U.S. to Fund Opioid Addiction Treatment in Jails and Prisons

The Biden administration this week accelerated efforts to fund opioid addiction treatment in prisons and prisons. This is a core part of its drug policy agenda, calling on states to adopt new Medicaid programs to cover health care for incarcerated people.

under new guidance Through the Centers for Medicare and Medicaid Services, states can ask the federal government to allow Medicaid to cover addiction treatment for up to 90 days before someone is released. Public health experts say that providing treatment during that critical time helps people survive the harsh conditions of prisons and prisons, and then return to their communities more easily.

Correctional facilities, where inmates disproportionately suffer from opioid use disorders and often fail to find a cure during and after their incarceration, are a devastating problem in a country that currently kills more than 100,000 Americans each year. It claims to be at the forefront of the overdose epidemic.

Dr. Rahul Gupta, director of the White House’s Office of National Drug Control Policy, noted the concentration of Americans imprisoned for opioid use disorders. He added that failing to treat addiction in jail or prison would be “the biggest loss to society and taxpayers.”

The stakes in this matter are neatly represented by a row of white bars looming over a common area at Curran Fromhold Correctional Institution, a Philadelphia prison on the Delaware River that Dr. Gupta visited on Thursday. And the bars that line the second-floor aisle are intended to prevent residents with opioid use disorders from attempting suicide by jumping while they’re in withdrawal.

Federal law prohibits hospitalized Americans from receiving coverage through Medicaid, a federal health insurance program for low-income individuals, unless they are in a hospital or other inpatient setting. Known as the Inmate Exclusion Policy, this ban means that states, counties, and cities will pay for programs that help opioid users manage or prevent the debilitating cravings and withdrawal symptoms that persist while incarcerated. increase.

Curran-Fromhold’s medication treatment program offers methadone and buprenorphine, two of the most common and effective treatments for opioid dependence, which have been shown to reduce cravings. It is funded by the City of Philadelphia and is clearly covered by Medicaid, he said, Dr. Gupta. Medication programs in jails and prisons can be expensive to operate.

Bruce Hardman, director of medical operations for the Philadelphia prison system, said if Pennsylvania can secure Medicaid funding for prisons, the move would allow the system to fund other major programs and medications. You will be able to save money on

“They allow us to provide services that we can’t afford right now,” he said, referring to potential Medicaid funding.

Even before issuing the new guidance, the Biden administration was encouraging states to apply for Medicaid programs. became the first state It is on track to be approved, with applications pending in a dozen other states. Dr. Gupta said the new guidance will most likely lead to more states seeking Medicaid coverage for the types of jobs Curran-Fromhold provides.

One state that could seek funding is Pennsylvania, which is grappling with a devastating rise in drug overdoses in recent years. A spokesman for the Pennsylvania Department of Human Services said state officials are still reviewing plans to apply for the Medicaid program and, meanwhile, are concentrating on restoring Medicaid benefits to inmates after they are released.

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

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

Some conservative critics of opioid addiction treatment say that because buprenorphine and methadone are opioids, their use should not be encouraged. But the Medicaid program is already showing bipartisan appeal, with conservative states like Kentucky, Montana and Utah applying.

For states that want to participate in the program, the federal government is asking correctional facilities to provide methadone and buprenorphine. The guidance also asks states to suspend rather than terminate Medicaid coverage while people with insurance are incarcerated, allowing them to get health insurance more quickly after they are released. You can go back.

Dr. Gupta said such an approach would allow newly released people to see the doctors they saw before they were detained. Correctional facilities are also expected to provide inmates with 30 days of treatment after release, giving people a head start on their reintegration into society.

Dr. Josiah D. Rich, an epidemiologist at Brown University, said:

People in prisons and jails particularly vulnerable Leading to fatal overdose shortly after release when tolerance to the drug is weakening. Days and weeks after release It decreases significantly when inmates use either buprenorphine or methadone.

According to federal officials, about 2 million people are incarcerated in jails and prisons in the United States every day, a significant portion of whom have opioid use disorders. Withdrawal symptoms can be particularly severe during short stays in prison, many of which do not have treatment programs. The federal government estimates that about 9 million people cycle through prisons each year.

Buprenorphine and methadone usually require sustained, uninterrupted use to help drug users taper off cravings. In other words, a Medicaid program with a 90-day coverage period can pay for treatment for most or all of your time in prison.

Researchers at the Prison and Prison Opioids Project presume that the group led by Dr. Rich is researching treatments for incarcerated people. only about 630 Of the approximately 5,000 correctional facilities in the United States, we provide medication treatment for opioid use disorders. Researchers estimate that about 2% of US inmates are known to have received such treatment in prison or prison.

Dr. Gupta pointed out that what he said was an obvious irony in a large portion of America’s prison population, where people are imprisoned for drug use and then denied treatment.

The Biden administration’s move to ask states to use Medicaid funds in prisons and jails overlaps with bipartisan efforts in the House and Senate. Medicaid Reentry LawThis gives compensation up to 30 days before the prisoner is released.

The administration said it plans to have all 122 Federal Prison Service facilities available for drug treatment by the summer.but most imprisoned people They are held in state and local prisons and detention centers, featuring a patchwork of medication policies that may vary by location. The facility will only allow medication to those who received medical treatment prior to their incarceration.

Dr. Elizabeth Salisbury Afsher, an addiction specialist at the University of Wisconsin-Madison, who has advised prisons on treatment programs, said: ‘The educational gap is widening’

Dr. Dorian Jacobs, a physician who helps run the Curran-Fromhold prison’s addiction treatment program, encountered a resident with an opioid use disorder.

“It’s just part of us,” she said.

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