美国国家公共电台 NPR County Jails Struggle With A New Role As America's Prime Centers For Opioid Detox

 

RACHEL MARTIN, HOST:

The opioid abuse crisis in this country is overwhelming America's county jails. The jails weren't built to become the largest drug treatment centers, but that's what they are in many states. The National Sheriffs' Association estimates that between half and two-thirds of today's jail population has a drug or alcohol abuse problem. As NPR's Eric Westervelt reports, to deal with the opioid epidemic¹, more jails are struggling to expand what's called medication-assisted treatment.

ERIC WESTERVELT, BYLINE²: Felipe Chavez walks the hall of what looks like a regular hospital wing - small doctor's offices with padded exam tables and that disposable medical paper. He looks younger than his 23 years - sleepy eyes and loose-fitting clothes, like a teenager in baggy³ pajamas⁴. But the hunter orange of everything he's wearing - down to the plastic slippers⁵ - all show he's in the San Mateo County jail's medical clinic, in Redwood City, Calif., where he gets his regular dose of methadone. Chavez is serving somewhere between four months and four years for selling fentanyl and other opioids, drugs he says have ruled his life since a sports injury years ago.

You're 23?

FELIPE CHAVEZ: Yeah.

WESTERVELT: When did you start using opioids?

CHAVEZ: Twelve.

WESTERVELT: Wow, age 12.

CHAVEZ: Yeah. I was using oxycodone - 30 milligram pills. And I was smoking them. Then I went to heroin⁶, then heroin went to fentanyl and then, yeah, just slowly worked up the ladder.

WESTERVELT: Yet Chavez is one of the lucky ones here. Because he was in a local methadone program before he got arrested again, he's been allowed to keep using that synthetic⁷ opioid substitute in jail. Methadone and a couple of other drugs help jailed addicts⁹, like Chavez, temper cravings and, in theory, stay off more powerful and destructive opioids.

CHAVEZ: It's all about if you want to get clean or not. You know, the methadone is just there to help. I mean, you got to dedicate to the methadone because you got to start somewhere, you know?

WESTERVELT: With the medication-assisted treatment here, Chavez says, I just feel more normal, like a normal person. More research is needed. But so far, studies have shown that medication-assisted treatment works well in reducing fatal overdoses, relapse and the spread of infectious diseases, such as HIV.

But this kind of drug-based approach is relatively¹⁰ new in San Mateo, as it is for many jails across the country. For nearly a quarter-century, this jail's flagship addiction¹¹ treatment program has been an abstinence-based approach called Choices.

CARLOS MORALES: Everybody here is an addict⁸. Everybody is in recovery. Some of these folks will be going to prison - a small segment of them...

WESTERVELT: Carlos Morales is the county's director for correctional health services. He shows me around the Choices wing. About 100 inmates¹² linger around plastic padded tables and in chairs outside their cell doors.

For decades, this kind of cold turkey, abstinence and talk therapy program has been the model for county jails across America. But a rise in fatal overdoses of inmates nationally - some died from dehydration¹³ during detox or overdosed just after they were released because drug tolerance¹⁴ had dropped - prompted Morales to rethink the abstinence-only model.

MORALES: Dead addicts don't recover, so this is our opportunity to engage this population.

WESTERVELT: Morales has pushed to add medications to the jail's drug treatment toolbox.

MORALES: We know that the potential for overdosing - if you're an opioid users, you come in here, you detox and you go out - 40% chance of OD'ing. And we have a potential to do something about it.

WESTERVELT: Only a dozen opioid addict inmates are undergoing some form of medication treatment here. Morales wants to expand those numbers and increase the voluntary use of the drug naltrexone - known by its brand name, Vivitrol - for inmates getting released. Vivitrol blocks the effects of opioids and alcohol for about a month. But it's slow going. There are deep worries about costs and safety. Inmates can hoard¹⁵ and then sell, trade or abuse some of the treatment drugs. Medication-assisted treatment has proved a hard slog for jails across the country.

Scientist Andrew Klein consults with jail drug treatment programs in almost every state. He says only about 12% of the nation's roughly 4,000 county jails now offer some form of medication-assisted treatment for opioids or other addictions¹⁶.

ANDREW KLEIN: Although this number is not - you know, it's not the majority of jails. Five years ago, it was zero. And the number is increasing every week. So jails are - especially with the opioid epidemic - scrambling¹⁷ to catch up.

WESTERVELT: The scramble¹⁸ is especially tough for jails in more rural counties. Carrie Hill directs the National Sheriffs' Association's Center for Jail Operations.

CARRIE HILL: Even if they wanted to provide medication-assisted treatment within the jails, there may not be a methadone clinic for 60 miles. Or we may not even have the doctors who have the necessary licenses¹⁹ to provide certain medications.

WESTERVELT: Hill's group is working on solutions that include mobile units - a kind of opioid addiction van - that could deliver treatment drugs to hard-to-reach jails. Peter Koutoujian is a leading voice on the issue. He's the sheriff of Middlesex County, Mass. - among the states hardest hit by the opioid epidemic.

While he supports expanding medication for inmates, he's wary²⁰ of making it the centerpiece of problem-solving. That kind of thinking, Koutoujian says, got us into this crisis in the first place.

