Vermont’s medication program for incarcerated people with opioid use disorder has helped reduce overdoses after release, though Covid-19 reversed some progress.
That’s the topline lesson gleaned in the first published analysis of the Vermont Department of Corrections’ medication-assisted treatment, co-authored by researchers at the University of Vermont, the corrections department and the state’s Agency of Human Services.
Published in September’s edition of the Journal of Substance Use and Addiction Treatment, the study examined treatment engagement and overdoses at three points in time: before Vermont’s prisons implemented medication-assisted treatment — or MAT — statewide, after it implemented the program but before Covid, and after the onset of Covid-19. Researchers had presented much of the data to the Legislature in preliminary form, though the analysis had not yet been peer-reviewed and published.
Perhaps most striking, researchers found that fatal overdoses within a year of release fell from 27 before the program was implemented to fewer than 10 afterward, with the decrease continuing during Covid-19.
In 2018, state lawmakers passed Act 176, making Vermont the second state to offer all three FDA-approved medications for opioid use disorder throughout its prison system. Advocates had pushed for the change, arguing that taking people off these medications when they entered the prison system increased the risk that they would relapse or overdose upon release.
Elias Klemperer, principal investigator on the study and an assistant professor of psychology and psychiatry at UVM, said his team’s analysis indicated Act 176, which he called “groundbreaking,” had made progress.
“We were able to see a pretty substantial reduction in overdoses after Act 176 was implemented,” Klemperer said in an interview. But, he noted, “the beneficial effects were somewhat reduced” during Covid-19 — a trend reflected nationwide, he said.
The percentage of people with opioid use disorder who, upon release from prison, sought out medication-assisted treatment rose from 33.9% to 41% following the implementation of Act 176, according to the study, though the metric fell to 35.6% with the onset of Covid-19.
Similarly, the percentage of people who experienced non-fatal overdoses within 30 days of release from prison fell by a third, from 1.2% to 0.8% after Act 176. But that same number rose significantly alongside Covid-19, from 0.8% during the November 2018 through February 2020 period, to 1.9% from April 2020 through March 2021.
When a person leaves prison, they’re at a higher risk of overdose than the average person, Klemperer said — anywhere from 10 times to more than 100 times higher, according to different studies, he said.
That’s part of why medication-assisted treatment is so important in prisons, said Klemperer, who praised the corrections department as “phenomenal partners” in the study.
Klemperer noted that some of the study’s numbers differ from those used by the Department of Corrections because the authors used a different method to count incarcerated people. For this study, Klemperer and his colleagues counted anyone who had been in a Vermont prison for at least one night.
The study measured outcomes from July 2017 until the end of March 2021. According to Annie Ramniceanu, a co-author on the study and the corrections department’s director of addiction and mental health systems, department data has suggested some more recent improvements. For example, in 2022, 69.8% of individuals who received the treatment in corrections’ custody had a Medicaid claim enabling them to stay on the medication within 45 days of release, according to Ramniceanu.
Asked about opioid use disorder treatment within the Department of Corrections, spokesperson Isaac Dayno said the department is exploring ways to expand treatment options. Nick Deml, the department’s commissioner, had recently toured Vermonters for Criminal Justice Reform in Burlington and recovery organization Jenna’s Promise to “discuss further partnership,” Dayno said.
As for the progress already made, Klemperer said it’s easy to view the study’s findings through both a glass half-full and half-empty perspective.
“That’s a lot better than we were doing before (medication-assisted treatment) was available,” he said. “But half empty: we can do a lot better.”