Shelby County Medically Assisted Treatment and Referral to Services for Justice-Involved Adults (M.A.T.R.S)

Description of the Issue In July of 2021, the Shelby County Division of Community Services Office of Justice Initiatives (SC OJI), located in Shelby County, Tennessee, applied for funding under the BJA FY 21 Comprehensive Opioid, Stimulant, and Substance Abuse Site-based Program (COSSAP) announcement. In December of 2021, SC OJI was awarded $1.2 million in funding for the Shelby County Medically Assisted Treatment and Referral to Services for Justice-Involved Adults (SC-MATRS) program. The SC-MATRS application that was submitted and subsequently awarded included several key treatment providers and staff. Dr. David Stern was identified as the Medical Director of the project. Dr. Stern is a healthcare leader who was to provide direct patient care to residents enrolled in the program. Dr. Stern had previously been the principal investigator/project director on a wide array of federal, state, and local grants over the course of his nearly fifty-year career. Dr. Stern was also the co-founder and director of Integrated Addiction Care (IAC), the sole treatment provider named in the application. In the spring of 2022, Dr. Stern left the SC-MATRS project when he resigned as the director of IAC. Months later, in the summer of 2022, IAC was sold to another healthcare provider. Around this same time, Melody Freeman, the program coordinator for Shelby County, also left the project. A community partner who was to play a role in client referrals, the West Tennessee Forensic Center, also left the project in the summer of 2022. These departures placed the SC MATRS project in a difficult position. The need for expanded MAT treatment options and support networks in Shelby County remains, as high poverty rates are accompanied by high levels of opioid addiction and a lack of health insurance coverage among residents. The opioid epidemic continues to take its toll on Shelby County. As of November 12, 2022, 399 drug overdose deaths have occurred year-to-date. Historically, OD deaths have occurred disproportionately among older White males; in 2018, 83% of fatalities were age 21-59, 64% were male, and 66% were White, despite Whites comprising only 35% of the population. In 2019, however, Black males experienced the largest increase in fatal ODs. Their share of OD deaths increased 40%, from 18% in 2018 to 30% in 2019 (SCHD, 2020). This trend is has continued in year-to-date numbers from 2022. Through November 18, 2022, 42% of suspected drug overdoses were Black males and 18% were by Black females, compared to 27% by White males and 11% by White females. The SC OJI team remains motivated to address the ongoing overdose and opioid use trends in Shelby County despite SC-MATRS implementation setbacks. A sense of urgency over a year in to proposed programming has led SC OJI leadership to focus on a new plan with a new treatment provider that is already embedded on the frontline of substance abuse and MAT treatment in Shelby County. The original goals that were awarded funding under Category 1, Subcategory 1a. remain the same - SC OJI seeks to fund detox and MAT treatment options for people who are justice-involved or at risk for being justice involved with histories of SUD/OUD. SC OJI will be unable to fund the proposed program without federal assistance because the program will focus on providing MOUD to justice-involved individuals and those at risk for being justice involved. Neither the drug-involved nor the justice-involved are populations typically targeted for community or government support. That is, both substance use and behaviors that bring about justice involvement generally are viewed as matters of choice and believed by most private citizens and policy-makers to incur “just deserts” for the people. New Project Design and Implementation Alliance Health Services (AHS) is a large non-profit behavioral health provider in Shelby County. In addition to outpatient, intensive outpatient, home-based, and community-based programs, AHS contracts with the State of Tennessee to provide a continuum of mental health and substance use services, including Medically Monitored Detox (MMWM, Medically Monitored Withdrawal Management for opiates, alcohol, and benzodiazepines) and Medication Assisted Treatment (MAT) services. Alliance Health Services has previously been chosen by the Tennessee Department of Mental Health and Substance Abuse Services for funding for expanded crisis stabilization unit (CSU) capacity with walk in triage capabilities for adults (18 years and older). AHS has established itself as an alternative to incarceration for intoxicated residents who come into police contact. When appropriate, local law enforcement can bring intoxicated residents struggling with substance abuse to AHS for services, in lieu of arrest and entrance into the justice system. Because of this service option, AHS is a key resource for law enforcement officers dealing with non-violent offenders who need detox and other treatments rather than incarceration. AHS is also home to Shelby County’s only Mobile Crisis Response Team, which provides crisis intervention services to anyone in Shelby County who is in crisis and in need of mental health care. AHS status as a hub for treatment options for justice involved individuals at high risk of overdose (HROD, and those in need of evidence-based medications for opioid use disorder (MOUD) is well established in Shelby County. AHS is the only established safety net provider for crisis stabilization services in Shelby County. This safety net allows uninsured residents to receive walk in services without regard to cost or ability to pay. However, AHS services for these populations are currently operating at capacity. AHS currently has the ability to operate four uninsured walk-ins in need of detox can receive services. AHS detox services continuously run at capacity and always maintains a waiting list of approximately 60-100 people. However, AHS has the license and space to provide five additional beds if new funding sources can support new programming. The new SC-MATRS proposal centers on a system of screening eligible individuals who are at risk of or who are justice-involved individuals for risk of OD with (AHS) as the sole provider. Appropriate holistic treatment (to include MOUD, when clinically necessary) by AHS, detox services, and referral to other treatment and service providers, when necessary. and those who are at risk of incarceration due to HROD. SC MATRS programming will rely on its unique positioning as a law enforcement drop-off site and refer the abundance of in-house walk-ins, and other client referrals to appropriately screen and refer to detox, MAT, and outpatient or long-term residential SUD treatment. SC-MATRS contributes to COSSAP’s goals of reducing the impact of opioids, stimulants, and other substances on individuals and communities and reducing the number of overdose fatalities. The program meets the allowable use of grant funds in three ways because it involves: 1) diversion from incarceration and the provision of treatment and services to individuals at high risk of overdose (HROD); 2) evidence-based detox and medications for opioid use disorder (MOUD), including peer recovery support services, and 3) a court-based intervention program (Drug Court) to prioritize and expedite treatment and recovery services to individuals at HROD. Finally, SC-MATRS addresses the grant program area of developing a comprehensive, locally driven response to SUD/OUD that expands access to supervision, treatment, and recovery support services within Shelby County.