Colorado jail leaders are scrambling to find funding to maintain a new state-mandated program that provides medication and therapy to people in jail who are addicted to opioids.
Jail leaders knew a one-time federal grant would help them launch a program to treat people’s addiction with medications such as methadone, naltrexone and buprenorphine during the initiative’s inaugural year.
But with the initial $3 million in funding set to dry up by the end of June, some jail administrators said they’re surprised and frustrated to learn the state is not stepping up with a clear plan to help them pay to keep the program running.
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The state Behavioral Health Administration, which aims to help Coloradans access mental health and addiction services regardless of their ability to pay, said jails must adjust their budgets or find alternative funding to sustain their medication-assisted treatment programs, Stefany Busch, the Colorado Behavioral Health Administration’s media manager, wrote in an email to The Colorado Sun.
“I don’t think they understand how bad this is going to impact smaller and rural counties,” said Jackie Felix, behavioral services program administrator at the Delta County Jail.
“As a rural county with limited economic resources, we rely on state-level support to bridge this gap,” she said. “This is just one more hurdle in a program that has the potential to be so helpful and so progressive. The frustration level is palpable across the state.”
The medication-assisted treatment program, or MAT, launched last year to help jails respond to the opioid crisis by allowing them to offer anticraving medications — such as injections of the opioid-blocker Vivitrol — along with counseling to help stem overdose deaths.
The program also aims to increase community safety by reducing recidivism and can help people with opioid addiction get treatment in jail and after their release, Felix said.
Since 2011, the state has required jails to provide mental health and substance use disorder services through a program called Jail Based Behavioral Health Services. In 2023, jails were required to add the medication-assisted treatment program to their existing behavioral health services.
Jails recently received money from the state to continue running jail-based behavioral health services but won’t get any more state or federal funding, so far, to help continue running the new medication-assisted treatment portion of the program, Felix said.
The Delta County Jail received $380,000 from the state this fiscal year for its behavioral health services and $20,000 from federal grants to start the opioid treatment program.
The Behavioral Health Administration said jails should pull funds from their behavioral health services budgets to help fund the medication-assisted treatment program until a permanent solution can be found.
Jails can request opioid settlement money or other funding from their county leaders, the Behavioral Health Administration said.
The state Medicaid program is exploring other solutions such as one that would allow it to seek a federal waiver to provide medication-assisted treatment for Medicaid-eligible people up to 90 days before their release.
“This would provide a long-term solution to cover jail based medication-assisted treatment costs, but if enacted, would still be a few years away from adding support,” Busch wrote in the email.
Diverting funds to pay for other substance use services
If the Delta County Jail is unable to find alternative funding for its opioid treatment, leaders there will have to do what the Behavioral Health Administration suggested and divert funding from other key services, Felix said.
“The other end of jail-based behavioral health services is going to suffer because we’ll be pulling funds from those essential services to remain legally in compliance with state regulations for medication-assisted treatment,” she said. “The jails will suffer but not as much as the inmates will.”
The behavioral health services program provides mental health support, clothing, help obtaining identification cards, cellphones and assistance with obtaining emergency housing after their release, Felix said, and those benefits may have to be removed or reduced to help fund the treatment program.
“There will have to be some cutbacks on staffing or salaries or programming services,” Felix added.
With the medication-assisted treatment program in its first year, it is unclear how much funding is needed to run it, Felix said.
The cost of the program depends on the size of the jail and what percentage of the incarcerated population receives medication-assisted treatment, a number that changes sometimes daily, Busch wrote in an email.
It currently costs about $859 per person per week to receive medication-assisted treatment at Delta County Jail, Felix said.
Felix estimates it will cost about $87,000 to provide that treatment this upcoming fiscal year. Currently, she has about $12,000 left to administer the program before the money is spent by the end of June.
The Behavioral Health Administration is partnering with state agencies to find funding, and jails can explore grants to help fund the state’s MAT program.
“BHA is committed to working with jails to support identifying other funding streams to keep this vital service afloat,” Busch wrote.
Addressing a lack of funding for medication-assisted treatment in jails across the state is a priority for the attorney general’s office, Lawrence Pacheco, a spokesperson for the AG’s office wrote in an email to The Sun this week.
The attorney general announced an award program in January that would allow people to nominate jails that could receive one-time $50,000 grants to help the facilities continue running the opioid treatment program.
Jails: De facto medical and mental health treatment providers
Law enforcement officials have long argued that people with addiction and mental illness should receive treatment from community-based providers who are better trained and more suited to take care of them, said Capt. Daniel Cano Jr., Delta County Jail administrator.
But jails have become de facto treatment providers for people with mental illness and substance use disorders because of underfunded and disorganized mental health services in the community, according to Human Rights Watch.
State and local governments shut down mental health hospitals during the deinstitutionalization movement from 1955 to 1980 but failed to provide adequate alternatives, according to the advocacy organization.
