Carbon County prison officials have questions regarding a medical assistance treatment program at the correctional facility after learning a grant-funded injectable drug to help curb alcohol and illicit drug withdrawal is not being utilized.

During the county prison board meeting last week, several prison board members voiced concerns over the MAT program not utilizing Vivitrol for inmates in the program.

Last year, Carbon County received a $111,760 grant from the Pennsylvania Commission on Crime and Delinquency. The money is for the reimbursement of Vivitrol administration and treatment expenses at the correctional facility once it is used.

However, District Attorney Michael Greek said Vivitrol isn’t being used at the facility, and no official standard operating protocol is in place for the program.

Carbon County, which started the MAT program in January with an agreement with PrimeCare Medical and Carbon-Monroe-Pike Drug & Alcohol Commission, has 33 inmates in the program.

As of the meeting, approximately 145 inmates are being housed at the facility.

Kelly Ehrich, vice president of PrimeCare, said that the medical staff offers the inmates a choice of the medication they want that helps in substance abuse disorder, two of which are daily pills and two of which are injectables.

“Why?” Greek asked. “The grant was for Vivitrol, and we’re offering a choice on a program that we’re not even required to have in place.”

He noted that Vivitrol takes the possibility of a person “cheeking” the medication and is monthly instead of daily.

Greek also asked why the prison board never saw the operating procedures for the program, which Ehrich said are the same standard procedures other counties, as well as Maryland and New York use.

“I was supportive of it when Vivitrol was the choice,” he said. “I didn’t know that we’re in a situation where it is offered but nobody is choosing to take it. I think in terms of law enforcement, and what we’re trying to do up there, it’s a problem for us.”

The program

Sheriff Daniel Zeigler asked for a full description of what happens to determine if a person can be in the program.

When a person comes into the correctional facility, the protocol is to screen for substance use disorder. The inmate may get referred to drug and alcohol for further assessment. If it is determined the MAT program would be beneficial for them, the person’s records are sent to prison medical, where blood work and other medical tests are completed before offering them their options for the program.

“We do offer them Vivitrol, but they are choosing an alternative,” Ehrich said.

“We’re running a correctional facility, they’re not necessarily patients to us, they’re prisoners at the facility and we’re offering a choice to them on what type of medication they will receive,” Greek said. “Sometimes it can end up being distributed to other people within the prison. We got the grant for it (Vivitrol) and all the paperwork (for the MAT program) that it was based on Vivitrol.”

He asked if inmates already incarcerated can also request the program and not just people entering the prison. The answer was yes.

Since the program began, approximately 70 inmates have requested access into this program.

Ehrich said if a person comes into the facility already on one of the four medications, they continue the care with that medication.

Medicine choices

Commissioner Mike Sofranko asked if the county legally has to provide choices for what an inmate takes in this program.

Ehrich said PrimeCare’s policy is based on what is recommended from other states since Pennsylvania has not set statewide policies on this matter.

“We do not have to offer them a choice,” she said. “However, I can’t force them to take Vivitrol and I can’t change them over if they come in on one of the other medications.”

Ehrich pointed out that about a third of those entering the prison are already on one of the substance use disorder medications so they have to continue with that medical protocol.

Commissioner Rocky Ahner questioned why the county even has to have a MAT program if they are legally required to continue providing inmates with the medications if they come into the facility already taking them.

“When this was presented to us about Vivitrol, I thought that was going to be the drug that stops the person from cheeking or giving it to them one to two months before being released” he said. “It looks like we are just giving a pill to anyone who walks into the prison. That’s what my issue is.”

“This Vivitrol was supposed to be something to put people on the road to recovery,” he added, asking if maybe they are admitting people into the program too early, when they are entering, rather than started treatment a month or two before they are released.

Ahner pointed out that prison guards must sit with inmates when taking pills for extended periods of time to make sure the meds are taken.

“Our guards are not babysitters,” he said. “The way it was sold to me was the shot was going to help because it was once a month. What is happening wasn’t how it was presented to me.”

County Administrator Eloise Ahner interjected that the conversation is mixing the MAT program and the Vivitrol grant together and pointed out that they are two separate issues.

The county insurance company recommended creating the MAT program following a lawsuit in the state, while the Vivitrol grant was discovered and applied for after the MAT program was agreed upon to begin in the prison.

“You have to give choices,” she said.

Judge Joseph Matika, who oversees the veterans treatment and drug treatment courts in Carbon County, said that while that may be the case, what was presented to the county and approved in June 2024 was for injectables and not pill forms for these medications.

“I’m confused as to why PrimeCare has decided to use Subutex (oral) as opposed to injectable, which was the proposal proposed to commissioners,” he said, adding that previous discussions also stated that the MAT program would be based on an outlined agreement between PrimeCare and the jail and asked if that discussion ever occurred.

Rocky Ahner pointed out that another issue is reporting on whether the person using the drug was addicted to alcohol or opiates because the funding sources are different for that as well.

“How many are opiate versus alcohol?” he asked. “Are we looking at that?”

The discussion continued to circle with questions, finally concluding that a meeting between the county, prison and PrimeCare needed to take place to determine a policy that benefits the county prison operations.

“I’m being critical of the policy, not the people who are doing what is under the terms,” Greek told PrimeCare staff, agreeing that a meeting will be set up to go over everything further.

Last month, county officials heard a presentation at Carbon-Monroe-Pike Drug and Alcohol on the MAT program and the medications being used.