A national push to treat jail inmates struggling with opioid use is fueling a dramatic increase this year in the number of Hennepin County inmates receiving treatment.

Hennepin County jail staffers monitor as many as 250 inmates a month who are going through opioid withdrawal. So far this year, more than 350 inmates in the jail and workhouse have voluntarily accepted treatment — up significantly since last year when only 10 people in custody in the county were medically treated for opioid use.

The change came when county officials decided this year to join a handful of places nationwide that fund and treat inmates struggling with opioids.

This particular population is significant. A high percentage of inmates make up the victims in the county who die because of opioid overdose. Though the county program to treat inmates is less than a year old, officials already are making changes to increase the number of those getting treatment and keep them sober once they're released.

The program's prescribing doctors use telemedicine to check up on inmates by video and save trips to the jail. The county recently received a $1.3 million grant to help start a transitional clinic at Hennepin Healthcare for inmates treated in jail.

The jail treated a record 75 inmates in August, and program coordinators have little doubt the demand for help will keep growing.

"We still have an opioid crisis, and I think the numbers will go up as more people learn about the treatment we offer," said Dr. Tyler Winkelman, a physician with Hennepin Healthcare who works with the program. "But almost everybody I've treated for opioids were also using methamphetamines. So the opioid crisis is going to get more complex before it gets better."

'No bump in the road'

The jail initiative became a Hennepin County priority after a study examined 775 statewide opioid-related deaths spanning 2015 and 2016.

Among the findings, 252 of the deaths occurred in Hennepin County, more than half of them within three months of the inmates leaving prison or jail. Blacks and American Indians died in higher percentages than whites after their release, according to the study.

The county runs the program, which started in February, with a $500,000 opioid response grant from the state Department of Human Services. The Hennepin County Sheriff's Office has agreed to put approximately $300,000 in its annual budget to continue the program. Medicaid doesn't pay for people in jail.

"We are very pleased with the results," said Hennepin County Sheriff David Hutchinson. "When someone comes into our jail, it's our responsibility to do everything we can to make sure they don't come back. We treat the underlying issues that caused a person to end up in jail, so that people can lead a more stable, sober life that helps them be productive members of our community."

New inmates are screened by a nurse care coordinator for opioid addiction, and if they qualify are allowed to take alternative medications administered by medical staffers.

Before the program, a person either wouldn't get treatment or they would have to stop any treatment they were on, said Winkelman.

"It was pretty unbelievable," he said. "The person wouldn't receive treatment and then have withdrawal symptoms. They would have cravings when they leave jail and a high risk of overdosing. Now there is no bump in the road."

The program could only persuade 10 people to volunteer for treatment in its first month, even though many incoming inmates had been in treatment and were interested in restarting, said Winkelman.

More recently, he's surprised that many haven't heard of medical treatment for opioid abuse disorder and what treatment would look like after their release from jail.

Beyond medication, the program provides a social worker to help inmates work through health insurance and treatment needs, and a peer recovery specialist for mental and practical support, said Winkelman.

Inmates leaving jail receive a week's worth of medication until they find a new treatment provider.

Inmates at the Hennepin County workhouse in Plymouth are handled the same as those at the downtown jail. Fifty-six people have participated in the workhouse program since it started there in March, said Catherine Johnson, director of the county's Community Corrections and Rehabilitation Department. The workhouse can handle 60 people at a time; the crucial part is making sure they continue treatment after release, she said.

"Our goal is to reduce recidivism and increase public safety, and addiction is a barrier," Johnson said.

Hennepin County joins New York City, Denver, Baltimore, several cities in New Jersey and Cook County in Illinois among jurisdictions nationwide that treat opioid users in jail and prison. In Rhode Island, overdose deaths for inmates decreased 60% in the first year after they left jail.

County officials hope to track released inmates who were treated in jail, but some legalities have to be tied up. Julie Bauch, the county's opioid response coordinator, said she would like to use the data to address racial disparities in the criminal justice system and how they can improve culturally specific treatment.

"We have good intentions, but right now the system is one-size-fits-all," she said. "We have the courage and the know-how to listen to what communities are saying they need."

David Chanen • 612-673-4465