#she died six months after that. she’d been living without treatment for a year prior to diagnosis like… they could’ve saved her | Explore Tumblr Posts and Blogs

ofravensandgenesis · 4 years

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I'd love to ask about '03 Rachel/Faith notes, backstory, past Faiths, Bliss Mechanics, Tracey, etc' and 'Redshift Collision', if that's okay! 👀

Oo, fun choices! :D Thank you for asking!! ♥ Putting it below the cut, also trigger warnings for mentions of child abuse, drug use, dark backstories, in line with or inspired by Far Cry 5 canonical content. Trigger warnings for Redshift Collision include mentioned fantasy religious content, topic of euthanasia mentioned, magical diseases, etc. Long post is long, I hope the read is enjoyable though!! :0

————— 03 Rachel/Faith notes, backstory, past Faiths, Bliss Mechanics, Tracey, etc ————— So this folder breaks down into a dozen docs with split up notes, we’ll touch briefly on a bit from most of if not all of them, but the list is as follows:

01 Faith Character Notes, NPC Followers

02 Rachel Jessop’s Backstory for ACABH

03 Deaths of the Former Faiths Prior to Rachel, Some Bliss Mechanics

04 Tracey Lader Backstory Notes for ACABH

05 Types of Bliss Drug

06 Bliss Dart Mechanic Notes

07 Faith NPC compilation links

08 Overarching Bliss Realm Mechanics

09 Priestess pictures for Athalia - refs, tattoos, etc

10 Jacob’s Men talking about Bliss Shipment Amounts for Various REgions, Bliss Barrel capacity

11 Faith’s character arc, [Redacted for spoilers] - Major Plot Developments for All Main Characters

12 Angels versus Lost Souls

So, fun tidbits from these various docs! Some are implicitly dark because Faith is a Seed and Seeds don’t get to have happy, fun backgrounds in cult-centric AUs like ACABH, poor souls. The first Angel that Faith ever made, and the first ever Angel of the Project, was a woman named Abigail. It was an accident. Researched the first and last (and alternate) names for both Rachel Jessop, Faith, and Tracey Lader. Fun stuff honestly, Tracey’s is very fitting in that one definition of the name is taken from the Irish word "treasach" meaning "war-like" or "fighter." Lader is from Old English and Middle English words meaning to load; draw up (water specifically.) Rachel is as far as biblical names go, the name of the favorite wife of Jacob, and means “ewe” as in a female sheep. Fitting in a metaphorical sacrificial lamb way, if one chooses to look at it like that, among other sheep-like metaphors such as following the herd, etc. Rachel’s father was a doctor who researched the biochemistry of various plant based compounds that he extracted from specimens he grew at home in controlled conditions. Her mother ran a florist shop and delivery chain, and grew orchids in the green house as a past time. Rachel was passionate about the sciences when she was young, but neither parent looked upon this favorably for various (toxic and abusive) reasons, leading Rachel to become far more withdrawn and reclusive about her passions and activities—in as much as she could manage, beneath her parents’ ironclad rule. Rachel in the present day still is passionate about biology (specifically botany) and biochemistry, but keeps that to herself unless she really happens to trust the other person. There was a brief time when she was a more rebellious and spirited young girl—but her parents quickly stamped that out through any means necessary, including force. It is a major reason as to why Rachel is so conflict avoidant: she remembers how badly it can go, how quickly it can escalate, and she is so very aware of the inherent fragility of both life and limb. There are quite a few conflicting points-of-view regarding the deaths of Rachel’s predecessors, and a great deal of misinformation. Rachel believes that the Seeds aren’t being entirely forthcoming with her about how their own abilities work and the limits of said abilities, and that there’s a lot of secrets not being told regarding the details of how the two former Faiths died. Selena was the first Faith, chosen while the Project was still in its infancy, long before they had made it to Hope County, and Joseph was so sure she’d be the prophesied fourth Herald to help shepherd the faithful through the Collapse. Lana was the second, stepping up to fill the role when Selena died—but Lana died two months later, with both Faiths’ deaths serving as markers of the dangers of the then proto-Bliss-realm. Rachel had been at the Project for half a year at that point, and was the one who took up the mantle of Faith and has served ever since for the past seven years. She was eighteen when she took up the name Faith, but despite her young age had marked accomplishments to her name that had put her forward as a candidate, namely her works with the geneticist Peter on developing the first strains of the drug that would later come to be called the Bliss. This lead to huge leaps and bounds of development with regards to the psychic network that would become the Bliss Realm, and without Rachel’s work, it would be safe to say the Bliss both in drug and psychic plane form, would likely not exist. Jessop as a name is potentially from