An unprecedented systemwide use of medication-assisted treatment in Connecticut's prisons and jails is having a strikingly positive effect on recidivism—at least for those inmates with access to the treatment. In discussing the need for wider use of methadone in the state's correctional facilities, the medical director of the Connecticut Department of Corrections offered a quick explanation at this week's conference of the American Association for the Treatment of Opioid Dependence (AATOD).
“Things don't happen fast in corrections,” Kathleen Maurer, MD, told the audience in attendance at the March 13 morning plenary session at the conference in New York City.
Still, Connecticut remains light years ahead of the typical state in the degree to which criminal offenders have access to addiction treatment services before, during and after their time behind bars. As in all states, the need in Connecticut is particularly great amid the opioid crisis. Maurer said that more than half of the state's overdose death victims in 2016 had experienced some correctional involvement at some point in their lives.
Maurer outlined a three-pronged effort to place Connecticut offenders with substance use disorders on a path to recovery and a lower likelihood of reoffending:
Around 100 individuals a year are diverted before arraignment to a Treatment Pathway Program. Maurer said 60% of those receiving these services complete their treatment plan, with those on medication for opioid dependence completing treatment at a higher rate.
Medication treatment while in custody has reached all of Connecticut's state and local correctional facilities. Inmates receiving medication tend to incur fewer disciplinary violations while in custody, Maurer said.
Post-release, offenders with substance use disorders participate in a Living Free Program. Eighty percent of those for whom medication treatment is recommended stay on a medication, with most receiving buprenorphine. Housing and employment data are encouraging, but the most striking numbers show a virtual absence of rearrests after six months.
Maurer considers the use of peer services to be a critical component in post-release support. “I don't think you can do reentry without peer support,” she said.
Progress in insurance
Joining Maurer for the plenary session were representatives of major public and commerical insurance systems. Jason Helgerson, New York's Medicaid director, discussed plans to reduce opioid use in the state's Medicaid population by 20% by 2020.
Efficiencies in the state's Medicaid system have resulted in federal incentive payments that will lead to further reforms, as the state moves into value-based Medicaid payment for providers (already around 38% of the state's Medicaid payments are value-based, Helgerson said).
Mark Friedlander, MD, chief medical officer at Aetna Behavioral Health, outlined the major insurer's 2022 goals of a 50% decrease in inappropriate opioid prescribing and a 50% increase in the proportion of opioid use disorder patients receiving medication treatment.
He explained that Aetna issues no prior authorization requirements for buprenorphine. Methadone is covered less consistently, with challenges in provider billing procedures partly responsible for this, Friedlander said.
The Summits for Clinical Excellence bring together thought leaders on cutting-edge topics in multi-day national and regional conferences. Summits on mindfulness, trauma, process addiction, and shame appeal particularly to private practice behavioral healthcare professionals. Other Summits address the national opioid crisis from a regional perspective and engage a diverse group of stakeholders.