Along with much wider naloxone availability, evidence-based MOUD treatments, Emergency Department engagement programs, and retaining the new pandemic-driven flexibilities in telehealth and other treatment modalities, the panelists emphasized two other areas of policy reform that could have potentially outsize impact. The first is expanding Medicaid in those states that haven’t yet done so to provide coverage for in-patient and out-patient substance use treatment. The second is overhauling the addiction-related regulations and practices in correctional facilities that house such large populations of drug users.
LaBelle noted, “We know that you’ve got up to a 40 percent greater chance of overdosing if you are not treated with a Medication for Opioid Use Disorder (MOUD) while you are incarcerated. First of all, it’s against the law to force someone on methadone or buprenorphine to stop and go into withdrawal when they enter corrections. From federal court cases we know that’s a violation of the Americans with Disabilities Act. It’s also a violation of the Eighth Amendment.”
“At Georgetown,” LaBelle continued, “we worked with the Sheriffs’ Association and the Bureau of Prisons on this issue, and there is a great interest in expanding access to treatment and corrections to evidence-based treatment. Groups like the National Sheriffs’ Association and others are calling for the elimination of the Medicaid Exception (that bars the use of Medicaid funds to cover inmate health care services). So the proposed Medicaid Reentry Act would allow incarcerated individuals to get Medicaid coverage for addiction treatment starting 30 days before their release.” Once released, the former inmates are again eligible for ongoing Medicaid coverage of their continuing treatment.
“We know from Rhode Island’s experience how they decreased overdose deaths in the reentry population by 60 percent and six percent overall in the state by implementing Medicaid-based treatment in corrections,” LaBelle said.