Biden administration to fund opioid addiction treatment in jails and jails

The Biden administration this week ramped up efforts to fund opioid addiction treatment in prisons, a core part of its drug policy agenda, calling on states to pass a new Medicaid program that will cover health for prisoners.

According to new guidelines from the Centers for Medicare and Medicaid Services, states can ask the federal government to allow Medicaid to cover drug treatment for up to 90 days before a person’s discharge. Public health experts say providing treatment during this critical time could help people survive the often harsh conditions in jails and prisons and then return more easily to the community.

Correctional facilities, where inmates disproportionately suffer from opioid use disorder and often cannot find treatment during and after incarceration, have claimed a place at the forefront of the devastating overdose epidemic in the country, which now kills more than 100,000 Americans every year.

“That’s where most people are, and that’s where you’ll get the most benefit,” said Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy. , referring to the high concentration of Americans incarcerated with opioids. use the mess. Neglecting to treat drug addiction in jails and prisons, he added, has “the greatest cost to society, to taxpayers.”

The stakes of the issue are perfectly represented by a row of white bars that dominate a common area of ​​the Curran-Fromhold Correctional Facility, a Philadelphia prison along the Delaware River that Dr. Gupta visited on Thursday. The bars, which line a second-floor walkway, are intended in part to prevent residents with opioid use disorder from jumping off to attempt suicide while experiencing withdrawal symptoms, officials say. of the establishment.

Federal law prohibits incarcerated Americans from receiving coverage under Medicaid, the federal state health insurance program for low-income people, except in a hospital setting such as a hospital. The ban, known as the inmate exclusion policy, means states, counties and cities generally foot the bill for programs that help opioid users manage or prevent debilitating cravings and symptoms. withdrawal programs that follow them throughout incarceration.

Curran-Fromhold’s drug treatment program offers methadone and buprenorphine, the two most common and effective opioid addiction treatments that have been shown to alleviate cravings. It’s funded by the city of Philadelphia, making it an obvious target for Medicaid coverage, Dr. Gupta said. Medication programs in jails and prisons can be expensive to operate.

Bruce Herdman, chief of medical operations for the Philadelphia prison system, said if Pennsylvania gets Medicaid funds for the prison, the move would save the system money for other key programs and drugs.

“They will allow us to provide services that we currently cannot afford,” he said, referring to possible Medicaid funds.

Even before issuing the new guidelines, the Biden administration had encouraged states to apply for the Medicaid program. In January, California became the first state to be approved, and more than a dozen other states have pending applications. Dr. Gupta said the new guidelines will most likely require more states to apply for Medicaid coverage for the kind of help offered by Curran-Fromhold.

One state that could apply for funds is Pennsylvania, which has faced a devastating rise in drug overdoses in recent years. A spokesperson for the Pennsylvania Department of Social Services said state officials are still evaluating plans to apply for the Medicaid program and are focusing on restoring inmates’ Medicaid benefits after release in the meantime.

Regina LaBelle, who served as the acting director of the Office of National Drug Control Policy under President Biden, said she’s worried state health departments don’t have the resources to apply for the program.

“It takes a lot of staff time,” she said. “Do they have people in their Medicare and Medicaid Services office who can devote time and energy to this document?”

Some conservative critics of opioid addiction treatment argue that since buprenorphine and methadone are opioids, their use should not be encouraged. But the Medicaid program has already shown bipartisan appeal, with some conservatively leaning states, such as Kentucky, Montana and Utah, applying for it.

For states that wish to participate in the program, the federal government requires correctional facilities to offer methadone and buprenorphine. The guidelines also ask states to suspend, rather than terminate, Medicaid coverage while insured people are incarcerated, allowing them to return to their health plans more quickly once they are released.

Dr Gupta said such an approach could better enable newly released people to see a doctor they had seen before their incarceration. Correctional facilities will also have to provide inmates with 30 days of treatment upon release, giving people a head start as they reintegrate into society.

“It’s all the transitions where things break down, both from the transition from outside to inside and then from inside to outside,” said Dr. Josiah D. Rich, an epidemiologist at Brown University.

Incarcerated and prison people are particularly vulnerable to fatal overdoses soon after release, when their drug tolerance has waned. Studies show that the chances of overdose in the days and weeks after release are significantly reduced if an incarcerated person uses either buprenorphine or methadone.

About two million people are held in jails and prisons every day in the United States, and a significant portion of them suffer from opioid use disorder, according to federal officials. Withdrawal symptoms can be particularly acute during short prison stints, many of which have no treatment programs. About nine million people pass through prisons each year, the federal government estimates.

Buprenorphine and methadone usually require sustained, uninterrupted use to help addicts gradually subside their cravings. The average length of stay in a Philadelphia prison is about 120 days, which means that the Medicaid program, with its 90-day coverage period, could pay for treatment for most or all of the prison time. a person there.

Researchers from the Jail and Prison Opioid Project, a group that Dr. Rich helps lead that studies the treatment of incarcerated people, estimate that only about 630 of the nation’s roughly 5,000 correctional facilities offer drug treatment for addiction-related disorders. use of opioids. About 2% of people incarcerated in the United States are known to have received such treatment in jail or prison, the researchers estimate.

Dr. Gupta pointed to what he called a glaring irony for much of the US prison population: people are incarcerated for their drug use and then denied treatment.

The Biden administration’s push for states to use Medicaid funds in prisons and prisons overlaps with a bipartisan effort in the House and Senate to pass the Medicaid Re-entry Act, which would grant coverage within 30 days preceding an inmate’s release.

The administration said that by summer, all 122 Federal Bureau of Prisons facilities will be equipped to offer drug treatment. But most of those incarcerated are in state and local jails and jails, which have a patchwork of drug policies that can vary by site. Some correctional facilities only allow one treatment, while others only allow medication for those who were on it prior to incarceration.

“There’s a stigma both around the use of drugs for treatment, but also a stigma around opioid use disorders in general,” said Dr Elizabeth Salisbury-Afshar, a medical doctor in addiction at the University of Wisconsin-Madison which has advised prisons on treatment programs. “There is a wider educational gap.”

Dr Dorian Jacobs, a doctor who helps run Curran-Fromhold prison’s substance abuse treatment program, said she’s met residents with opioid use disorder who don’t know that it was a disease that should be treated like any other.

“It’s just part of who we are,” she said.

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