NIH/JAMA Study Draws Attention to The Lack of MOUD in Corrections; Can Medicaid & 14th Amendment Rights Challenge The Status Quo?

Highlighted Stories

Editor's Note

This week’s first highlighted story comes from the National Institute of Health (NIH). The article reports on a study published in JAMA which was supported by the NIH’s National Institute on Drug Abuse (NIDA). The study found that medication for opioid use disorder (MOUD) was offered in fewer than half the jails throughout the country, even though MOUD reduces opioid use, prevents overdose deaths, and supports long-term recovery --it should be noted that the Department of Justice Civil Rights Division states that it is a violation of the Americans with Disabilities ACT (ADA) if a jail does not allow incoming inmates to continue a MOUD that was prescribed before their detention.

The second highlighted story from the University of New Mexico talks about a study of methadone treatment in the Bernalillo County jail, the Metropolitan Detention Center. This study found that there is a lower rate of recidivism for those who received methadone while incarcerated. The third highlighted article from Corrections 1 also touts the benefits of MOUD but refers to it as medication assisted treatment (MAT). That article goes on to say that MAT remains controversial in corrections --despite, as mentioned above, the DOJs ruling that denying such treatment is a violation of the ADA.

Why is this proven treatment with the imprimatur of a Department of Justice ruling so controversial? Let us imagine a similar study but changing the disease to which there is also a proven treatment: diabetes and insulin. It is not hard to predict that there might be an attempt to improve the bleak statistics such as those in the NIH article, if more than half the diabetics who enter jails were not receiving insulin (although it is still not rare or unheard of that incarcerated diabetics do not receive insulin and suffer adverse outcomes, even death). In the end, what the NIH and Corrections 1 article could be interpreted as saying is that within the carceral system there is some barrier to the treatment of substance use disorder (SUD). If one were to take a wild guess that barrier might have something to do with the carceral system often viewing SUD not as a disease but as a moral failure of character.

In previous Editor’s Notes, we have addressed correctional intransigence concerning the healthcare of incarcerated people. As before COCHS sees the entitlement of Medicaid creating rights under the 14th Amendment as a possible way to address correctional intransigence.

Let’s be explicit, what COCHS is once again suggesting is that with the 1115 Waivers that permit Medicaid behind the wall and sections 5121 and 5122 of the Consolidated Appropriations Act of 2023, individual Medicaid beneficiaries may have statutory and constitutional rights to challenge the failure to receive care no matter the moral judgement a carceral system has about SUD. Subjective moral opprobrium does not create a barrier to an individual’s rights under the 14th Amendment. Going back to the diabetes example, it would not be challenging for our subscribers to imagine a plaintiff’s attorney arguing that an incarcerated person under the 14th Amendment has a right to obtain care whether that person is diabetic or suffers from SUD.

Will pursuing the 14th Amendment rights of an incarcerated Medicaid beneficiary prove to be effective? We don’t know. But as we have seen with the NIH article the inability of the carceral system to treat what is a treatable disease requires new approaches. To quote Franklin D. Roosevelt, “Above all, try something”.

MOUD/MAT In Corrections

A new look into addiction treatment availability in the U.S. criminal justice system reveals that fewer than half (43.8%) of 1,028 jails surveyed across the nation offered any form of medication for opioid use disorder, and only 12.8% made these available to anyone with the disorder. With two-thirds of people who are incarcerated in U.S. jails experiencing a substance use disorder — in many cases, an opioid use disorder — the failure to make these medications widely available in criminal justice settings represents a significant missed opportunity to provide life-saving treatments in an environment where people in need of care can be easily reached.

If you provide methadone treatment or other substance use disorder treatments in jails, will it reduce people from going back to jail? Several University of New Mexico researchers say yes. Studies show when someone enters the criminal justice system, they're much more likely to go back. Brady Horn, a professor in the Department of Economics studied a program within Bernalillo County's Metropolitan Detention Center (MDC) that provides methadone treatment in their jail. “People who receive methadone maintenance in jails, went back to jail less, which saved New Mexico taxpayers more money in the long run,” Horn says.

MAT is a more effective and cost-efficient way to treat addiction and is the approach most supported by research. In the correctional community, MAT has been shown to more safely manage detox, reduce withdrawal symptoms, improve patient engagement in rehabilitative programs, and provide a smoother transition to community-based care upon release. Yet despite the compelling and growing body of evidence that MAT is medically effective, promotes better health outcomes, and reduces the incidence of relapse, the treatment remains controversial and stigmatized, largely due to the myth that MAT simply replaces one drug with another.

2024 Election

Matt Mahan, Mayor of San Jose writes in this op-ed: Fentanyl and drug addiction are overwhelming California communities. Drug overdoses are now the leading cause of death for Californians aged 15-44. Addiction is fueling the homelessness crisis and creating an epidemic of retail theft that’s raising costs for working families. To stop the suffering, we need to get more people into treatment — now. That’s why a growing community of locally elected officials are voting yes on Prop. 36. Let California judges require drug treatment that ends suffering on streets.

This article contains a guide of the most common offices for which citizens will cast their ballots this November. The article also explores how those offices can make decisions to reduce the number of people behind bars, improve conditions in prisons and jails, and help turn the page on America’s failed experiment with mass incarceration.

