Carbon County jail leaders question MAT rollout and use of Vivitrol grant

Carbon County jail inspectors and county officials said they will review the jail's medication-assisted treatment (MAT) program after weeks of concern that the county's Vivitrol grant and the PrimeCare contract were not being implemented as the board understood.

Inspections board members and the jail's medical contractor discussed the program at length on the record, raising three central concerns: whether an SOP (standard operating procedure) documenting which MAT options will be offered exists, why many inmates are receiving buprenorphine (pills commonly known as Suboxone/Subutex) rather than injectable antagonists such as Vivitrol, and whether grant funds earmarked for injectable medications are being spent or are available for reimbursement.

The board said it approved a proposal in late June that described injectable treatment options; several members said they believed the program funded by the grant would primarily use injections such as Vivitrol. The county's reimbursement grant for Vivitrol was cited at $111,000 during the meeting, and officials asked whether that money is being spent given that most patients have chosen oral buprenorphine while detained.

PrimeCare representative Derek Keys said the contractor offers multiple forms of MAT and that the program in practice is patient-choice driven. "Vivitrol was one of the first medications that started to gain momentum," Keys said. "The overwhelming majority of our patients... are choosing alternatives." He added that other states where PrimeCare operates have statutory mandates around offering MAT; Pennsylvania is not yet under such a mandate, he said.

A guest who chairs the county's opioid settlement advisory committee said she and others had understood the Vivitrol grant application and county proposal to prioritize injectables. "When I reviewed the proposal, I assumed based upon the fact it said injections that that meant Vivitrol or Sublocade," she said, and said she was surprised to find buprenorphine tablets being used instead.

A case manager with experience running MAT inside nearby county jails urged the board that early spikes in requests are typical when a new program starts and said clinical screening and counseling can be used to prioritize who should begin which treatment. "There are a lot of clinical factors that go into when we're first meeting with an inmate in regards to recommendations for Vivitrol versus Suboxone versus Methadone," the case manager said. She recommended delaying induction for detained people who are likely to remain incarcerated longer and focusing injectable doses on people being released soon when overdose risk is highest.

Board members raised operational concerns: jail staff said watching in-person medication administration consumes significant officer time, and law-enforcement officials said medication diversion and internal distribution create investigative burdens. One commissioner asked whether the board could place a temporary hold on new inductions while the policy and contract are reviewed; county officials said referrals could continue to arrive but that the jail's case manager position is currently vacant, which limits capacity.

PrimeCare and county staff said the contract model the company uses in neighboring counties (Pike and Monroe) follows corporate MAT policy and that those programs have SOPs; the board asked PrimeCare and the county solicitor to meet with two commissioners to reconcile the written proposal approved by the commissioners with how the program is being operated.

The meeting produced a clear next step: the board said it will review the MAT SOP and the PrimeCare contract and hold a follow-up meeting with PrimeCare, county legal counsel and county officials to determine whether changes are needed to align practice with the grant and the county's expectations.

Votes at a glance from the meeting: the board approved the minutes for the Feb. 19, 2025 meeting (one recorded abstention); the warden's report and the personnel report were accepted; and the board approved an emergency-response belt policy to be incorporated into the jail SOP. The meeting record shows the motions carried; detailed roll-call vote counts beyond the noted abstention were not provided in the transcript.

Why this matters: The county's opioid-settlement and grant funds are intended to reduce overdose risk and support reentry. Board members and the jail's law-enforcement stakeholders said they need clarity on which medications will be provided, how grant reimbursement will be documented, how staff will manage medication safety and diversion, and who decides clinical eligibility so the program meets both public-safety and clinical goals.