a root name of Joseph in the form of Yosef, meaning “may God increase, or add (another son)” which ties into Rachel’s family’s thwarted desire for a son rather than a daughter very well in this AU. Thematically, Rachel does arguably share ideology from both Jacob and Joseph, so in a way that is also extremely apropos for her. Ah, Tracey. She did not come from a happy home life either—but that doesn’t surprise anyone in the slightest I think. Her father left her mother the moment he found out she was pregnant, and that’s all Tracey knows and wants to know of him. Her mother worked hard to support them but was absent most of the time, leaving Tracey with relatives to keep an eye on her. Said relatives were very shitty in their treatment of her, leading to a whole host of problems for Tracey to deal with growing up, ranging from neglect to verbal and emotional abuse. This is a cluster of reasons among others that lead to Tracey learning to look out for herself—and to stick up for those who couldn’t look after themselves. She and Rachel met in high school, and they were each other’s first real meaningful friend. It was when they were together that they first thought of the possibility of a better life than all the horror and terribleness they had to live through so far in their very young lives. They were so sure they’d be friends forever...until they weren’t. As of writing this, there are currently six major strains of the drug bliss in ACABH, including Regular Bliss, Sleeper’s Bliss, The Chosen’s Sacrement, The Angels’ Bliss, Cleanser Bliss, and Red Bliss. Variant strains within those major categories also exist as it’s an on-going series of projects for Faith and her followers, with varying levels of involvement from other Heralds, regions, etc. Red Bliss is specific to Jacob’s region and is used in both the Judgification process and the Trials. The others are all largely self explanatory for the most part, or explained or will be explained in the fic. Bliss darts! These are what John’s hunters use, same substrain of Sleeper Bliss that Jacob’s hunters and Faith’s followers use in the form of Bliss arrows and Bliss grenades (think like smoke grenades) to capture non-Project-members too, alongside their attempts to capture the Deputy. Joshua still has a nice stash of them at this point, so the whole family’s in on this. Commonly used even in the Project’s rank and file to subdue kidnapped targets. People can die permanently if they suffer sufficient psychic injury or psychic death in the Bliss in general, but that’s not a guarantee. If some form of psychic death is induced while the person is in the Bliss, it’s possible with immediate medical response to potentially resuscitate said person. Some people can “die” in the Bliss without problem though, aside from likely waking up in a panic as if from a very stressful nightmare. Most people can’t without being connected to the private Bliss network in Jacob’s region—Jacob’s is specifically split off from the rest of the Bliss Realm through the exclusive use of Red Bliss, though Faith and her priestesses could in theory cross over and connect to Jacob’s network, they generally do not. It is easier for Jacob’s people to cross over to the main Bliss network than it is for other rank and file or even Chosen that belong to other Heralds to enter the Red Bliss network if they are not induced into it through drug use. The Heralds have a much easier time of it, but it’s still difficult—Faith and Joseph have abilities that allow easier passage for it among other things, whereas John would struggle more with it sans other additional factors to help said effort along. Athalia was originally one of John’s people before she transferred to help support the previous Faiths, and Rachel retained her as Head Priestess from early on, striking up something like a friendship over time. Some of Athalia’s loyalties may still lie with her old Herald though moreso than her chosen Herald, certainly some of her outlook mirrors John’s dogma moreso than Faith’s, though Athalia keeps that underwraps more often than not. They have a SHIT TON of bliss being shipped around to the different regions. They have to have one hell of an industry for making the stuff to keep up with that scale, depending on what the chemical makeup and ratios are. The doc regarding the plotting of Faith’s arc is all spoilers, so we’re skipping any mention of it here. Angels are different from what the Project calls Lost Souls due to the fact that Angels aren’t 100% disconnected from their bodies and lost in the Bliss Realm, they’re still distantly connected to their corporeal forms in reality, just busy enjoying the Bliss high trip and for the most part uninterested in returning to the real world...for the most part. A minor part of the job for Faith’s people is to ensure that the Angels don’t wander too far in the Bliss realm, or else they’ll become Lost Souls and if gone too far for too long (average length of time spent too far required to become a Lost Soul is a little over a week), this separation can induce major multiple organ failure, including cardiac arrest. It is possible to revive a Lost Soul, much like with reviving someone who died a