PETER KOUTOUJIAN: Medication-assisted treatment is very important. But people have to remember, if you do the medication without the treatment portion - the counseling and the support - it will fail. And we will just fall prey²¹ to another easy solution that just simply does not work.

WESTERVELT: This August, Massachusetts will start a pilot program in jails in seven counties to add all forms of medication-assisted treatment for opioid addicts. And the jails will carefully track data on efficacy, including relapse, recidivism²² and overdoses.

Eric Westervelt, NPR News.

1 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 baggy   

adj.膨胀如袋的，宽松下垂的

参考例句：

• My T-shirt went all baggy in the wash.我的T恤越洗越大了。
• Baggy pants are meant to be stylish,not offensive.松松垮垮的裤子意味着时髦，而不是无礼。

4 pajamas   

n.睡衣裤

参考例句：

• At bedtime,I take off my clothes and put on my pajamas.睡觉时，我脱去衣服，换上睡衣。
• He was wearing striped pajamas.他穿着带条纹的睡衣裤。

5 slippers   

n. 拖鞋

参考例句：

• a pair of slippers 一双拖鞋
• He kicked his slippers off and dropped on to the bed. 他踢掉了拖鞋，倒在床上。

6 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

7 synthetic   

adj.合成的，人工的；综合的；n.人工制品

参考例句：

• We felt the salesman's synthetic friendliness.我们感觉到那位销售员的虚情假意。
• It's a synthetic diamond.这是人造钻石。

8 addict   

v.使沉溺；使上瘾；n.沉溺于不良嗜好的人

参考例句：

• He became gambling addict,and lost all his possessions.他习染上了赌博，最终输掉了全部家产。
• He assisted a drug addict to escape from drug but failed firstly.一开始他帮助一个吸毒者戒毒但失败了。

9 addicts   

有…瘾的人( addict的名词复数 )； 入迷的人

参考例句：

• a unit for rehabilitating drug addicts 帮助吸毒者恢复正常生活的机构
• There is counseling to help Internet addicts?even online. 有咨询机构帮助网络沉迷者。 来自超越目标英语 第3册

10 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

11 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

12 inmates   

n.囚犯( inmate的名词复数 )

参考例句：

• One of the inmates has escaped. 被收容的人中有一个逃跑了。 来自《简明英汉词典》
• The inmates were moved to an undisclosed location. 监狱里的囚犯被转移到一个秘密处所。 来自《简明英汉词典》

13 dehydration   

n.脱水，干燥

参考例句：

• He died from severe dehydration.他死于严重脱水。
• The eyes are often retracted from dehydration.眼睛常因脱水而凹陷。

14 tolerance   

n.宽容；容忍，忍受；耐药力；公差

参考例句：

• Tolerance is one of his strengths.宽容是他的一个优点。
• Human beings have limited tolerance of noise.人类对噪音的忍耐力有限。

15 hoard   

n./v.窖藏，贮存，囤积

参考例句：

• They have a hoard of food in the basement.地下室里有他们贮藏的食物。
• How many curios do you hoard in your study?你在你书房里聚藏了多少古玩？

16 addictions   

瘾( addiction的名词复数 )； 吸毒成瘾； 沉溺； 癖好

参考例句：

• He has removed the stigma of drug addictions. 他已经洗去吸毒的污点了。
• Intelligent people are good at using reason to control excessive addictions. 智慧的人善于用理性来控制过度的嗜欲。

17 scrambling   

v.快速爬行( scramble的现在分词 )；攀登；争夺；（军事飞机）紧急起飞

参考例句：

• Scrambling up her hair, she darted out of the house. 她匆忙扎起头发，冲出房去。 来自《现代英汉综合大词典》
• She is scrambling eggs. 她正在炒蛋。 来自《简明英汉词典》

18 scramble   

v.爬行，攀爬，杂乱蔓延，碎片，片段，废料

参考例句：

• He broke his leg in his scramble down the wall.他爬墙摔断了腿。
• It was a long scramble to the top of the hill.到山顶须要爬登一段长路。

19 licenses   

n.执照( license的名词复数 )v.批准，许可，颁发执照( license的第三人称单数 )

参考例句：

• Drivers have ten days' grace to renew their licenses. 驾驶员更换执照有10天的宽限期。 来自《现代汉英综合大词典》
• Jewish firms couldn't get import or export licenses or raw materials. 犹太人的企业得不到进出口许可证或原料。 来自辞典例句

20 wary   

adj.谨慎的，机警的，小心的

参考例句：

• He is wary of telling secrets to others.他谨防向他人泄露秘密。
• Paula frowned,suddenly wary.宝拉皱了皱眉头，突然警惕起来。

21 prey   

n.被掠食者，牺牲者，掠食；v.捕食，掠夺，折磨

参考例句：

• Stronger animals prey on weaker ones.弱肉强食。
• The lion was hunting for its prey.狮子在寻找猎物。

22 recidivism   

n.累犯，再犯

参考例句：

• Many areas and work units have experienced no recidivism at all for as long as ten or more years.不少地区和单位出现了连续几年、十几年没有发生重新犯罪的好典型。
• It needs to supplement the personality factor to confirm the ordinary recidivism.在普通累犯成立的条件中,应增加罪犯的人格因素。