Now people who are repeatedly arrested are often people of color, others living in poverty, people with low education, those who are unemployed and others who have serious unmet medical and mental health needs, according to the Prison Policy Initiative.
The Colorado Sun visited the Delta County Jail on March 28.
Cameras in the jail’s control room at one point showed one man with mental illness repeatedly pacing from one corner in his small cell to the other.
“He will do that for hours at a time,” a guard told a Sun reporter.
The medical facility, where people are seen for medication-assisted treatment and other health concerns, is next to padded cells where people who are a harm to themselves or others are held until medical staff release them.
Others who are in withdrawal are monitored while they detox from substances in another small room nearby that has lights that never turn off.
At the Delta County Jail, which can house just over 80 people, people are given two blankets and a mattress with no sheets nor pillows — to help prevent self-harm and suicide.
Typically, about 65% of people incarcerated there are receiving behavioral health services, Felix said. Of those participants, just over 20% are enrolled in the medication-assisted treatment program.
“We want to turn these people back into society knowing that those cravings are taken care of in here, so they don’t go right back out and use, and eventually overdose and die,” Felix said.
Chelsea Herrera, 25, who was incarcerated at the Delta County Jail several times last year, said medication-assisted treatment gave her a chance to recover and heal.
“Once you’re in the drug world, you get stuck there and you lose hope,” Herrera said Tuesday. “But once you start the medication-assisted treatment program, it gives you hope, so that you don’t need street drugs to continue to get through your life.”
People with alcohol addiction can also benefit from the program by receiving a Vivitrol shot once per month, Herrera said.
Herrera also participated in therapy while she was in the program and said she didn’t comply with medication-assisted treatment until she was also able to receive grief counseling inside the jail.
In 2020, Herrera got into a car wreck and accidentally killed her grandmother. Soon after, she said she began abusing alcohol.
But grief counseling at the jail helped her find a new desire to address not only her addiction but also the trauma from the deadly crash.
Now, she works at a local bar in Alamosa, goes to counseling and takes medications. She’s out of jail, and has been sober for five months now.
“I’m doing really well,” Herrera said. “I’m able to work at a bar without having cravings, which feels really good. I feel free.”
Treatment to help reduce deaths and recidivism
Many women are incarcerated because of trauma and addiction and if they receive therapy in jail, their chance of relapsing or committing new crimes sharply drops, said Lew Swarthout, a mental health and medication-assisted treatment provider and owner of Milestone Psychiatry, who prescribes medications at the Delta County Jail.
“If you don’t treat them, they’re going to come back to jail,” he said. “There’s so much fentanyl out there and it’s so cheap that they’ll have a bad day and end up relapsing.”
The need for medication-assisted treatment programs in jails and prisons is great, because drugs are very much present inside of correctional facilities, he said, the result of smuggling that jails and prisons all over have failed to curb.
“People steal to buy drugs and when they’re in prison, there’s more drugs there than on the streets,” Swarthout said. “Their families send them money and then they buy drugs with it. It’s a huge epidemic. Men’s prisons have a lot of gangs set up and many of these facilities will hire former inmates to try to give them a chance. It could be former inmates, their family and corrections officers who bring drugs in.”
Concerns about a reduction in behavioral health services at the Delta jail come after the closure in early February of Integrated Insight Community Care, a Delta-based clinic that provided medical and mental health care to some of the most vulnerable people on the Western Slope.
The loss of services at Integrated, which cared for about 1,400 patients, is significant because many people who were released from Delta County Jail were linked to medical, mental health and addiction services there.
Now that the clinic is closed, when vulnerable people are released from the jail they will be without their best option for mental health stabilization and substance use disorder recovery, Felix said.
“The concern is, it takes a long time to build trust between a population that is stigmatized and punished to find a therapist that they can rely on and trust,” Felix said.
“When we release these people we want them to follow up with providers and stay on their meds and if we don’t have someone to immediately refer them to, who will hold them accountable for staying on their protocol?” Felix asked.
Since the medication-assisted treatment initiative began at the jail last April, just three out of 22 of the program’s participants have returned to the jail, Felix said. The three people who returned were receiving care at methadone clinics outside the jail.
“It’s not uncommon for methadone users to continue to use other illicit drugs, so their lifestyle doesn’t change much when they are released, which is likely what contributes to the recidivism,” she said. “Zero percent recidivism is ideal but the purpose of medication-assisted treatment is harm reduction and zero overdoses is a success as well.”
Many people incarcerated at the Delta jail have a mental health and substance use disorder. But there’s a small population that has both conditions as well as intellectual and developmental disabilities. They will not only need mental health and addiction treatment but other support services, including help with daily living, when they’re released, Felix said.
“They’re already suffering in the community with a lack of resources and they don’t have the mental fortitude to ask for help or know who their resources are,” Felix said. “I need a bigger community base and team to ensure that, when they’re released from here, they’re getting the support they need because they’re going to need it for the rest of their lives.”