[T]he state Senate has advanced a bill that expands medication-assisted treatment for Vermont prisoners who are addicted to opioids.
The version of S.166 that received preliminary approval on Tuesday would allow inmates to begin taking buprenorphine – also known as Suboxone – while behind bars even if they had not been receiving that medication before incarceration.
The bill also gives the state until Oct. 1 to figure out how to expand the use of methadone in prisons.
The newly revised legislation strikes a balance between the Department of Corrections and Vermonters for Criminal Justice Reform, which has pushed for immediate expansion of both Suboxone and methadone access for inmates.
“I did feel like this was a reasonable compromise,” said Tom Dalton, the reform group’s executive director.
Vermont’s “hub and spoke” system offers medication-assisted treatment statewide on an outpatient basis. The program has been credited with greatly reducing opioid use and overdoses.
But inmates can’t access that treatment in the same way as the rest of the population does.
Current Department of Corrections policy is to offer 120 days of medication-assisted addiction treatment to inmates who had been undergoing such treatment prior to incarceration. But inmates who hadn’t been getting Suboxone or methadone before arrest aren’t eligible to begin taking those medications, meaning they face medically supervised opiate withdrawal behind bars.
Critics say that hurts the state’s efforts to recover from the opioid epidemic and increases the risk of relapse and overdose after an inmate is released.
S.166 offers a framework to address such concerns.
First, it says all inmates will be screened for “opioid use disorders” as part of an initial health screening conducted within 24 hours of incarceration. Also, the bill adds statutory language to make clear that buprenorphine and methadone are among the medications that inmates are entitled to continue receiving after imprisonment.
More significantly, the bill would allow an inmate who “screens positive as having a moderate or high risk for opioid use disorder” to start receiving Suboxone treatment in prison – even if he or she had not been getting that medication on the outside. That would take effect July 1.
“This is something new that the department is not (currently) doing,” said Sen. John Rodgers, D-Essex/Orleans and vice chair of the Senate Institutions Committee.
Initially, S.166 also called for inmates to be able to initiate methadone treatment while behind bars. But Corrections Department officials objected, saying they don’t yet have the resources for that kind of expansion.
“We still have some underlying issues that we’re going to look into further … because not all (correctional) facilities have access to a hub for methadone treatment, and that presents a problem,” Rodgers said.
The Corrections Department could choose to undertake its own methadone program in-house, but officials say that would require compliance with a long list of federal regulations connected with that drug. “The facilities don’t have the ability to do that yet,” Rodgers said.
So the revised version of S.166 gives the Corrections and Health departments until Oct. 1 to come up with “a plan to operationalize” methadone use for inmates who show moderate or high risk for opioid addiction.
That plan will include information about who decides whether inmates should initiate methadone treatment; who has prescriptive authority; and how much the treatment expansion will cost.
Dalton said he is “a little bit frustrated” that methadone access won’t be expanded more quickly. But he said he understands the potential complications that come with such a program.
While Dalton plans to continue lobbying to strengthen the bill when it reaches the House, he said the current version does represent “a huge step forward” for medication-assisted treatment in prisons.
Annie Ramniceanu, the Corrections Department’s mental health systems director, said officials have been “moving in this direction for quite a while” with efforts to expand addiction treatment.
But she said it also makes sense to take some time to plan the logistics of additional expansions.
“We didn’t want to be overpromising things,” Ramniceanu said. “We want to get this right, and we want to do what we say we’re going to do.”
In another vote Tuesday related to prisons and prescription drugs, the House gave preliminary approval to H.874. That bill includes new statutory language about what the Corrections Department must do if an inmate’s medication is discontinued.
In such cases, officials will have to give an inmate a “specific explanation of the decision, both orally and in writing.” The department also must follow up with the original prescriber if the inmate authorizes release of that information.
Additionally, the department would be obligated to collect data on the frequency of medication discontinuance and report back to the Legislature.
Rep. Curt Taylor, D-Colchester, said members of the House Corrections and Institutions Committee have heard complaints about a lack of effective medical care inside prisons. That “may be a particularly acute problem for those with mental health crises or those using psychotropic medications,” he said.
“Our hope is that the report will better define any problem regarding inmate access to prescription drugs and provide the basis for further action, if needed,” Taylor said.
Contributing: Elizabeth Gribkoff
