Methadone Treatment for Opioid Use Disorder Improving Access Through Regulatory and Legal Change: Proceedings of a Workshop (2022) / Chapter Skim
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6 Improving Access to Quality Treatment in the Criminal Justice System and Other Institutional Settings
6 Improving Access to Quality Treatment in the Criminal Justice System and Other Institutional Settings
Pages 59-72
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From page 59... ...
. • The Transitions Clinic Network employs people with a history of incarceration as community health workers to help patients navigate health care and social support systems upon release from incarceration (Wang)
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From page 60... ...
CROSSCUTTING REGULATORY ISSUES THAT IMPACT CORRECTIONAL FACILITIES AND OTHER INSTITUTIONS While most of the world has figured out that punishment does not work as a remedy for addiction, Josiah "Jody" Rich, professor of medicine and epidemiology at Brown University and a 28-year consultant to the Rhode Island Department of Corrections, pointed out that the criminal justice system remains stuck in the punishment mode. As an example, he said, the United States spends $182 billion per year on mass incarceration, but only $2.8 billion per year on treatment for opioid use disorder (OUD)
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From page 61... ...
Rich noted that while racial disparities in the criminal justice system itself also extend to treatment in the community, he suggested that if high-quality treatment could be expanded in correctional settings and linked to high-quality care in the community, some of those racial disparities might be offset. Medication is the gold standard for OUD in the criminal justice system as in other settings, said Rich.
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From page 62... ...
This is probably best addressed by revising clinical practice guidelines, he said. Other mechanisms Rich supports are reducing the obstacles for prisons to become OTPs, expanding how OTPs function in correctional settings, expanding the use of mobile units at correctional facilities, and enabling these facilities to have their own pharmacies with Drug Enforcement Administration (DEA)
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From page 63... ...
TRANSITIONING FROM INCARCERATION TO THE COMMUNITY For people with OUD, the transition from incarceration to the community is a high-risk period associated with poor health outcomes, said Emily Wang, professor of medicine and public health at the Yale University School of Medicine and director of the SEICHE Center for Health and Justice. "A primary reason for this is that most return home without any access to safe housing, food, or gainful employment, and this is worsened by structural barriers that prevent people with criminal records from obtaining public assistance or applying for jobs," she said.
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From page 64... ...
The crux of the Transitions Clinic Program are community health workers, people with histories of incarceration, who help patients navigate the health care and social support systems after release from incarceration, said Wang. For patients with OUD, this may include providing naloxone, clean needles, referrals to safe injection facilities, evidence-based pharmacotherapy, and counseling, as well as addressing the social determinants that augment drug use: lack of food, housing, and income, she said.
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From page 65... ...
The Act would also provide access to care coordination, enabling a smooth transition for patients, and create federal oversight for correctional health care that receives Medicaid funding, she said (Khatri and 3 The Inmate Exclusion Policy excludes incarcerated individuals from receiving Medicaid. To learn more about health coverage for incarcerated people, go to https://www.healthcare.
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From page 66... ...
Data from the Transitions Clinic Network indicate that this in-reach approach substantially improves engage ment. Multiple pathways within Medicaid are being explored as sources of sustainable funding for community health workers, said Wang.
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From page 67... ...
The upper panel shows the drive time in minutes to the nearest OTP or to the nearest FQHC by county in Indiana, Kentucky, Ohio, Virginia, and West Virginia. The lower panel compares the drive time in minutes to the nearest OTP versus the nearest CVS pharmacy or chain pharmacy, also by county in the same five states.
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From page 68... ...
CIVIL RIGHTS LITIGATION TO ENABLE METHADONE TREATMENT IN INSTITUTIONS As alluded to by Judge Barrasse, the ADA specifically requires that people with addictions receive access to treatment, including methadone, in jails, prisons, and other aspects of the criminal legal system such as courts, 6 For an overview of the evidence base for medications for opioid use disorder, please see the National Academies' report titled "Medications for Opioid Use Disorder Saves Lives," available at https://nap.nationalacademies.org/catalog/25310/medications-for-opioid-use-disordersave-lives (accessed June 12, 2022)
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From page 69... ...
• Skilled nursing facilities that refuse, as a blanket policy, admission to patients solely because they are on methadone or buprenorphine are violating civil rights statutes. • Sober homes that reject people solely because they are receiving treatment with methadone or buprenorphine are violating federal civil rights statutes.
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From page 70... ...
Dorchak described another complication in the laws pertaining to incarcerated people with OUD: There is a carve-out in the ADA that denies protection for people illegally using drugs and an exception to the carveout, which is that current illegal drug use does not apply to the provision of health care. For example, if a person entering a correctional setting takes buprenorphine but is also using cocaine, the cocaine in their system does not mean they lose their ADA protections for the buprenorphine because that is the provision of health care, which is still protected.
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From page 71... ...
. • Allowing pharmacies located in correctional facilities to dispense methadone and enable more correctional facilities to have their own pharmacies with Drug Enforcement Administration certification to distribute controlled sub stances (Rich)
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