Nearly a third of Vermont’s inmates are receiving medication-assisted treatment for opioid addiction, illustrating a dramatic expansion of the prison program over the past several months.
In legislative testimony, Corrections Department Commissioner Mike Touchette said there were 543 prisoners enrolled in treatment as of Wednesday. That’s about 31 percent of the department’s average daily inmate population of 1,750.
In early September, the treatment census was just 135. The growth of that number shows that the department has overcome some serious problems since a legislatively mandated enhancement of treatment services took effect last summer.
But Touchette cautioned that there’s still work to do.
“Do we have it right? I would tell you, no, we don’t have it right yet,” he said. “We’ve made significant progress. We’ve learned an awful lot. We’re trying to balance the treatment needs of individuals and also balance the safety and security of our facilities.”
As Vermont continues to battle an opioid epidemic, state corrections officials had taken heat for not treating enough inmates, thus putting them at a greater risk for relapse and overdose upon release.
The state Legislature last year approved Act 176, which sought to bolster the administration of buprenorphine and methadone behind bars.
The changes included allowing inmates to start medication-assisted treatment while in prison even if they hadn’t received such services prior to arrest. The statute also eliminated a 120-day limit on medication-assisted treatment in state prisons, saying inmates should receive those prescriptions “for as long as medically necessary.”
Corrections officials say it’s been a challenge to implement those changes. That was apparent a few months after Act 176 took effect, when prisoner advocates and lawmakers said many inmates were waiting too long for addiction assessments or had been unfairly denied access to treatment.
A treatment-policy change subsequently opened the door for more inmates to get into the program. And Touchette told the Senate Health and Welfare Committee on Wednesday that the department has made a “huge commitment” to expand the program while working through the details of a novel, complex treatment system.
Part of the issue is that the prison population is constantly shifting, particularly in a state like Vermont that has no county jails to house suspects awaiting trial. Touchette said 1,700 inmates have been assessed for substance-use disorder since July 1, and more than 1,000 have received treatment at some point.
Touchette said he’s surprised that treatment numbers have been so high. But he also said it’s an indicator of the addiction challenges that the state is facing.
“We all see what’s happening in the communities, and we’re a reflection of what our communities are struggling with,” Touchette said.
Asked whether some inmates might be misusing the treatment program, Touchette said he has no way to quantify that at this point.
Also, corrections officials noted that inmates receive treatment only after a medical determination that it is necessary. Annie Ramniceanu, the department’s director of mental health and addiction services, said drug screenings and patient histories are among the information that’s taken into account.
“Medical providers who are licensed and have the waivers to administer these medications are the ones who make those final determinations,” Ramniceanu said.
No inmate is forced to undergo medication-assisted treatment, she added.
Tom Dalton, executive director of Vermonters for Criminal Justice Reform and a frequent critic of prison addiction policies, said he’s “not shocked” by the number of inmates receiving treatment. In fact, he said enrollment in the program “should tick up even a little bit more.”
There’s a strong link, Dalton said, between opioid use disorder and involvement in the criminal justice system. Dalton also believes that “many of these people are sitting in prisons because we didn’t give them access to treatment in the past.”
A robust treatment census “tells me that this program is going to have a very significant impact on the community and the state, and that’s something we should celebrate,” Dalton said. He added that he is “cautiously optimistic” about the state’s progress in expanding treatment.
That doesn’t mean that Dalton is entirely satisfied with how things are going.
He said he’s still hearing reports of inmates who are waiting too long – sometimes months – to begin treatment. Also, Dalton said not everyone is getting adequate care coordination after release, and a significant number of inmates are receiving buprenorphine “at what they consider to be less than a therapeutic dose.”
An insufficient dose drives some inmates to continue to purchase buprenorphine on the black market, Dalton said. Touchette did not make the same connection in his legislative testimony, but he did tell senators that buprenorphine continues to be the “largest contraband-introduced item” in the prison system.
The black market question is one of many that’s still unanswered in the early days of Vermont corrections’ expansion of medication-assisted treatment. State officials said it’s still too early to determine the program’s impact.
“It’s going to take some time to fully understand how this works and how we keep people safe and provide the treatment that is really necessary,” Touchette said.
Officials also will have to figure out how to fund the initiative for the long term. There’s $800,000 allocated for medication-assisted treatment in the current fiscal year, and another $400,000 already allocated for fiscal 2020.
Beyond that, “there isn’t specific funding earmarked at this point, so that will be a challenge going forward,” said Matt D’Agostino, the department’s financial director.
