[S]ix weeks after the state Senate voted to enhance opioid-addiction treatment for prisoners, the House is pushing to expand the program even further.
Representatives on Friday gave final approval to a version of S.166 that says Vermont inmates should be able to receive medication-assisted treatment behind bars even if they had not been undergoing such treatment before their arrest.
In contrast with the Senate’s version of the bill, the House’s amendment eliminates the current 120-day cap on medication-assisted treatment in prison. It also says addiction treatment must be part of “re-entry planning” for inmates who will soon be released.
Overall, the latest draft of S.166 takes a stronger stance on the importance of bolstering prison-based services for inmates who are struggling with addiction.
“It is the intent of the General Assembly that medication-assisted treatment offered at or facilitated by a correctional facility is a medically necessary component of treatment for inmates diagnosed with opioid use disorder,” the bill says.
Vermont’s hub and spoke system offers buprenorphine – also known as Suboxone – and methadone to combat opiate addiction in outpatient clinics throughout the state.
The program has received national recognition, but prisoners don’t have the same access to such services. Though the Department of Corrections has been expanding medication-assisted treatment, those who enter the prison system without previously having received buprenorphine or methadone are not eligible to start those prescriptions while behind bars.
That means some inmates face medically supervised opiate withdrawal. Some say that leads to higher risk of relapse and overdose, undermining Vermont’s efforts to confront the opioid epidemic.
That’s where S.166 comes in.
The Senate’s version, approved last month, adds buprenorphine and methadone to the list of drugs inmates are entitled to continue receiving after incarceration. It also called for all inmates to be screened for “opioid use disorders” within 24 hours of imprisonment.
The Senate bill expanded medication-assisted treatment by allowing inmates to start receiving buprenorphine even if they hadn’t had a prescription on the outside. But the bill gave state officials until Oct. 1 to figure out how to expand the use of methadone in prisons.
The House bill gets rid of that study and says inmates can switch from buprenorphine to methadone if the latter drug “is deemed medically necessary” by a provider authorized to prescribe it.
The Corrections Department had expressed concerns about the logistics of expanding methadone prescriptions in prison, especially given strict federal regulations on that drug. But the new plan is to continue using the state’s “hub” providers rather than having the department try to set up its own methadone-distribution system.
That’s in part because “there didn’t seem to be enough volume” of methadone demand for the Corrections Department to continue studying the feasibility of an in-house system, said Annie Ramniceanu, the department’s mental health systems director.
There generally are about 60 to 70 inmates receiving medication-assisted treatment at any given time, Ramniceanu said. Of those, only about 10 percent are taking methadone.
“In looking at the (medication-assisted treatment) reports that we see on a daily basis, the population is pretty stable,” she said.
There also had been concerns that there is no hub available to serve the Southern State Correctional Facility in Springfield. Ramniceanu said any Southern State inmates who require methadone might be moved to another prison, unless there are factors that prevent such a transfer.
Wider availability of methadone isn’t the only new feature in the House bill. Other revisions include:
• The legislation says inmates should receive medication-assisted treatment “for as long as medically necessary,” thus eliminating the department’s 120-day time limit for such services.
That change and others in the House bill earned applause from Vermonters for Criminal Justice Reform, which has lobbied hard for S.166. The group took to social media to proclaim that “Vermont communities are safer when Vermont correctional facilities treat addiction.”
• The bill attempts to clearly delineate what qualifies as “medically necessary.” The term is defined in part as “health care services that are appropriate in terms of type, amount, frequency, level, setting and duration to the individual’s diagnosis or condition, are informed by generally accepted medical or scientific evidence and are consistent with generally accepted practice parameters.”
• Medication-assisted treatment must be part of release planning for inmates who require it. If such treatment can’t start before release, “the department shall ensure comprehensive care coordination with a community-based provider,” the legislation says.
• The House also added a provision that says the Corrections Department must submit to the Legislature an evaluation of the treatment program’s effectiveness by January 2022.
Lawmakers said they’ve allocated money in fiscal year 2019 for expansion of medication-assisted treatment in the state’s prisons. A fiscal note prepared by the Legislative Joint Fiscal Office says the enhanced program is expected to cost $800,000 to $850,000 annually.
Ramniceanu cautioned that those costs are not set in stone. “Because this really hasn’t ever been done before, we’re offering our best estimates as to the cost,” she said.
Given the House’s amendments to S.166, the bill now will go back to the Senate.
