In jails and prisons, the White House sees an opportunity to reduce opioid overdoses

The Biden administration this week accelerated efforts to fund opioid addiction treatment in jails and prisons, a key part of its drug policy agenda, by calling on states to adopt a new Medicaid program that will cover health care for the incarcerated people.

Under new guidance from the Centers for Medicare and Medicaid Services, states can ask the federal government to allow Medicaid to cover addiction treatment up to 90 days before someone is released. Public health experts say providing care during that critical time could help people survive the often harsh conditions of prisons and jails, then more easily return to the community.

Correctional facilities, where inmates suffer from disproportionate opioid use disorder and are often unable to find treatment during and after their incarceration, have reclaimed a place at the forefront of the nation’s devastating overdose epidemic, now killing more than 100,000 Americans every year.

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

At stake is clearly represented by a row of white bars looming over a common area at the Curran-Fromhold Correctional Facility, a Philadelphia prison along the Delaware River that Dr. Gupta visited on Thursday. The bars, which flank a second-story walkway, are intended in part to prevent residents with opioid use disorder from jumping to attempt suicide while experiencing withdrawal symptoms, according to facility officials.

Federal law prohibits incarcerated Americans from receiving coverage through Medicaid, the federal state’s health insurance program for low-income people, unless they are in an inpatient setting such as a hospital. The ban, known as the prisoner exclusion policy, means that states, counties and cities typically foot the bill for programs that help opioid users manage or prevent the debilitating cravings and withdrawal symptoms that follow them during the incarceration.

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

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

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

Even before issuing the new guidance, 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 guidance will most likely force more states to seek Medicaid coverage for the kind of help Curran-Fromhold offers.

One state that may be seeking funding is Pennsylvania, which has faced a devastating rise in drug overdoses in recent years. A spokesman for the Pennsylvania Department of Human Services said state officials are still evaluating plans to apply for the Medicaid program and in the meantime have focused on restoring prisoners’ Medicaid benefits after their release.

Regina LaBelle, who served as acting director of the Office of National Drug Control Policy under President Biden, said she is concerned state health departments may not have the resources to apply for the program.

It takes up a lot of staff time, he said. Do they have people in their Medicare and Medicaid Services office who can devote the time and energy to that document?

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

For states that want to participate in the program, the federal government is asking prison facilities to offer methadone and buprenorphine. The guidance also calls for states to suspend, rather than terminate, Medicaid coverage while people with the insurance are incarcerated, allowing them to return to their health plans more quickly once released.

Dr. Gupta said such an approach could better enable those who have just been released to see a doctor they had seen before their incarceration. Correctional facilities are also expected to provide prisoners with a 30-day supply of care following their release, giving people a head start when re-entering society.

It’s all transitions where things fall apart, whether transitioning from outside to inside or from inside to outside, said Dr. Josiah D. Rich, an epidemiologist at Brown University.

People in prisons and jails are especially vulnerable to fatal overdoses shortly after being released, when their tolerance for the drugs has weakened. Studies show that the risks of overdose in the days and weeks after release are substantially reduced if an incarcerated person uses buprenorphine or methadone.

About two million people are held in jails and jails on any given day in the United States, and a substantial portion of them have opioid use disorder, federal officials say. Withdrawal symptoms can be especially acute during shorter stays in prisons, many of which lack treatment programs. According to federal government estimates, about nine million people pass through prisons each year.

Buprenorphine and methadone typically require long, uninterrupted use to help addicts gradually quench the craving. The average length of stay in a Philadelphia prison is approximately 120 days, which means that the Medicaid program, with its 90-day coverage period, could pay for most or all of your time there .

Researchers at the Jail and Prison Opioid Project, a group Dr. Rich helps lead that studies treatment among incarcerated people, estimate that only about 630 of the nation’s approximately 5,000 prison facilities offer drug treatment for use disorder. of opioids. About 2 percent of people incarcerated in the United States are known to have received such treatment while in prison or jail, researchers estimate.

Dr. Gupta pointed out what he said was a blatant irony in a large segment of the American prison population: people are incarcerated for their drug use, then denied treatment.

The Biden administrations are pushing for states to use Medicaid funds in prisons, and prisons are overlapping a bipartisan effort in the House and Senate to pass the Medicaid Re-entry Act, which would guarantee coverage in the 30 days before inmates are released.

The administration said that by the summer, all 122 Federal Bureau of Prisons facilities will be equipped to offer medical care. But most incarcerated people are in state and local jails and jails, which feature a patchwork of drug policies that can vary by location. Some correctional institutions allow only one treatment, while others allow drugs only for those who received them before being incarcerated.

There is stigma around both the use of drugs for treatment but also the stigma of opioid use disorder in general, said Dr. There is a wider education gap.

Dr Dorian Jacobs, a doctor who helps run Curran-Fromhold Prison’s addiction treatment programme, said she has met residents with opioid use disorder who didn’t realize it was an illness that should be treated. treated like any other.

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