Five Questions With: Leslie Bridgman

As CODAC Behavioral Healthcare’s director of correctional services, Leslie Bridgman oversees CODAC’s medication-assisted treatment program.

Created four years ago, the MAT program gives inmates within Rhode Island’s prison system access to medications used to treat opioid addiction. CODAC’s involvement with the state’s Department of Corrections began in October 2016, when it was awarded RIDOC’s contract for the medication-assisted program.

PBN: How many people in the R.I. Department of Corrections’ prison system have participated in the MAT program? Is it possible to track the program’s success rate once inmates are released?

BRIDGMAN: Since 2016, we have treated over 5,000 individuals. Currently, our average daily census is between 310-320 patients a day. Tracking the success of the program has been and continues to be a priority. Our hope is that this data can help further increase buy-in for the program. … Rosemarie Martin, and her staff at Brown University’s School of Public Health, are the program evaluators. Aside from tracking our growth, her team is also looking at follow-up rates in the community, recidivism and mortality.

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PBN: Is the program being used in all the Adult Correctional Institutions facilities? Is it available to juveniles as well?

BRIDGMAN: Yes, the program is offered in all six facilities at the R.I. Department of Corrections, and we currently have patients in all six facilities. We do not currently have any juveniles in the program, but of course it is available if determined to be medically appropriate. We are not currently providing medication-assisted treatment services at the Rhode Island Training School.

PBN: What is the enrollment process for inmates – how do they find out about the program, and are they able to begin it right away?

BRIDGMAN: The enrollment and referral process begins the night of commitment. For those coming in on medication from the community, the continuation process is seamless. An active script for the medication is confirmed, and the patient receives his/her medication the following day.

CODAC opened a dispensary inside the Intake Service Center in February 2018. Having this co-located dispensary allows for us to dispense and deliver medication to all the facilities in real time. Within their first week at the RIDOC, they are seen by a CODAC clinician and begin group therapy. At commitment, all offenders are asked about their substance use. Any report of opiate use creates a direct referral to CODAC.

A recommendation we always tell other states is, “Don’t re-create the wheel.” We spent the first few years screening all commitment with an evidenced-based tool, assuming that this was how we would capture all those in need of treatment. Soon we started to see that we were getting the same, if not, more-accurate referrals from the nursing assessment done at commitment. So, not only was this process more effective, but it was also efficient.

Understanding that we can still miss people, details about the program are presented during orientation at the men’s and women’s awaiting trial buildings. We also stress there is no incorrect referral path. Offenders can be self-referred, referred by medical staff, mental health staff, security or another contracted provider. We want to encourage treatment.

PBN: Are there any signs that the MAT program could be used as a national model?

BRIDGMAN: Yes, numerous states from across the country have reached out looking for guidance on how to implement medication-assisted treatment programs within their correctional systems.

In January of this year, the [Substance Abuse and Mental Health Services Administration] SAMHSA-funded Opioid Response Network hosted a conference in Providence for states interested in implementing medication-assisted treatment programs to gather. It was a chance to highlight the RIDOC model.

In 2019, CODAC partnered with the Hampden County Sheriff’s Department in Ludlow, Mass., to operate a co-located dispensary, as well. I bring this up because I believe it proves that our model … [can be replicated] in other states and different correctional systems. I think our experience is most valuable because we are candid about mistakes and missteps. Since we were the first to offer all three [Food and Drug Administration] FDA-approved medications in a state’s correctional system, we had to learn by trial and error.

PBN: What’s the reaction been from RIDOC and inmates?

BRIDGMAN: Overall, we would say positive. We have been very fortunate to have really amazing champions on our side, starting from the director’s office. I can’t speak about the program without mentioning Dr. Jennifer Clarke, the medical program director of the RIDOC. It was her vision and perseverance that really made this program a reality. Patients have been and remain grateful. Many have faced incarcerations in which they had to “go cold turkey.” They can vividly recall how they felt, emotionally and physically.

Having worked at CODAC’s Newport site when I first started in this field, I can remember patients knowing they may be incarcerated and wanting to start decreasing their medication. The fear and anxiety was so real. Now, we hear a lot of patients feeling “hopeful” about their reentry. They credit that hope to this program.

Elizabeth Graham is a PBN staff writer. She can be reached at Graham@PBN.com.