By Joyce V. Kimbler Judge, Medina County Court of Common Pleas

The Medina County Common Pleas Court was recently awarded a grant from the United States Department of Justice of over $260,000 to enhance the Adult Drug Court program in Medina County. The purpose of this grant is to expand services to better address the opiate epidemic in our community.

The heroin crisis has been devastating to Medina County. Over the past four years, heroin-related deaths have risen each year in Medina County. The Drug Task Force reported that Medina had 258 drug overdose cases in 2016. Deaths from those overdoses rose from 20 in 2015 to 34 in 2016. This number could have been higher if not for local law enforcement officers trained to administer Narcan, an opioid overdose antidote. Opioids include heroin and pharmaceutical medicines such as: hydrocodone (Vicodin), hydromorphone (Dilaudid), morphine (MS Contin), codeine, oxycodone (OxyContin, Percocet), fentanyl and methadone. Studies indicate over 80 percent of opiate-addicted individuals began their addiction by being placed on prescription medications.

Opioids stimulate nerve receptors in the brain that are part of a natural reward system. Repeated exposure to opioids may also disrupt other brain regions causing the overproduction of a chemical called noradrenaline, leading to withdrawal symptoms such as severe bone pain, chills, sweating, nausea, vomiting, anxiety, muscle cramps and diarrhea. An opioid overdose results in a slowing or cessation of breathing. This can happen suddenly or slowly over a few hours. Without oxygen, the person loses consciousness, can experience brain damage and may die. Successful treatment of opioid use disorders requires a combination of medication, behavioral counseling and other support services. Medication-assisted treatment focuses on the use of medication as an assistant to other forms of treatment. It also seeks to interrupt the addiction process by blocking the receptors in the brain.

The Medina Intervention Program and the Medina County Common Pleas Court’s Adult Drug Court received a grant from the Department of Justice to expand the use of medically-assisted drug treatment for chemically dependent offenders. The Bureau of Justice grant provides funding to offer Vivitrol, a drug which works by blocking opioid receptors in the brain which effectively stops a person from getting high. This is a voluntary program. A defendant cannot be ordered to participate in the program. Treatment also requires screening by a physician. Vivitrol is an antagonist. Antagonists bind with the receptor sites but they do not stimulate the receptors. Instead, they prevent opioids from getting through. To use naltrexone, a patient must first be detoxified fully from opioids followed by 7-10 days of continuous abstinence before taking the medication. Vivitrol is a long-acting injectable form of naltrexone. The effects last for approximately 30 days. This increases medication compliance over oral forms of naltrexone which a patient may stop taking prematurely.

Additionally, Medina County Court of Common Pleas partnered with the Ohio Department of Rehabilitation and Corrections to receive a state grant. With the help of DRC grant funding, Alternative Paths has hired a Vivitrol jail clinician who does drug assessments and case management with these individuals while they are in jail. If deemed appropriate, the defendant may receive the first Vivitrol dose while in jail just prior to their release.

Upon release, they are connected to The LCADA Way, or another provider of their choice, to receive their additional treatment and monthly injections together with counseling services while on supervision. If the defendant is not in jail, the assessment may be done by The LCADA Way or the provider of the defendant’s choice. While on supervision, the continuum of treatment and compliance is overseen by the probation department. Treatment may include residential treatment or intensive outpatient treatment; stable housing, attendance at 12-step meetings and random drug and alcohol testing.

While not a cure all, medication assisted treatment is another tool to be used in dealing with opioid addiction. Results of randomized, controlled studies have shown that medication assisted treatment combined with counseling reduced unauthorized opioid use significantly better than counseling alone. Best practice standards require drug courts to permit the use of medication assisted treatment in appropriate cases. Working with our treatment partners the Medina Intervention Program will continue to seek out the best evidence based practices available to deal with this problem facing Medina County.