The comments by Commissioner Phelps would be hilarious if the subject were not so serious! He makes no mention of what we all know, and all studies show: the main source of illegal drugs in prison is guards smuggling them in … because he will not admit that his agency is OUT OF CONTROL!
Lt. Gov. Bethany Hall Long and Rep. Melissa Minor-Brown get it, but few other state officials – prison administrators and legislators – do!
This report by Pew, of course, has valid recommendations.
Excerpts from the Article:
One change undertaken by Delaware officials would have the biggest impact on the state’s struggle with addiction: Make medication-assisted treatment available to everyone in prison who needs it. So says a new report from the Pew Charitable Trusts.
Medication-assisted treatment is considered the gold standard when it comes to treating addiction and helping people stay sober, and most people incarcerated in the state’s prison system don’t have access to it.
Making it available to all prisoners is one of eight recommendations Pew researchers made to the state’s Behavioral Health Consortium in a report released Thursday.
Delaware “will be a national leader in treating underserved populations” should they take these steps, the researchers said, because few states have shifted to offering all three forms of medication-assisted treatment to every state prisoner who wants it.
When Rhode Island implemented a similar structure, it saw a 61 percent decrease in post-incarceration overdose deaths – and that translated to a 12 percent decrease in overdoses statewide.
“It’s very costly for the state to not do these things,” said Lt. Gov. Bethany Hall-Long, who chairs the Behavioral Health Consortium. It is responsible for implementing the recommendations. However, she added, the process of expanding treatment and implementing Pew’s recommendations must be rolled out over the coming years and won’t be funded overnight.
“There will be no quick fix to this long-term problem,” Hall-Long said.
The Department of Corrections already received a two-year commitment from the state Division of Substance Abuse and Mental Health for $350,000. That money is to go toward the expansion of medication-assisted treatment in the prison system. Pew recommended the prison system use part of the money to develop policies and procedures necessary to expand the services.
Methadone can alleviate heroin cravings but doesn’t produce any significant euphoric effects.
Pew researchers also found that the DOC will need to amend its behavioral health contract in order to expand MAT and include all three FDA-approved drugs, methadone, buprenorphine and naltrexone.
“We just have to do it,” said Rep. Melissa Minor-Brown, who chairs the Corrections committee and will play a large role in implementing some of these recommendations. “It’s the ethical thing to do.” This recommendation has the power to change Delaware’s addiction landscape when it comes to addiction, according to Pew researchers.
The prison system has become the largest provider of addiction treatment nationwide. Unfortunately, many of these agencies lack the resources to adequately offer support.
Delaware DOC officials estimate it will cost $144,000 to treat 100 people with methadone each year, according to information provided to Pew researchers. For buprenorphine – also known as suboxone – estimates say about $576,000 per year will be needed to treat that same number of inmates.
The DOC estimates that 46 percent of its incarcerated population – which typically hovers above 6,300 people on any given day – has substance use issues, according to the report, but other research groups have found that the number is likely larger due to the ratio of opioid use disorder in the general population.
The DOC does offer naltrexone – more commonly known as Vivitrol – to participants in its residential drug treatment program known as Key-Crest, according to the Pew report. But DOC officials reported only 34 people accepted the injection that prevents a person from feeling the effects of drugs in the 12 months it was offered.
The DOC also began offering in late 2018 buprenorphine to people detained for probation violations and already taking the medication. According to the report, 10 people received this continued treatment as of early December 2018.
Using DOC estimates, nearly 2,900 people would require medication-assisted treatment, meaning the lowest possible cost incurred by the DOC for methadone would run well over $4 million. The cost of buprenorphine and naltrexone would be even higher.
The job will now fall to the DOC to create cost estimates and accurate plans for how to potentially implement expanded MAT, and to the General Assembly to allocate money. Gov. John Carney has appointed a commission to focus on re-entry and ensuring those returning to the community from prison have the support they need. This, as well as an additional recommendation from Pew in which the DOC was encouraged to require continued care for those with opioid use disorder after they’re released from prison, fall directly in line with Carney’s efforts.
“The court rightly found that jails must provide necessary medical care for opioid use disorder, just like any other disease. We don’t expect jails to solve the opioid crisis, but the least they can do is not make it worse.”
In addition to MAT in prisons and continued access to care after a prisoner’s release, researchers also found that Delaware would benefit from these six recommendations:
1. Evaluate and change the reimbursement rates from Medicaid to better reflect surrounding states and ensure they are comparable to the services they’re providing.
2. Expand the number of dosing sites or locations for people to receive medication-assisted treatment, so more people have access to this care and can find it in new locations.
3. Mandate the use of a common assessment tool to determine a person’s substance use disorder diagnosis and subsequent treatment plan.
4. Change the Medical Practice Act to allow all waivered physicians assistants to prescribe buprenorphine even if their supervising physicians do not.
5. Remove the requirement that providers must obtain a waiver in order to prescribe buprenorphine via telemedicine.
6. Create a task force of private insurers, employers and other stakeholders to create a set of policies for private payers to adopt in order to increase access to addiction treatment for those with private insurance.