Bliss-plane death, but it requires that the person’s soul in the Bliss Realm be found and brought back immediately, to sustain the body without extensive external life support systems. Even then, brain death has been known to happen. What counts as “too far” varies from person to person, but the general rule of thumb is within shouting distance—namely, having the Angel’s psychic form in the Bliss Realm’s counterpart of the real world being within shouting distance of where the Angel’s physical body is in the waking world. Brief bouts of separation have not been noted to cause harm to Angels, so it’s fairly lax as duties go to shepherd their souls about and is often tasked to lower ranking Priestesses on the day to day basis. ————— Redshift Collision ————— Redshift Collision is a fun idea that spawned from a crossover fanfic idea I was considering a while ago before letting it evolve into its own original fantasy setting with sci-fi elements instead. It centers on a character named Edgar Loom, short for Loomis, which is his family name. A bit of cultural trivia about the name: The reason he’s called Loom instead of Loomis is because only the heads of a house may use the full family name, everyone else is introduced with a derivative surname. As Loom is next in line to be the head of their household, he is typically the one people refer to when using the name “Loom”, though casual use of the derivative name happens for applicable family members here and there as the situation calls for. First names are typically a much more private affair, and people typically have “use” names that they give when introducing themselves to others including but not limited to prospective business partners, strangers, distant family members, etc. Telling someone your given first name is seen as a huge sign of trust, the equivalent of saying that the other person is part of your inner circle. It is generally expected that first names not be given out prior to knowing someone for a socially acceptable amount of time (length of time not given because I’m not done working out the calendar yet.) Typically, the head(s) of house can use just the family name as their use name if desired, or if there are multiple heads of house then their own use name can be used either as a stand alone or combined with the famiy name. In Loom’s case, since he’s next in line, his use name is typically Loom by default, thus why he’s called that in the ensuing paragraphs. Loom is the only child of his parents, much beloved and happy with his lot in life, having spent his time apprenticed in order to learn how to take up his father and mother’s trade, namely overlooking the production of luxury textiles in the guild of weavers (you can imagine where their ancestors got the surname Loomis from.) Tragedy however has befallen their world in the last two decades, an unknown cataclysmic event has shorn the very fabric of reality in such alien angles, even the gods are left scrambling as they try to figure out what has happened—and what is happening. Despite the new dangers and unforeseen changes that continue to twist the fabric of their world however, life goes on. People still survive, and flourish, adapting as they can to the strangeness that has taken root upon their planet. However, one of the new shifts brought about in their world includes new diseases—plagues. One such disease is called Wraith Fade, so named for what a person becomes as the disease progresses, and how. It is unknown how Wraith Fade is transmitted, but it is widely suspected to be magical in some form, due to lack of evidence for it being transmitted through the more common corporeal means. Loom contracts Wraith Fade, and he and his family all know that it’s a death sentence—sufferers of Wraith Fade are typically observed to have a year or for the more robust two before succumbing to the disease. Typically, the course of treatment is for the afflicted persons to make good of their last days, and then to call for a doctor to help with euthanasia—most countries if not all sponsor covering costs for this procedure to varying degrees, due to the dangers that wraiths pose if left unchecked. And wraiths are very dangerous, and very hard to kill. One of the early to mid stage symptoms is what appears to be a magically-induced loss of voice—both medical professionals and thaumaturgical researchers are at a loss for the mechanics of it, as studies do not register readings of magical structures either natural or artificial that would induce a silence effect. Various treatments have been attempted, but no direct results have been observed thus far in the trials. Another symptom is what has been referred to as “greying”—specifically, a gradual fading into total translucency and loss of most forms of color in the afflicted person’s physical appearance. The silencing and greying that sufferers of Wraith Fade endure eventually comes to encompass most if not all sounds that they make towards the end of the disease’s incubation period, and coupled with the greying effect this translates into a near silent and visually obscured entity when the person loses themselves fully to wraithood. Older wraiths have been observed as occasionally being able