Lawmakers, Healthcare Facility Clash Over Treating Inmates With Addiction

By Paul Gaita 10/30/18
Is the risk of overdose higher in prison or upon release?
inmate receiving medical care from a nurse

A fight is underway in the state of Vermont over the execution of legislation designed to provide treatment for prison inmates with addiction.

S.166, which was signed into law in May 2018, provides treatment with buprenorphine to inmates with the approval of a doctor—but legislators were dismayed to find that the medication was only being provided to inmates who were within weeks of their release dates.

At the heart of the argument is the determination of medical necessity for treatment. 

State Senator Tim Ashe, who was the bill's main sponsor, told the Burlington Press that holding back treatment until a release date is counterintuitive. "For people who are serving relatively brief sentences, those who suffer from addiction should be getting the treatment and not having arbitrary deadlines," he said.

Centurion Managed Care, the state-contracted company assigned to provide health care for Vermont inmates, said the deadlines are in place to avoid increased risk of overdose after release.

Risk of overdose is low in prison, according to Annie Ramniceanu, director of mental health and addiction services for the state Department of Corrections (DOC)—and therefore buprenorphine is not medically necessary until the risk is higher upon the inmate's release. "Just because you want it doesn't necessarily mean you meet that medical necessity," she said.

Ramniceanu's position has health care advocates and criminal justice reform groups up in arms.

Tom Dalton, executive director of Vermonters for Criminal Justice Reform, filed a complaint with the Department of Health's Board of Medical Practice against Centurion's medical director, Dr. Steven Fisher, that claimed that inmates are suffering due to the company's directives and have taken to using buprenorphine smuggled into prisons.

"Many high-risk incarcerated patients who are self-identifying as struggling with addiction and asking for help are unable to access treatment," wrote Dalton in the complaint. "Some are being released back into our communities untreated."

Dalton's stance is echoed by other public figures, including Burlington Police Chief Brandon del Pozo, who in a Facebook post from October 17 wrote, "Treat every prisoner who needs it with buprenorphine, methadone or Vivitrol as best fits them (Vermont is at least trying)"—as part of a list of strategies to combat the regional opioid epidemic that has gained national attention.

DOC Commissioner Lisa Menard told the Burlington Press that the department is working to fully implement S.166 in the prison system, including a recent expansion of treatment to inmates who have reached their minimum release date, and treating inmates with longer sentences with other forms of medication-assisted treatment (MAT). 

For Dalton, however, it's the core issue that needs changing. "Their ignorance is killing people," he said.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.