Luzerne County prison nurse explains need for new medication-assisted treatment

Luzerne County Council members were recently riveted hearing nurse Megan Serpico’s viewpoint on why opioid settlement funds should be used to add Sublocade to the county prison’s medication-assisted treatment program.

Serpico is the prison’s medication-assisted treatment coordinator and works closely with inmates battling opioid substance use disorder.

The county is expected to receive $25 million over 18 years from the state’s settlement against opioid manufacturers and wholesale distributors, and $1 million must be programmed by the end of this month so it doesn’t have to be returned.

Council is expected to vote Aug. 13 on the county Commission on Opioid Misuse and Addiction Abatement’s recommendations to earmark the following amounts to expand these existing programs: medication-assisted treatment at the prison, $625,404; warm hand-off and certified recovery specialist services, $208,468; and school opioid prevention education programs, $208,468.

Sublocade is “very different” because it is injected in the belly every four weeks and has a chemical property causing it to mix with fat and solidify to create a “depo” that feels like a marble under the skin within five minutes, Serpico told council at its last work session.

Every day, a layer of the depo is shed to stop opioid cravings, she said.

“Cravings — in combination with depression and anxiety — are the biggest struggle, and that’s what leads to relapse, or taking more of something that they shouldn’t,” Serpico explained.

Serpico presented several reasons why this injection is better than another buprenorphine-based treatment currently offered at the prison — daily Subutex pills.

Subutex must be correctly dissolved under the tongue and is wasted and not effective if it is accidentally swallowed, she said. The pill also may not metabolize correctly if the inmate has liver problems or other issues.

Sublocade takes a significant amount of time to leave the system if injections stop, preventing sudden physical detoxification symptoms that come with oral medications, she said.

“That’s been a huge part for the success of Sublocade because many people that start to experience those physical symptoms instantly go into drugs that cause them to relapse without seeking any alternative treatment,” Serpico told council.

With the four-week injection, inmates also have more time to get acclimated and make arrangements for their next dose outside the prison after release, she said.

The depo also can’t be given to someone else — a practice known as diversion — unless it is cut out of somebody, which would be detected by prison staff, she said.

County Correctional Services Division Head James Wilbur highlighted this point to council.

“That is the key — diversion — from a security custody standpoint. That’s why this is a big advantage because that diversion’s going to be almost cut down to — I’ll never say zero — but very close to zero. So it’s a huge advantage,” Wilbur said.

Councilman Harry Haas said county officials want to spend the settlement funds wisely, and Sublocade targets “very high addiction recidivism.”

“This gives me hope,” Haas said.

Councilwoman Patty Krushnowski asked if it is easy to access Sublocade outside the prison.

Serpico said most, if not all, medication-assisted treatment clinics now offer Sublocade. All doses are tracked in the state’s drug monitoring system, allowing clinics to make sure they are timed correctly, she said.

Councilwoman Brittany Stephenson told Serpico her presentation was “amazing” and said she’d like to hear more often from nurses and others “on the ground doing some of this work” helping those with substance use disorder.

“I want it to be heard. I want the people to know that you’re there and this is something we are actively working to address, and now for 2024 it is a major priority for us to make sure that these programs are implemented with precision and with intention,” Stephenson said.

Council Vice Chairman Brian Thornton thanked Serpico for the information and also for her work “saving lives.”

Warm hand-off/recovery specialist

Warm hand-off programs set up services in the presence of the person with substance use disorder, increasing the likelihood treatment will proceed.

Certified recovery specialists are credentialed to use their own personal experience recovering from substance use disorder to serve as a “role model, mentor, advocate and motivator for others experiencing a battle with opioid addiction,” the agenda said.

The supplemental funding will make both more accessible to inmates adjusting after release and those visiting walk-in mental health crisis centers the county is launching through outside providers in Wilkes-Barre and Hazleton, officials said.

County Human Services Division Head Lynn Hill told council certified recovery specialists have “lived experience.” She pointed to citizen commission member Mary Butera as a “shining example” of a recovery specialist who compassionately and empathetically helps individuals navigate treatment and recovery options and gives them hope that there is “light at the end of the tunnel.”

Butera told council she and other recovery specialists are out in the community wherever they are needed —under bridges, in homeless camps and emergency rooms.

Regarding prevention education, Hill said programs and services will be expanded to ensure students in all county districts “understand the perils of addiction” and available resources if they are struggling.

“I am thrilled with the options that we came up with,” Butera told council. “It’s devastating to see how many are impacted by the opioid epidemic.”

An additional $1 million in prior county opioid settlement receipts must be earmarked by the end of this year, said county Manager Romilda Crocamo.

The commission plans to hold a public hearing in September to discuss options and accept public input, Crocamo said.

Periodic reports on outcomes of the funded programs and services also are required, she said.

Activated in May, the commission includes Butera, Hill, Crocamo, Wilbur, county Council Chairman John Lombardo, county District Attorney Sam Sanguedolce and county Drug and Alcohol Administrator Ryan Hogan.

Lombardo said he is pleased with the proposed package, describing it as a “great solution” to cover worthwhile programs within the upcoming deadline.