Bill would expand addiction treatment for prisoners

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MONTPELIER — A reform group is pushing for an immediate expansion of medication-assisted treatment for prisoners addicted to opioids.

Tom Dalton, executive director of Vermonters for Criminal Justice Reform, says offering treatment even to those who weren't receiving it before being arrested is "the single most important thing that we can do to address the opiate crisis right now."

The state Department of Corrections "can implement this," Dalton told the Senate Institutions Committee on Tuesday. "They don't need another extension. They don't need to do another report."

But the current version of a bill addressing the situation (S.166) gives the department more time to study how offering more comprehensive and immediate treatment would work and how much it would cost. That's necessary because "there's a lot to consider," said Annie Ramniceanu, the department's mental health systems director.

"We at the department don't feel that this is kicking the can down the road because we're not willing to do this. We are," Ramniceanu said. "We just want to be sure we're providing accurate information and that we're actually able to do what our charge is."

Vermont's medication-assisted treatment program — also known as the "hub and spoke" system — offers methadone and buprenorphine on an outpatient basis throughout the state.

The program is growing and has received national attention. A recent study found that a sampling of Vermont hub and spoke participants reported dramatic drops in drug use, overdoses, hospital visits and arrests.

But prisoners don't have the same access to hub and spoke services that the rest of the population has. Some have said that leads to more relapses and overdoses, damaging the state's efforts to address the opiate crisis.

On Tuesday, Dalton told the story of a man whose methadone treatment was interrupted by arrest. After going through "horrible withdrawal" during a brief prison stay before the charges were dropped, he relapsed and eventually died from an overdose before he was able to get back into treatment.

"To me, this was a really horrific example of taking a success and turning it into a tragedy based on lack of access to medication-assisted treatment during periods of incarceration," Dalton said.

Dalton said he's been working on the issue for five years, and he acknowledged that the Corrections Department's treatment policies have been evolving and expanding. The department now offers medication-assisted treatment for a maximum of 120 days to inmates who had been receiving such treatment in the community.

But those who were not in treatment prior to arrest still are not eligible to receive methadone or buprenorphine — also known as Suboxone — behind bars. Instead, they are subject to withdrawal via what Ramniceanu described as a "compassionate taper."

"It's a medical protocol that allows a doctor to prescribe other medications to control other adverse symptoms that they have through withdrawal and allows them to be monitored more closely by the physician," she said.

S.166 would change the state's medication-assisted treatment policies for prisoners.

First, it adds "buprenorphine, methadone or other medication prescribed in the course of medication-assisted treatment" to the definition of medicines that inmates are entitled to continue receiving if they had a prescription before incarceration.

In some ways, that gels with the department's current policy. But Ramniceanu noted that the bill would extend medication-assisted treatment by eliminating the department's 120-day limit on such treatment.

A second provision in the original version of S.166 was more controversial. It would have allowed inmates who had not been previously enrolled in medication-assisted treatment to start that program in prison if a screening identified them as "positive for opioid dependence."

That could extend methadone or Suboxone to a new — and potentially large — group of inmates. Sen. Dick Sears, D-Bennington and chairman of the Senate Judiciary Committee, supports that expansion.

"People with the highest rate of death from opiate overdose are people just released from jail," Sears said. "That's why I think it's important that anybody who's willing to go through treatment be able to receive that treatment while they're incarcerated."

Dalton agreed, pointing to Rhode Island's recent decision to expand prison-based medication-assisted treatment. The change reportedly has led to a big drop in deaths among former inmates, and it was recently held up as an example for Vermont by Burlington police Chief Brandon del Pozo.

But Ramniceanu contends that "we don't have the information or the resources to do what the initial draft of the bill required us to do."

For one thing, she said, the state has not performed a cost analysis of what it would take to expand medication-assisted treatment.

Also, there are questions about how expanding methadone access would work, whether it would be provided via the state's existing "hubs" or via the department itself. She cited stringent and detailed federal rules governing methadone delivery.

"If we were to become a full opioid treatment provider there are all kinds of regulations," Ramniceanu said.

Additionally, she said she's not sure that medication-assisted treatment is the best option for everyone. It's a "targeted intervention for a specific problem," she told committee members.

The push is to "give everybody methadone. Give everybody Suboxone. Let the gates open, and we'll solve the problem," Ramniceanu said. "I'm not so convinced of that."

The latest revision of S.166 still adds medication-assisted treatment to the list of prescriptions inmates can continue to receive behind bars.

But it does not specifically give inmates the right to start such a treatment program after being incarcerated. Instead, the bill allows the Corrections Department and the Vermont Department of Health to study the issue further, and report back to legislators by Dec. 1.

Institutions Committee members did not vote on the revised bill Tuesday. But committee chair Sen. Peg Flory, R-Rutland, indicated that it may be best to take a closer look at the issue.

"Everybody would like a whole loaf of bread immediately," Flory said. "Sometimes, you have half a loaf at a time."

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