Two months after a new law expanded Vermont prisoners’ access to addiction treatment, advocates say some inmates have been unfairly denied access to that treatment.
The controversy hinges on the interpretation of two words – “medically necessary.”
There’s general agreement that the state Department of Corrections and its contracted medical provider, Centurion, have implemented some aspects of Act 176 by ensuring that new prisoners are quickly screened and treated for addiction.
But there are gaps in treatment for prisoners who have been behind bars for a while. The department says Centurion is following national protocols for what’s considered medically necessary, but some say that clashes with the intent of the state’s new statute.
“This means that many high-risk incarcerated patients who are self-identifying as struggling with addiction and asking for help are unable to access treatment,” Tom Dalton, executive director of Vermonters for Criminal Justice Reform, wrote in a recent letter to the department. “Some are being released back into our communities untreated.”
The issue also has caught the attention of Joint Legislative Justice Oversight Committee members, who had pointed questions for corrections officials during a discussion of Act 176 implementation last week.
“It just seems to me that we’ve got some disconnect here between the (medical) provider, the department and the offenders,” said Sen. Dick Sears, D-Bennington and the committee’s vice chair.
As Vermont has enhanced access to buprenorphine or methadone treatment for residents with opioid-use disorder, prison policies also have been shifting in order to allow more inmates to receive that treatment.
But many have argued that those changes aren’t happening fast enough, putting inmates at greater risk of relapse and overdose and undermining efforts to confront the opioid epidemic.
That was the reasoning behind Act 176, which took effect July 1 after the Legislature’s approval this past spring.
Among the key changes in the law is the ability of inmates to begin receiving medication assisted treatment behind bars, even if they hadn’t been receiving those medications prior to their arrest.
The law also eliminated a previous 120-day limit on medication assisted addiction treatment in prison. Instead, inmates are now able to receive that treatment for “for as long as medically necessary.”
So far, though, the Department of Corrections is getting mixed grades on its implementation of the law.
In a Friday presentation to the Justice Oversight Committee, Corrections Commissioner Lisa Menard said officials have been screening new inmates for addiction and starting treatment as the statute requires.
As of Friday, officials said there were 135 inmates on medication assisted treatment. Menard said treatment inductions are “happening every single day.”
“If it is determined it’s medically necessary to induct them, and there is time to do so before they leave, that is being done,” she said. “Inductions are occurring.”
But the situation has been much more complicated for inmates who are not new to prison.
Act 176 says that, “if at any time an inmate screens positive as having an opioid use disorder, the inmate may elect to commence buprenorphine-specific medication assisted treatment if it is deemed medically necessary.” Those inmates “shall be authorized to receive the medication as soon as possible and for as long as medically necessary.”
That has resulted in a wave of requests for addiction screening. Corrections officials said there are 500 such requests, meaning about 30 percent of the state’s inmate population is awaiting screening.
Dalton produced a document that he said is being distributed to inmates who want screening. It informs an inmate that “you have been added to the list for consideration in the induction process,” but it warns that “waiting time may be lengthy.”
Menard acknowledged a significant backlog in screening requests and said the list is longest at Northern State Correctional Facility in Newport “because it is our largest facility.”
“The contractor (Centurion) has devoted some additional resources, and we are looking to see if we need to increase the contractor’s human resources in order to completely get through the backlog,” she said.
The wait list for screenings, however, isn’t the biggest point of contention in the Act 176 debate. Rather, advocates have zeroed in on a new policy that says starting longer-term inmates on addiction treatment becomes medically necessary only within 30 days of release from prison.
That could lead to the following scenario: An inmate with five years to go on a 10-year sentence screens positive for opioid dependence under Act 176, but he or she won’t be eligible to start medication assisted treatment until there’s a month to go on that sentence.
Some say that runs contrary to the intent of Act 176. Department officials, however, said Centurion is following current policy developed by the National Commission on Correctional Health Care, which includes the 30-day time frame as a guide for when to start medication assisted treatment prior to release.
“We did national research on this,” said Annie Ramniceanu, the department’s director of mental health and addiction services. “That is the standard of care.”
At the same time, both Menard and Ramniceanu repeatedly said the 30-day rule is a medical provider’s policy – not a department policy. Centurion could not be reached for comment on Tuesday.
The issue came as a surprise to some lawmakers who were involved in the passage of Act 176.
Rep. Alice Emmons, D-Springfield and chair of the Justice Oversight Committee, said lawmakers were “very clear that we wanted the same (treatment) system within the correctional facility as outside.” Legislators didn’t know there would be a different definition of “medically necessary” within prison walls, she said.
“If they’re using (opioids) while incarcerated, we wanted those folks to get on medication assisted treatment,” Emmons said. “That was our intent.”
The issue is further complicated, Dalton said, by the fact that the 30-day time frame is tied to an “exact, confirmed release date” that many inmates don’t get until it’s too late to start treatment. Release dates can change quickly due to factors like a judge’s decision or the availability of treatment beds.
That’s the case for one recently released inmate who said he could not access addiction treatment even though he had been screened and approved for that treatment. The inmate spoke to VTDigger on condition of anonymity due to the fact that he remains on furlough status that could be revoked by the corrections department.
When he finally received word of an available bed at a sober living facility, the former inmate said, he was told it was too late to start treatment inside prison. He said he volunteered to stay in prison longer in order to receive buprenorphine, but that request was denied.
After decades of addiction, the former inmate said he was released with just the phone number for a local “hub” treatment center.
“I was scared to be released out the door without being on something,” he said. “I’ve had numerous previous overdoses. I’m at high risk for overdose.”
He was able to quickly obtain a prescription for Suboxone the day of his release. But Dalton said others may not be so lucky, and he argues that some inmates are not receiving the care required under Act 176.
Despite those criticisms, corrections officials didn’t say they’d be pushing Centurion to make any policy changes. They did say, however, that there’s an internal working group looking at “how to better refine the accuracy of release dates” in regards to addiction treatment schedules.
“We’re going to make sure that those conversations and discussions take place so that the medical providers are comfortable with their decisions, but that they’re also aware of all the issues,” Ramniceanu said. “Because ultimately, we’re trying to reduce overdose deaths and provide people with the medical care that they need.”
Read the story on VTDigger here: Addiction treatment expansion hits snag in prisons.