“A big part of recovery is helping with stability, and it’s very destabilizing to be taken off your prescribed medication while incarcerated,” said Tom Dalton, with the Safe Recovery program in Burlington.
Safe Recovery provides clean needles, the opioid overdose reversal drug naloxone and counseling to intravenous drug users.
The combination of outpatient therapy and prescribed treatment drugs, typically buprenorphine or methadone — which deliver enough opioids to keep patients from experiencing withdrawal, but not enough to feel a high — is known as medication-assisted treatment. It is widely viewed as the most effective route to long-term recovery.
When people with addiction are held accountable for crimes they commit and incarcerated, it should not mean losing access to prescribed treatment medication, said Burlington Police Chief Brandon del Pozo.
“If somebody has diabetes and they’re incarcerated they continue to get medication for their diabetes. Yet if somebody is addicted to opiates, most of the time the treatment stops,” del Pozo said.
Police and prosecutors in Vermont increasingly say addiction is a public health problem that can’t be brought under control through arrest and incarceration alone.
That recognition can be seen in the use of court diversion programs, such as Chittenden County’s Rapid Intervention Community Court, and renewed efforts to provide timely access to drug treatment.
Further efforts are underway in Burlington and Chittenden County to coordinate the response of law enforcement with social services and medical providers to get people into treatment and recovery who are committing crimes to feed their addiction.
A major stumbling block in those efforts arises when the people they’re trying to help are sent to prison, they say.
Prisoners who lose access to treatment drugs often relapse in prison, where contraband drugs are not uncommon, Dalton said, or upon release.
At that point, they’re at greater risk of relapse and overdose, because their tolerance is diminished, Dalton said. Those who relapse are far more likely to reoffend, he added.
Dalton told the story of a client who was arrested for burglary. The person cooperated with police and sought treatment. After 15 months of documented sobriety, the person was sent to jail, Dalton said. After being tapered off buprenorphine while incarcerated, the person relapsed using contraband drugs.
Also, an unintended consequence of current Corrections Department policy is that some people are needlessly lose access to treatment medication.
Short-term prisoners can continue on the medication. But if a person is still incarcerated after 30 days — or 90 days at two prisons in northwestern Vermont — the policy is to taper them off their prescribed medication.
However, corrections officials will immediately discontinue or taper off treatment for incoming prisoners who are expected to be incarcerated for more than 30 or 90 days.
That can happen even before a defendant is sentenced.
One Safe Recovery client facing years in prison was tapered off methadone, but his charges were later dropped and he spent only two weeks in prison.
The experience of forced detoxification in prison was so miserable, the client did not want to resume treatment, Dalton said. A 2015 research paper conducted by a UVM graduate student compiled the experiences of Vermont prisoners tapered off drugs while incarcerated.
One former prisoner quoted in the paper described the experience as follows: “Every single day was just dreadful … like I’d get so hot that I’d sweat … I’d shiver and when I was throwing up I wasn’t throwing up anything. Just foam. Just big, big things of foam and it was nasty.”
Dalton said he was able to get the client to agree to resume treatment, but the person overdosed and died while awaiting a spot in treatment.
When people seek a refill of the overdose reversal drug naloxone from any of the state-funded distribution sites, such as Safe Recovery, they complete a survey.
People who are seeking a refill because they used the kit to revive someone from an overdose are asked whether that person was recently released from prison.
Twelve percent of people who said they used their kit to reverse an overdose said the person revived was recently incarcerated, according to Health Department figures.
The increase to a 90-day limit at the prisons in South Burlington and Swanton is part of a pilot program based on recommendations in a 2013 report from the Medication Assisted Treatment for Inmates Working Group, which includes the Corrections Department, the Health Department and social service providers.
That report actually recommended prisoners be able to continue receiving treatment drugs for 180 days or a year if their sentence was for a year or longer.
Asked if the DOC would support increasing the current 30- and 90-day limits to one longer statewide standard, Commissioner Lisa Menard said her department “is working as part of a larger MAT workgroup, which includes other (Agency of Human Services) partners and community-based organizations, to determine the appropriate strategy for MAT expansion across the state.”
In the past, DOC officials have raised the problem of drug diversion when discussing increased access to treatment medications. In prison, these drugs can quickly become currency or make recipients targets of coercion, complicating long-term access for prisoners.
The experiment with increasing the limit to 90 days was originally supposed to be for one year but is still ongoing, according to Menard. Meanwhile, the 2014 law establishing the pilot program also required the working group to report back to the Legislature in January 2015 with findings and recommendations.
Nearly two years after the report was due, state officials said they expected to submit the document to lawmakers soon.