Inside Chittenden Regional Correctional Facility. Photo by Cory Dawson/VTDigger
That’s good news, according to state officials and social service providers who say national research shows people in recovery who stay on medication-assisted treatment while incarcerated are less likely to relapse or overdose.
Medication-assisted treatment is the combination of outpatient therapy and prescribed medication, typically buprenorphine or methadone, which deliver enough opioids to prevent withdrawal but not enough to experience a high. It’s widely viewed by experts as the most effective path to long-term recovery from opioid addiction.
The pilot, carried out from 2014 to 2015 and continued informally throughout the current year, found that just seven out of 406 inmates who participated had to be removed for breaking the rules by doing things such as diverting their medication or using contraband drugs.
“We see that as a success. This is a program that we’re very pleased with,” said Corrections Commissioner Lisa Menard. Her department carried out the pilot program with help from the Vermont Department of Health and community medical providers.
The report recommends further extending how long prisoners can receive medication-assisted treatment and expanding the program statewide. Currently extended treatment is only available at the two prisons in northwestern Vermont.
Officials who published the report — which was provided to lawmakers nearly a year after it was statutorily required to be completed — weren’t able to track outcomes for people given extended access to treatment, according to the report.
That’s because doing so would be too costly and difficult, said Tony Folland, clinical services manager and state opioid treatment authority at the Health Department.
“Anecdotally, though, we hear that those folks who continued on their medication were much better about following up with their provider once released, and they were able to continue their care uninterrupted,” Folland said.
There is also the national research that bears out the benefits of prisoners having continued access to medication-assisted treatment while incarcerated, he said.
The report states that the likely benefits of continuing medication-assisted treatment from intake to release include better continuity of treatment, smoother transitions in and out of incarceration and decreased risk of overdose.
The Office of the Defender General also observed fewer complaints to its prisoners’ rights investigators as a result of the extended access to medication-assisted treatment, according to the report.
But the program is not without its challenges. Ben Watts, health service administrator for the Department of Corrections, said the department is still concerned about the treatment drugs being diverted despite the low rate of people being that had to be removed from the pilot.
“The patients on (medication-assisted treatment) are highly visible within the facility, which might make them a target for pressure to divert their medication,” Watts said.
The report said that there were “several incidents of injury and violence” that were believed to result from other prisoners pressuring participants to give them their medication. Watts was not immediately able to say how many incidents were recorded during the pilot program.
There are also logistical challenges. Folland said it’s difficult to confirm the prescriptions of people who are arrested and jailed on nights, weekends or holidays, especially for patients receiving methadone, which requires state and federal approvals.
“It just hasn’t been set up as an emergency medication,” Folland said.
It’s also critically important for physicians working for the Department of Corrections medical services contractor to coordinate with a patient’s physician in the community, Folland said.
That’s challenging because behavior that will get a prisoner removed from the program in prison, such as taking a different drug they’re not prescribed, on the outside might trigger more intensive therapy and counseling, not an end to treatment as it does in prison.
Folland said there needs to be a system to resolve when a physician in the community is at odds with a DOC physician over what’s best for a patient.
Tom Dalton, with the Howard Center Safe Recovery program, said minor rule violations also should not lead treatment being ended. The Safe Recovery program works with intravenous drug users to avoid disease and overdose while trying to get them into treatment.
“We need to make sure that we’re not allowing small technical violations of protocols to remove people because the outcomes are too important to these people’s lives, their families and our communities,” Dalton said.
The report states that prisoners who receive medication-assisted treatment through their term of incarceration have higher rates of returning to outpatient care upon release “irrespective of compliance.”
“For this reason, policies favoring treatment termination for patients who use substances negate a fundamental principle — that longer retention in treatment is correlated highly with increased treatment success,” the report continues.
Currently, prisoners who were receiving medication-assisted treatment immediately prior to being incarcerated are tapered off treatment medication at 30 days.
The pilot extended that window to 90 days at Chittenden County Regional Correctional Facility in Burlington and Northwest State Correctional Facility in Swanton.
The new report recommends that number be increased to 120 days on a case-by-case basis determined by medical need. Dalton said that a similar report from 2013 recommended extending access for up to a year, and he said a longer time frame should be considered. However, DOC officials said the 120-day limit is based on federal guidelines.
Implementation statewide would cost an estimated $250,000, according to the report. Menard and Folland both said they would like to see that recommendation put in place provided the Legislature appropriates the money.
“Given the potential to save lives that was absolutely our recommendation: Let’s find a way to do this in the financial setting that we have,” Folland said.
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