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As we seek to confront the overdose crisis, one area too often overlooked is the criminal justice system, which accounts for more than one-third of referrals to addiction treatment programs.
Approximately half of individuals incarcerated in the U.S. meet criteria for substance use disorder (SUD). Incarcerated individuals are up to 40 times more likely to die of an overdose within two weeks of release, which is a leading cause of post-release fatality due to loss of tolerance to opioids during incarceration when medications for opioid use disorder (OUD) are not provided. Furthermore, whether an individual receives medication for OUD while incarcerated may rest in the hands of a jail administrator with no medical training.
We know that treatment during and immediately following release reduces the risk of death by up to 75%. Nationwide, medications for OUD are underutilized in criminal justice settings, even despite the removal of barriers to buprenorphine allowing for licensed health care practitioners to prescribe without an X-waiver. Incarcerated individuals still face the prospect of forced withdrawal from and lack of access to evidence-based, life-saving medications such as methadone or buprenorphine upon incarceration.
What is Maryland doing about this crisis? The State Opioid Use Disorder Examination and Treatment Act (formerly, House Bill 116 , 2019) required local correctional facilities and the Baltimore Pretrial Complex to implement programs for OUD screening, evaluation and treatment including methadone, buprenorphine and naltrexone by January 2023.
Maryland has fallen behind in meeting the law’s requirements despite sincere efforts.
COVID-19 initially delayed implementation efforts, so the Governor’s Office of Crime Prevention, Youth, and Victim Services allocated grant funding for Health Care Access Maryland (HCAM) and Health Management Associates (HMA) to support correctional facilities with technical assistance. In its FY23 report , only 19 of Maryland’s 24 correctional facilities submitted aggregate data on implementation status and overall, the number of incarcerated individuals treated for OUD fell far below national estimates of OUD prevalence in incarcerated settings.
What are the barriers to full implementation in Maryland pre-trial facilities? Ongoing, sustainable funding is key.
Access to insurance benefits in Maryland are suspended during incarceration, making medical care a state-funded enterprise administered by contracted medical vendors, departments of health or facility employees. Thus, new treatment programs incur new costs, which require additional funding.
In Maryland’s case, local grant opportunities were made available through the Opioid Operational Command Center, but administrative burdens associated with grants and imposed restrictions on use of funds for new positions beyond the grant period were identified as barriers .
In January this year, I gave testimony as part of the Community Overdose Action Town Hall Series. Maryland’s Office of Overdose Response held the town halls statewide to hear from the community about ways to address the overdose crisis.
My testimony focused on ways to reduce the impact of SUD on the county level and in Maryland more broadly. Although there are no easy solutions to this multipronged problem, there are areas that are critically in need of funding now – including resources needed to meet the mandate of the State Opioid Use Disorder Examination and Treatment Act. We also need more robust data collection, and health information exchange.
It’s imperative that financial support for these programs is built into correctional budgets, rather than solely as time-limited grant opportunities, especially in the correctional setting when resources are spread so thinly.
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