to silence entire areas seemingly at will for brief periods of time, and some of the more markedly dangerous individual wraiths have even learned to disappear from sight completely in what appears to be true invisibility. Their hardiness and resistance to what would constitute mortal injury to many living beings also seems to be supernatural in origin, though it is yet one more area that eludes researchers and experts to a vexing degree. What makes wraiths so dangerous however is their penchant for hunting in sporadic and irregular patterns, and the predominant pattern of many wraiths taking to heavily populated areas as a preference. Why they hunt people is a mystery, as sufferers of Wraith Fade are noted as slowly losing sensations of hunger and thirst, and late stage sufferers going without either food or drink without succumbing to starvation or thirst beyond noted secondary effects. The individual modus operandi of a given wraith develops over time, to terrifying results. It is not unusual or imprudent for the public to break into mass hysteria should a murder occur in a city, with people fearing that a new wraith has taken up residence. It is for this reason that sufferers of Wraith Fade are at times persecuted and sometimes killed on sight by unruly mobs, so-called vigilantes, and at times even government-sanctioned organizations in some countries. It is dangerous to travel for both the afflicted and for others, should the afflicted’s health take a turn for the worse and their condition deteriorates faster into wraithood. There is no known cure for Wraith’s Fade—but there are rumors of one, in the strange and distant city-state of Wyrrawyr. Loom is however a soul defined by hope, in that moment of definition. He chooses to try and seek out this rumored cure, and he and his family and friends have a tearful goodbye, knowing this full well could be the last time they see each other in this life. Wyrrawyr is a strange place. It is the city of stained glass, the gateway to the Snowfeld Sea, the broken circle which once sat as the crown jewel of the mighty Hederan Empire, the land of a thousand sieges—and a land of the old ways. Wyrrawyr has been conquered many times, but no conqueror has ever met with good fortune when trying to rule that place. Ill fortune plagues any power that tries to rule that city for long, and Wyrrawyr has garnered a reputation as a place to avoid...not that everyone listens to such tales. It is known as a cursed place to many, but those brave souls who dare to call it home say otherwise. The local gods of Wyrrawyr in particular are strange in their antics when seen through the eyes of the more northern countries, but not so strange as the people—some of whom say the city itself is a divine being in its own right. It is for that reason first and foremost that the Northern Alliance calls it the city of heretics, proud and unyielding in their strange ways. But age-old feuds are reduced to mere distractions as the entire world shudders as the shifts seemingly grow more aggressive where once they were placid. The landscape of their home world seems to shift more drastically in a short span of time than ever it has before, and many are driven to terror at the thought that reality may be collapsing into an unrecognizable form of chaos as they watch the mechanics of their world come apart at the seams. Loom arrives to a sundered Wyrrawyr, as parted and torn with unknown magical phenomena as if a slip-strike earthquake had cracked the earth’s crust open. It is in a sundered Wyrrawyr that Loom meets Death. Specifically, the local Wyrrawyran incarnation of Death, who offers Loom a deal: stand as Death’s champion and agent to investigate the phenomenons, and to enact Death’s will in restoring a form of natural order back to their world—among Loom’s tasks should he accept is to find those souls spirited away by forces unknown. Gods unknown, perhaps, is Death’s suspicion. In exchange for Loom’s services, Death offers him an out that will spare him from dying from Wraith Fade—and this is the only way to avoid that fate and all the sinister after effects that come with it. But both their deal and the “cure,”—in so much as it can be called that—requires Loom to leave their home world, never to return again. Loom must go where Death cannot: into the new world that is slowly colliding with their own, the two ripping each other apart like the collision of galaxies into a new, singular galaxy. A world where magic is a foreign idea, and technology is the watchword of nearly all who live there. A world that is out of place. This collision shouldn’t have happened. These two worlds were not on a collision course—far from it, they had been moving away from each other in their shared planes of existence. That is why the gods of Loom’s world have taken to calling the matter the Redshift Collision. It is the possibility of survival and a world full of the unknown that Death offers, should Loom agree—or, as a mercy, the option of a swift, safe, and painless passing into death and the afterlife, if Loom would prefer to die in his home world while he is still himself. Loom accepts. And that’s the starting point for Redshift Collision’s story!

