New Opportunties to Save Lives in Jails and Prisons Amidst Twin Crises

After two decades of a growing opioid crisis, we are now confronting a second crisis – the COVID-19 pandemic. With no proven treatments or vaccines, the outside world is sheltering in place and seeking out scarce personal protective equipment and hand sanitizers. Jails and prisons are decarcerating through early releases and judicial actions, e.g., waived bail and referral to diversion programs. The National Commission on Correctional Health Care is providing COVID-19 guidance and webinars for correctional facilities.

The confluence of these crises poses unique risks to people who work or are confined in correctional facilities. The viral illness-like symptoms of inadequately treated opioid withdrawal is easily confused with COVID-19 symptoms, thus delaying recognition of both. Runny nose, vomiting, coughing, diarrhea, and patient agitation expose others to potentially infected bodily fluids. Buprenorphine or methadone can quickly relieve symptoms and save lives, but their use has been hindered by logistical barriers and access to licensed providers.

Unprecedented Waivers
New opportunities for saving lives have emerged. Federal regulating agencies including SAMHSA and the DEA have issued unprecedented telehealth waivers facilitating compliance with national practice guidelines. The initial in-person physical exam requirements for prescription of buprenorphine have been waived, allowing for initial and subsequent telehealth visits. Non-HIPAA-compliant telemedicine applications such as FaceTime or Skype are permitted during the COVID-19 crisis. The DEA has issued an exception to separate state registration requirements, permitting doctors and other clinicians with DEA licenses to prescribe across state lines, as long as other state requirements are met. Patients currently enrolled in opioid treatment programs may receive up to 28 days of methadone, potentially reducing transport to the OTP to secure methadone doses. Telehealth visits for currently enrolled OTP patients (but not new OTP patients) are permitted. Requirements for OTPs to establish a new off-site location, potentially within a correctional facility, have been loosened.

These exemptions create compelling reasons for correctional facilities to expand their opioid treatment services: Doing so will reduce postrelease deaths from overdose, and will create a safer environment within their walls.

Kevin Fiscella, MD, MPH, CCHP

Dr. Fiscella is a professor at the University of Rochester in the departments of family medicine and public health sciences, as well as the Center for Community Health and Prevention. He also works as a family physician, HIV physician, and addiction medicine physician at Jordan Health, Rochester, NY. He serves on the NCCHC board of directors as liaison to the American Society of Addiction Medicine.