Meeting People Where They Are: Corrections, Telehealth, and OUD

Despite constitutional protections ensuring health care, few experiences are as predictably inhumane as a person’s entry into American corrections with an active opioid use disorder (OUD). For those taking non-prescribed opioids, the immediate impact is agonizing withdrawal, nearly always without substitution opioids such as methadone or buprenorphine. People in formal treatment on methadone or buprenorphine have the same experience: “I suffered like I was—I cried like a baby” (Maradiaga, 2017). OUD does not disappear during incarceration. This results in an active contraband economy and its associated dangers: hazards of purchase, institutional punishment for those who are caught, an institutional approach that sees contraband as the problem rather than a symptom. The vast majority of people who are ultimately released face one of the most predictably hazardous periods in America: during the weeks after re-entry, their mortality rate is over 100 times that of their community cohort. Yet the factors leading to overdose after re-entry include a host of remediable circumstances (Joudrey, 2019).The ubiquity, unconstitutionality, and predictability of this re-entry harm not yet led to scaled treatment of OUD in US correctional settings. This situation is slowly changing, with the state of Rhode Island offering all three FDA approved medications for people during incarceration and finding a 50% improvement in post-release mortality. The American Civil Liberties Union has begun a campaign of lawsuits to uphold Eighth Amendment protections. A recent DEA decision to allow mobile methadone units provides the possibility of correctional contracts with Opioid Treatment Programs. Telehealth, however, holds the most promise for scaled, flexible, effective treatment during and after incarceration. This is especially true given the modifications to related regulations that began in early 2020 with the COVID-19 pandemic. Over the past year, our organization, Boulder Care, has partnered with Jackson County Community Justice (JCCJ) in southern Oregon. The model we collaboratively created addresses the “pain points” both for correctional sites and for providers of medications for opioid use disorder (MOUD). Our treatment of choice is buprenorphine-naloxone as it is the only MOUD that reduces mortality and allows for telehealth-based prescribing. Our model is designed to be readily replicated among different types of correctional settings in different geographies by different clinical organizations. Our ASAM workshop will introduce this model and the workflow and roles that make it work. These roles include a: Probation Officer Liaison who is familiar with corrections and probation work; Team Clinician who prescribes medication, addresses health conditions, and customizes care plans; Care Advocate who helps with scheduling, referrals, and pharmacy logistics; and a Peer Specialist who offers lived experience of recovery goals, challenges, and local resources.We will also describe the evidence-based aspects of our program that have led to high levels of care retention and patient safety after release.Workshop attendees will be able to hear directly from each member of the team, understand approaches to partnering and deploying the model, examine areas that may need troubleshooting, and obtain their own detailed description of workflow so as to best facilitate replication nationally.