#chyrstis #tw: child abuse mention #tw: abuse mention #tw: drug use #tw: euthanasia mention #tw: religious themes #ACABH #FC 5 #Far Cry 5 #Far Cry 5 AU #FC 5 AU #Faith Seed #Rachel Jessop #Tracey Lader #long post #original fic talk #Redshift Collision

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asecretsummer-rpgpromo · 7 years

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WANTED! FC can be changed!

♠ Amy White is 30 years old and is often confused with Minka Kelly. She is Open.

“This town has gone to hell.“

→ Background

The eldest of three sisters, Amy White has always valued family above pretty much everything else. She’s always been a real homebody and has never had any desire to really leave town or travel. Amy has always liked the simple life and all she really needs is her family and her cats. Which she knows makes her sound boring but Amy just… takes things as they come. She’s easygoing and perhaps a little too careful. A little too much of a control freak. Amy worries a lot, especially about her family. Her mother walked out on them all when she was nine years old and it really rocked her whole world, and she’s been pretty scared of losing anybody ever since. She’s always worried people will leave. Amy is grateful for their father, who raised the girls alone (even without much help from his brother, who had two daughters of his own), and instilled in them great qualities. The girls grew up polite and respectful. Well, mostly at least. The middle sister, Carla, can sometimes be a little on the wild side but Amy has a soft spot for her despite the arguments they get into.

When their baby sister Kimberley wound up in treatment for mental illness after intentionally running some poor high school teacher’s girlfriend off the road, Amy felt a little like she’d failed. She’s always put a lot of pressure on herself, especially to keep her siblings safe, and she felt she should have seen the warning signs. Her father told her not to be silly but she couldn’t help it. She visited her sister every day, dragging Carla along for the ride most of the time, and went along with the story that Kimberley was away on an internship. The teacher hadn’t wanted to press charges, he’d just wanted her to get better. Amy had no idea her little sister was capable of something like stalking, she didn’t understand how someone could get so attached to another person like that. Ever since Kimberley was released a year later, all better, Amy has been keeping a very close watch on her.

→ Back to Baberton

Baberton has become something of a nightmare town over the past three years, starting with the discovery of Annie Pierce’s body in the woods. The closest the White family really got to Annie Pierce was the girl’s torment of their cousin Sierra (who later went on to commit suicide, presumably because of the bullying years prior). Amy stays out of most of the drama, preferring to just float along and do her own thing. She works in the local shopping centre, in a clothing store, and has since she was around twenty-six. It’s nothing fancy but it’s good money and she’s able to pay all her own bills, unlike her sister Kim who works two part time jobs and their father still pays what she can’t afford. Kimberley was always the spoiled princess but Amy never minded, she understood why. Their father was always so worried about Kim, Amy could relate.

When she’s not working, Amy spends a lot of her time with her friends. She’s quite good friends with Emily Lane and, surprisingly, Xanthe Winters. She only met Xanthe properly a few months ago when she signed up for one of the new self defence classes at the town hall on Thursday and Friday nights. She kind of knew about the girl from various places and got the idea she was a bit of a stuck up cow but they sort of seemed to hit it off so Amy’s just glad to have another friend. Especially one that can teach her how to defend herself in a town as scary as this.

→ What’s Her Secret?

When she was seventeen, Amy was dating the most popular guy in school. She was madly in love with him and would have done pretty much anything he wanted her to do. Long story short, she wound up pregnant. Her father was rather disappointed in his ‘good daughter’ but supported her anyway. Amy made the rash decision to give the baby away, leaving town to live with an aunt to give birth in secret. She had a baby girl who was quickly adopted and she wasn’t even allowed to see her. The second the doctors took her away, Amy knew she made a mistake… but there was nothing she could do. She cried for months and eventually had to move on with her life. Sadly, she never quite managed to let go and still mourns the loss of her daughter and the life they could have had if she’d just kept her. Sometimes Amy gets quite desperate and thinks she’d do just about anything to have a second chance.

Signed up for Liam Turner’s adult one-on-one dance classes about a year ago, just for a new hobby, and has started to develop feelings for him. Amy knows he used to date her sister (and his other girlfriend basically just died) and it’s wrong, and she’s doing her best to just forget it since it’s embarrassing during lessons but she can’t seem to shake it.

Main | Plot | Most Wanted | Characters | Ask

#roleplay #rp #town rp #secrets rp #minka kelly

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rolandfontana · 6 years

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How Drug ‘Therapy’ Helps Philadelphia Inmates Recover from Opioid Addiction

During more than a decade of IV drug use, 34-year-old Ana Vasquez, a homeless IV drug user, has kicked heroin nearly a dozen times in Philadelphia jails, most recently in late November 2017 after she was arrested during a buy-and-bust operation with a single $5 bag of powder cocaine in her possession.

