New law requires opioid treatment in county jails

Monitor staff
Published: 8/6/2020 5:11:04 PM

Gov. Chris Sununu signed a bill last week that will require county correctional facilities to provide Medication-Assisted Treatment for opioid addiction in 2021.

Although data is not readily available for county correctional facilities, it is estimated that more than 50% of individuals currently incarcerated in New Hampshire state prisons have opioid use disorder, according to the Governor’s Commission on Alcohol and Other Drugs.

The most effective treatment for opioid addiction involves medications like methadone, buprenorphine and naltrexone, according to the American Society of Addiction Medicine. Yet, until last week, New Hampshire County jails were not required to offer this treatment.

Based on a 2019 report from the Commission on Alcohol and Other Drugs, county jails in New Hampshire varied in what medication-assisted treatment they offered.

While Merrimack and Keene offered a variety of programs for inmates who had been prescribed MAT before incarceration, other counties either offered these medications only to pregnant inmates or did not offer the medications at all.

There were a variety of logistical problems that made some facilities hesitant to adopt MAT. For example, any given doctor cannot administer methadone. They need to go through additional licensing through the state and federal governments.

Furthermore, some commissioners and superintendents had philosophical qualms with the treatment.

Amanda Bevard, the chair of Carroll County’s Commissioners, has previously said she believes MAT could cause inmates to become addicted to the medications designed to treat them.

The new law requires facilities to screen and offer MAT, regardless of if they had been prescribed this treatment prior to their arrest.

It is still unclear how correctional facilities will pay for these medications. Other states, such as Pennsylvania and Rhode Island, have allocated millions of dollars toward similar programs.

Jake Berry, the Vice President of Policy for New Futures, said that previously incarcerated people are at far greater risk for overdose than the general population in New Hampshire.

“They desperately need treatment available to them,” he said.

MAT drugs work by binding to opioid receptors in the brain – the same receptors that would otherwise be activated by heroin or morphine. Buprenorphine and naltrexone imitate opioids, activating the receptors enough to reduce craving and withdrawal, without producing a “high.” Naltrexone blocks receptors, preventing euphoria from opioids if someone relapses.

Without these drugs, inmates who struggled with opioid abuse are at risk for relapse, overdose, and withdrawal symptoms. In 2018, the U.S District Court for the District of Maine ruled that refusing to offer MAT qualified as cruel and unusual punishment, sparking a wave of policy changes across the country.

Proponents of these programs say they can lead to fewer overdose deaths after release from incarceration. One study, published in the New England Journal of Medicine found that drug overdose was the leading cause of death for those that were previously incarcerated.

Similar programs in other states have been successful in decreasing post-incarceration deaths. Rhode Island, the first state to offer all three MAT medications to its prisoners, saw a 61% decrease in post-release deaths and a 12% decrease in overall overdose deaths in the state in the year after the program began. There still needs to be further research to determine whether or not MAT impacts rates of recidivism, according to a report from the PEW Charitable Trusts.

Henry Klementowicz, a staff attorney at the ACLU of New Hampshire who testified in the Senate for a previous iteration of this bill, said correctional facilities have always been required to provide medical care to their inmates. Now, the law clarifies that MAT is a part of that care.

“When people are incarcerated, they lose their ability to work, to get health insurance, to shop for their own doctor,” he said. “It becomes an obligation of the society who is taking that freedom to provide them with this care.”




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