sober from all illicit substances, but we are making sure that our policies do not create barriers to treatment.
What do you see to be the most crucial issues/needs for substance use treatment in corrections?
The jail environment is really challenging for treating OUD because patients have a shorter length of stay. We can identify at-risk patients and get them on treatment, but you never know how long you’ll be able to continue a patient’s treatment before they are transferred or released.
To truly succeed with addiction treatment, patients need multidisciplinary programs to supplement their daily medical care. Establishing and funding both physical treatment (medication) and social treatment (counseling, support groups) – both within the jail setting and in the community upon release – is absolutely crucial for addressing the issues of addiction and reducing recidivism. If we want to see real change, those very intentional supports must be in place.
NaphCare’s mental health team does a great job with the psychiatric component of addiction while we have patients in our care, and we aim to connect our patients with treatment medication and community care upon discharge – but we can’t ensure they’ll go. There are so many social components to treating OUD; for example, if someone doesn’t have transportation, they can’t get to a clinic or pharmacy to pick-up their medication. That’s an even bigger problem when you consider that justice-involved individuals with OUD are 10 times more likely to overdose during the first two weeks post-release.
As NaphCare grows as a company, how will we continue to adapt to meet the increasing needs for substance use disorder treatment?
First, we’re going to keep SUD/OUD treatment a priority because the need for it is absolutely increasing. It’s our job and moral responsibility to treat patients humanely and keep them alive.
Second, we’re going to continue advocating for increasing initiation of treatment rather than just treating withdrawals. Our CEO, Brad McLane, believes in the promise of MAT and consistently encourages our partners to expand their MAT programming and resources.
One clear example of the success of a MAT initiation program has been at one of our partner sites in the Southwest. From fall of 2022 to fall of 2023, they had seven opioid-related deaths in custody and averaged about 15 overdoses a month. This prompted the facility administrators to fund a full initiation program for OUD. Since implementation of this program, almost 40% of the total population is now receiving OUD treatment with either methadone, naltrexone or buprenorphine, immediately starting as soon as clinically indicated after booking. In over 16 months since starting the full induction program, there have been zero overdose deaths and no suicides, and overdose events overall were cut in half.
It’s huge to show someone that recovery is possible with the right treatment.
With initiation, we also have the opportunity to engage people who may never have sought treatment in the community. It’s huge to show someone that recovery is possible with the right treatment. The correctional healthcare industry could make a large impact in this area because one in five arrests is due to a drug-related offense, and roughly 60% of the incarcerated population meet the criteria for SUD. If we can start treatment programs for people coming into the jails – and improve community support upon release – we can directly reduce the number of people with untreated SUD.
I’m also excited about the possibility of working with the NaphCare Charitable Foundation to look at studies surrounding SUD/OUD and drug use in our patient population. Looking at data from our sites across the country can help us identify trends and develop more SUD treatment solutions.
What is the most promising thing happening in correctional healthcare right now as it relates to addiction and substance use disorder treatment?
As I said before, correctional healthcare providers have the opportunity to engage patients in treatment. We’re also seeing more and more states understanding the necessity for OUD treatment and using Section 1115 waivers for Medicaid funding to support SUD treatment in correctional facilities.
Additionally, the development of long-acting injectable buprenorphine (LAIB) for OUD treatment holds a great deal of promise because it is administered as a sustained-release injection that delivers a steady dose to the patient over the course of a month. This helps prevent diversion and eliminates the need for daily treatment. However, the high cost of LAIB can be prohibitive for both correctional and community MAT programs, so I would love to see LAIB become more accessible since it is more efficient for OUD treatment.
Scott Bell, M.D., is board-certified in both Internal Medicine and Addiction Medicine. Dr. Bell received his medical degree from UAB School of Medicine. He completed an internship and residency in internal medicine at Emory University School of Medicine, followed by fellowships in addiction medicine at the University of Tennessee Health Science Center and Baptist Memorial Hospital-Memphis.