The crime is considered so minor that, even prior to the election of Philadelphia’s new reformist District Attorney Larry Krasner—who ended cash bail for most low-grade misdemeanors this year―Vasquez would have been processed through police headquarters and released to the street on her own recognizance not more than 72 hours after her arrest.

But under Philadelphia’s unique and controversial “detainer” system―which requires that defendants on probation who violate the terms of their supervised release be held without bond until they’ve had a hearing before the judge who originally sentenced them―it would be the middle of January before Vasquez was finally released from Riverside Correctional Facility (RCF), Philadelphia County’s only exclusively female jail.

From there, she hitched a ride seven miles south, back to her home in the city’s Kensington neighborhood, where she spent her first night of freedom braving the frigid weather by getting high on heroin and cocaine.

“No matter how many times you detox in jail, it never gets any easier,” she said, in an interview shortly after her release. “It’s horrible. No one wants to leave their cell [and] you got at least half of the people on the block going through it, vomiting, diarrhea, not eating or sleeping.

“Sometimes they would give us ‘comfort meds’ as they call it, but in reality they don’t do shit.”

So it was a surprise when I got a call from Vasquez last month, a few days after she’d been arrested once again—this time on a more serious felony charge of possession with intent to deliver heroin—and she sounded, well, buoyant.

“They got us on subs,” she said, referring to the drug buprenorphine (an opioid agonist sold under the brand name Subutex). “You believe that? They dose us every day. It took a couple days to get adjusted to it but really, I feel great.

“This is a great program.”

The program Vasquez is referring to provides the option of medical detox from opioids or maintenance using genetic buprenorphine to every incoming inmate suffering from opioid dependency. It was quietly launched as a pilot in February at RCF; and on Aug. 13 it was expanded to encompass all inmates entering the Philadelphia prison system.

“We make such an investment to help people while they are in the system,” said Bruce Herdman, the Chief of Medical Operations for the county’s Department of Prisons.

“It doesn’t make sense not to help them after their release.”

Agonists stimulate the same receptors in the brain as illicit opioids. Their long half-life makes them suitable for replacement therapy.

Evidence has long demonstrated that treatment using opioid agonists like buprenorphine and methadone are the best way to do that. Agonists stimulate the same receptors in the brain as illicit opioids. But their long half-life makes them suitable for replacement therapy because they attenuate cravings for 24-36 hours (compared to just four to six hours from the combination of heroin and fentanyl commonly sold in Philadelphia).

Among other things, this reduces the compulsion that comes from the need to constantly redose.

It also keeps people alive long enough to benefit from recovery. Just a week in jail without opioids can reduce a dependent individual’s tolerance enough that the dosage they were accustomed to when they were arrested could be fatal.

Herdman says that research shows inmates kept on agonist therapy in jail are two-thirds less likely to die of an overdose in the early weeks of their release than those who lose their tolerance while incarcerated..

Under Philly’s new program, inmates with opioid dependencies are given a single 8 mg dose of buprenorphine once a day (half the average recommended dose in most outpatient programs). The drug is dispensed as a crushed tablet to make it harder to divert.

Prior to release, those who choose to continue treatment are assigned to a clinic or physician in the community, ideally with minimal, if any, gap between doses. When the program started, it avoided that issue by providing a few days of medication or providing a short-run prescription to hold patients over. But the jail had to put that policy on hold because of limited resources.

Herdman acknowledges his team is still working up the learning curve.

“We found that we could not scale that practice, the logistics are so difficult,” he said. “The volume here is the biggest challenge, the sheer burden of the size. We send 200-some people to court each day and people are released 24 hours a day seven days a week.

“We had to train eight additional doctors to qualify for the federal waiver [needed to prescribe buprenorphine] just to keep up with intakes.”

Dr. Jon Lepley, Chief Medical Officer of Corizon—which is contracted to provide health care services to Philadelphia’s jails—helped pioneer the program in partnership with the prison system after learning about the disproportionate number of inmates who overdosed and died soon after leaving jail.

“Historically, when someone came in they would receive a nursing assessment and if they presented with opioid withdrawal symptoms they would be detoxed with ‘comfort meds,’ like clonidine, promethazine [an antihistamine] and loperamide [Imodium],” said Lepley.

