National Drug Control Strategy Highlights Opportunities, Barriers to MOUD in Corrections
By Alison O Jordan, LCSW, MSW, CCHP, AJOCA Consulting. Ms. Jordan is the liaison from the American Public Health Association on the NCCHC Board of Representatives.
The White House has released its National Drug Control Strategy for 2022. This document demonstrates the Administration’s policy priorities and sheds light on the direction the White House and federal agencies may act in the future to address access to substance use treatment, including a full range of Medication to treat Opioid Use Disorders options.
The section on Criminal Justice and Public Safety, pages 98-105, focuses heavily on the treatment of substance use disorders in state and local correctional facilities and community corrections and on improving treatment during incarceration and continuity of care after release. The report states:
“It is clear that the criminal justice system, while improving public safety, must also play an important role in ensuring that people within its custody or supervision and upon reentry who use drugs do not overdose and instead have access to the continuum of services and support. Ensuring meaningful rehabilitation and successful reentry advances public health and public safety goals.”
Key items in the document are summarized below.
To improve access to MOUD for incarcerated and reentry populations necessitates expanding access to MOUD in state and local correctional facilities and community corrections. The report highlights significant research findings regarding MOUD treatment during incarceration
- MOUD corresponds to a reduction in the risk of death after incarceration
- MOUD is offered in only about 12% of correctional facilities
- MOUD is available to less than 5% of youth 17 years old and younger while incarcerated
Best practices are highlighted, with suggestions from the National Association of Drug Court Professionals including “that medication decisions, including the decision to reduce or discontinue a medication, should be made by patients in consultation with a legally authorized and competently trained medical practitioner.” This recommendation extends to juvenile justice detention centers. Guidance also emphasizes that when specifying a treatment provider or medication,“… deference should be given to the treatment recommendations of medication professionals” and not a judge.
The Office of National Drug Control Policy is committed to working with Department of Justice’s Office of Justice Programs to give preference to funding grant applications that prioritize MOUD in jails.
To expand funding for SUD Treatment in the criminal justice system, the White House report recognizes that “federal Medicaid law generally prohibits federal Medicaid matching funds for otherwise reimbursable services for individuals when they are incarcerated,” but it notes that the SUPPORT Act provides opportunities for states to facilitate continuity of health benefits as individuals transition from correctional to community health care and encourages states to integrate best practices for SUD treatment in consultation with CMS. The report also calls for expansion of grant programs to incarcerated individuals.
To create the necessary flexibility for jails and prisons to offer MOUD, methadone and buprenorphine regulatory changes are specified for several federal agencies (SAMHSA, ONDCP, and the DEA).
To advance racial equity in investigation, arrest, and sentencing for drug-related offense, federal agencies need to use data to identify racial inequities and to assist in driving policy changes.Specifically,data sets are needed to: disaggregate individuals of Latino heritage by race; ensure racial and ethnic data is captured for the broadest number of groups; and allow for examination of disparities.
To ensure equitable treatment for individuals involved in the criminal justice system:
- Prosecutors and judges need to be engaged in the process of advancing equity.
- Expanded drug court program staff training is needed to reduce the role of personal biases in screening out eligible nonviolent drug court program candidate.
- Standardized policies are needed to help reduce racial disparities in referrals and improve access to treatment.
To promote alternatives to and continuity after incarceration, recommendations include:
- Expansion of screening to facilitate appropriate community-based services at the point of arrest, arraignment, and sentencing
- Facilitating support of drug court programs by ensuring federal agencies cannot compel participants “to cease use of MOUD when administered properly by trained professionals”
- Removing barriers to and establishing correctional to community provider relationships that expand access to support services after incarceration by facilitating “[w]arm hand-offs” that “increase the likelihood of engagement in services and improves treatment outcomes”
The National Drug Control Strategy includes specific criminal justice and public safety strategies that offer a framework to address national drug control policies that create challenges at the intersection of correctional health, substance use treatment, and public health. This data-rich strategic plan will be invaluable as state and local officials examine how changes to national drug policy, treatment, and reentry strategies can improve opportunities for treatment and lead to safer communities.
NCCHC RESOURCES TO SUPPORT MOUD
Bureau of Justice Assistance Managing Substance Withdrawal in Jails: A Legal Brief (.pdf)
Jail-Based MAT: Promising Practices, Guidelines and Resources handbook
Naloxone in Correctional Facilities for the Prevention of Opioid Overdose Deaths position statement
Opioid Use Disorder Treatment in Correctional Settings position statement
From the General Public to America’s Jails: MAT Saves Lives (white paper)
Standards for Opioid Treatment Programs in Correctional Facilities
Achieving accreditation shows that you are serious about using best practices and saving lives. An OTP seeking accreditation from NCCHC need not be in a facility whose health services are accredited.
NCCHC Resources can evaluate your current substance use disorder protocols, improve or launch new programs, and train your staff. You can save lives in correctional institutions and detention centers.
For assistance, please contact NCCHC at [email protected].