Action needed to help justice-involved individuals who have a substance use disorder

May 4, 2021

There is no legal, medical or policy reason to deny access to medications for opioid use disorder (MOUD) for justice-involved persons, according to leading medical, legal and health policy experts speaking on recent webinar from the AMA and Manatt Health. The webinar is part of a year-long series to showcase specific policy recommendations in action from the 2020 AMA-Manatt Health national policy roadmap.

“We need to take action to help the nation’s justice-involved population,” said AMA Immediate Past President Patrice A. Harris, MD, MA. “We are facing a multi-factorial drug overdose epidemic that has become worse from the COVID pandemic. Whether a person is in jail or prison, on parole, or in a drug diversion program, there must be a focus on evidence-based treatment.”

“Providing evidence-based care for opioid use disorder is the standard of care,” said Carolyn Sufrin, MD, PhD, Assistant Professor of Gynecology and Obstetrics, Johns Hopkins University School of Medicine. “This is true whether our patient is in a suburb, rural area, city or incarcerated. There is no medical reason to deny care to someone in a jail or prison.”

Clockwise from top left: Patrice A. Harris, MD; Carolyn Sufrin, MD; Emma Bond, JD; Elyse Powell, PhD; Jessie Rossman, JD; Jocelyn Guyer

Dr. Sufrin highlighted research showing that as many as one-third of individuals who are incarcerated in a jail or prison have an OUD. It is essential, she said, to provide access to OUD because of the health risks associated with withdrawal and increased risk of overdose upon release.  The risks are even more severe for women who are pregnant and post-partum.

There are legal protections to help all persons in a justice-involved setting start, continue and maintain access to MOUD, said Emma Bond and Jessie Rossman, attorneys with the American Civil Liberties Union (ACLU) in Maine and Massachusetts, respectively.

Ms. Bond highlighted several recent judicial opinions and pointed to the 8th and 14th Amendments of the U.S. Constitution and Americans with Disabilities Act as among those legal protections. She also recounted that in Pesce v. Coppinger and Smith v. Aroostook County, the judges’ opinions made clear that the individuals had a right to continue MOUD while incarcerated.

“Opioid use disorder is a chronic illness,” said Ms. Bond. “And the law is clear that jails must provide medical care for chronic illness.”

Ms. Rossman explained two federal cases, DiPierro v. Hurwitz and Scalfani v. Mici, in which the Bureau of Prisons and the Massachusetts Department of Correction, respectively, also agreed to continue MOUD access for individual clients during their incarceration.

“These are important victories,” said Ms. Rossman. “And one of the keys has been that each of these cases emphasized the medical standard of care. We need physicians to help us explain the medicine and the efficacy of MOUD in order to be successful.”

In North Carolina, successful implementation of pilot programs to increase access to MOUD in the state’s jails and prisons has come with the help of the state’s sheriffs, wardens, prison administrators and others directly involved in the public-private carceral system.

“They are my biggest allies because they see how beneficial it is to provide evidence-based medical care to those in their systems,” said Elyse Powell, PhD, State Opioid Coordinator, North Carolina Department of Health and Human Services (NCDHHS).

Dr. Powell said that the NCDHHS recently awarded $10.6M to fund 18 grantees to create jail-based pre-arrest diversion and/or re-entry services that connect people to SUD treatment, including MOUD. She also is helping to promote the expansion of treatment and recovery courts in partnership with the North Carolina Administrative Office of the Courts and said that a forthcoming $6.5M Bureau of Justice Assistance grant to fund jail-based MOUD programs to support people while they are incarcerated.

In summing up the webinar, Manatt Health managing partner Jocelyn Guyer noted that just because there are laws and medical evidence, it is essential for medicine, law and public policy to work together.

“Laws don’t enforce themselves, and patients don’t always know who to go to for help,” said Ms. Guyer. “The medical-legal-policy partnership is one that all states should seek to develop.”

Click here to read the full 2020 AMA-Manatt National policy roadmap.

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