“But attitudes really started changing after Mayor Jim Kenney’s Opioid Commission released its report last year recommending that county inmates be offered the option of medication-assisted treatment. That was a turning point.”

Before launching the program, Herdman and Lepley consulted with officials at Rikers Island in New York City, which started offering heroin-addicted inmates methadone maintenance in 1986. The jail added buprenorphine as an option in 2008.

According to Jonathan Giftos, the Clinical Director of Substance Use Treatment at Rikers, the jail treated 4,000 inmates using methadone or bupe last year, and 70 percent of program participants are on long-term maintenance.

Unlike Philadelphia, Rikers (which has had plenty of time for trial and error) has no dosage cap—inmates are provided an individualized dose and can choose which medication works for them. When they are released they receive either seven days of medication or a 14-day prescription until they see a physician.

It’s also the only jail with a federally licensed Outpatient Treatment Facility onsite, meaning that it prescribe and dispense methadone without needing to contract with one of the city’s already overburdened clinics.

“It’s really rewarding to provide people with evidence-based treatment while they are at such a vulnerable point in their lives,” said Giftos. “For decades the standard of care at other jurisdictions was to provide no medication.

“But now I think we are seeing a new standard of care emerge as more jails are looking at the data and success rates of methadone or bupe provided in a correctional setting.”

However, that needle is moving extremely slowly—given the number of victims who come in contact with the criminal justice system. Despite their proven effectiveness, demand for opioid agonist therapies by jails is virtually nonexistent.

In one randomized study, researchers reviewed 81 requests for proposals (RFPs) for contracted jail healthcare services in 28 states and found that only 11 requested MAT; and all but three limited its use to pregnant women—who can suffer severe complications from improperly managed detox.

As I’ve previously reported, it’s estimated that two-thirds of inmates entering jail have a diagnosable substance abuse disorder, yet few jails even provide basic medical care for managing withdrawal, let alone allow for ongoing maintenance treatment.

Fewer than 10 percent of America’s 3,300 jails offer any medication-assisted treatment.

Fewer than 10 percent of America’s 3,300 jails offer any medication-assisted treatment at all, let alone long-term agonist maintenance. Instead the roughly 200 jails, that provide MAT to inmates opt for the opioid antagonist naltrexone (sold under the brand name Vivitrol), which simply prevents individuals from feeling the effect of opioid drugs.

There is little data on the effectiveness of naltrexone for long-term success at preventing a relapse on illicit opioids (and to be fair, there’s not a whole lot on buprenorphine either, which wasn’t even an option for heroin addicts until 2002).

Although, a recent study found naltrexone is as effective as a daily oral dose of buprenorphine at preventing relapse after six month, the accuracy of that conclusion is undermined by the fact that more than a quarter of participants were unable to endure the required period of abstinence (up to four days) to even start taking Vivitrol.

But even if the data were sound, relapse prevention is just one measure of success.

Tens of thousands of human beings suffer needlessly through painful withdrawal while incarcerated in county jails, including people like Vasquez, whose entire criminal history is a reflection of a DSM-classified medical disorder. An untold number of them die in the process.

All of them would have a chance to be alive and in recovery today, if the municipalities where they perished had the political will and compassion to spend a fraction of the money treating their symptoms that they’ve shelled out in wrongful death lawsuits.

Philadelphia’s program will provide the option of treatment to thousands of potential inmates this year for just $500,000 out of the prison budget, according to Herdman.

As I recently reported, the ACLU is currently suing jails in three states—Washington, Massachusetts and Maine—for failing to provide appropriate treatment to detoxing inmates.

Christopher Moraff

Dr. Lepley says Corizon will begin including medication-assisted treatment with buprenorphine as a standard protocol in its jail contracts. But that does not mean the facilities will be required to employ it. And the Pennsylvania Department of Corrections told The Crime Report that it will begin piloting SUBLOCADE, the first once-monthly injectable buprenorphine formulation for the treatment of opioid use disorder, with a target date of November 2018.

According to DOC spokesperson Susan McNaughton, the immediate goal will be to use the drug to detox incoming inmates, but the long-term goal is to offer ongoing maintenance.

Christopher Moraff is a freelance writer who covers the intersection of policing, drug use and civil liberties for The Crime Report and other publications. He welcomes comments from readers.

How Drug ‘Therapy’ Helps Philadelphia Inmates Recover from Opioid Addiction syndicated from https://immigrationattorneyto.wordpress.com/

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