BOP

U.S. Senators Martin Heinrich (D-N.M.) and Bob Casey (D-Pa.) introduced legislation to protect prison officers, staff, and inmates from fentanyl and other illicit substances entering the Federal Prison System through inmate mail. By directing the Bureau of Prisons (BOP) to develop a strategy that guarantees all mail is screened for illicit contraband, the Interdiction of Fentanyl at Federal Prisons Act would reduce the risk of intentional poisoning or lethal exposure from illicit substances in federal prisons and support the 38,000 BOP corrections officers and staff that are dedicated to keeping prisons safe.

One of the country’s busiest federal prisons, Lewisburg, Pa, a transit point for 27,000 inmates a year, is buckling under a staggering array of problems, including substandard health care, crumbling facilities and harassment of employees by other staff. Among the most alarming findings is the unusual decision by the prison’s medical director to discontinue antidepressant medication for 15 inmates — without consulting or examining the patients. The medical staff also failed to provide inmates with basic care, tests and screening for colorectal cancer and diabetes. Investigators also found that corrections staff acted in grossly inappropriate ways — hanging framed Nazi-themed art from prisoners on the walls of staff-only areas.

A federal facility in Pennsylvania has failed to take steps to reduce suicide risks among inmates — contrary to policies from the federal Bureau of Prisons and repeated reports from the Justice Department’s Office of the Inspector General, according to the latest federal review on the facility. This latest report, part of the OIG’s unannounced inspection program of facilities run by the BOP, unearthed a host of additional issues at Lewisburg. The BOP’s nationwide staffing crisis continues to be a problem in this facility, as does inmate healthcare quality, leaking infrastructure and employee conduct.

Cancer

A new study by researchers at the American Cancer Society (ACS) showed individual or partner incarceration history was associated with a lower prevalence of receiving cancer screening. Compared to females without individual or partner incarceration history, women with partner incarceration history were less likely to receive breast cancer screening; women with individual incarceration history were less likely to receive colorectal cancer screening. Compared to males without individual or partner incarceration history, men with partner incarceration history were less likely to receive colorectal cancer screening.

Venereal Disease

This was a recorded webinar now available on YouTube that examined the scope of the syphilis increase in the correctional environment and offer best practices on syphilis identification and treatment. Best practices explored will include programmatic interventions (including adopting a universal "opt out" test strategy and reverse testing algorithm), point-of-care testing initiatives, considerations for identification and treatment of pregnant people with syphilis, and the importance of collaboration with health department officials on cases.

Climate Change/Heatwave

A new study by MIT researchers examines summertime heat exposure in prisons across the United States and identifies characteristics within prison facilities that can further contribute to a population’s vulnerability to summer heat. They found that the prisons that are exposed to the most extreme heat are located in the southwestern U.S., while prisons with the biggest changes in summertime heat, compared to the historical record, are in the Pacific Northwest, the Northeast, and parts of the Midwest. The team also looked at the demographics of 1,260 prisons in their study and found that the prisons with higher heat exposure on average also had higher proportions of non-white and Hispanic populations.

State Roundup

Alabama

A former corrections officer has formally pleaded guilty in the death investigation of Tony Mitchell in the Walker County Jail.Joshua Jones, 25, pleaded guilty to deprivation of civil rights. One of the charges against Jones involves the assault of a different inmate who was posing no threat to officers, according to court records. The records explain Jones hit the inmate in the face three times with a can of pepper spray.

California

Testifying Wednesday before a Senate Judiciary subcommittee, Breane Wingfield said she was 14 when, in 2005, she was sexually assaulted in a van by a deputy probation officer employed at Los Padrinos Juvenile Hall in Downey. It happened again at a holding cell at the Compton Courthouse, she said. And again, almost daily, she alleged, by a guard at Camp Joseph Scott, a juvenile probation facility in Santa Clarita.

Connecticut

Two incarcerated men have participated in a hunger strike for better conditions in Connecticut prisons for the past eight days. Jacky Robinson Jr. and Cornel Myers have refused food since Sept. 16. The men’s demands include improved medical treatment and mental health services for prisoners, fewer prison lockdowns and shakedowns, and increased communication between prisoners and the outside world.

Florida

Footage obtained through the “Ocala Gazette’s” lawsuit against the Marion County Sheriff’s Office showed that inmate Scott Whitley exhibited no physical violence toward Marion County Jail detention deputies before he was rushed to the floor, restrained and hit with a Taser 27 times over 12 minutes. Whitley died in custody on Nov. 25, 2022. The medical examiner ruled his death a homicide.

Illinois

A hazmat team arrived at Shawnee Correctional Center in Vienna after six staff members experienced medical symptoms. This incident comes amid several reports of reported drug exposures at the Illinois Department of Corrections. State Sen. Dale Fowler along with his fellow southern Illinois lawmakers sent a letter to Acting IDOC Director Latoya Hughes to formally request that she temporarily suspend processing all non-legal mail until action is taken to safeguard employees and inmates.

Mississippi

A statewide program wants to help people with mental illness facing felony charges get out of jail and into treatment. The forensic navigator program is a grant-funded collaboration between the Roderick and Solange MacArthur Justice Center at the University of Mississippi School of Law and the Department of Mental Health. A goal of the navigator program is to help reduce the wait time for forensic evaluations at the State Hospital. Evaluations help determine if a person is competent and able to understand the charges against them and they are able to help with their legal defense.

New Jersey

A 23-year-old Ocean Township man, Kavan Costello, who said he was beaten by Monmouth County Jail officers who knocked out two of his front teeth in 2020 won a $525,000 jury award. Costello was arrested Feb. 17, 2020, in Ocean Township. Officers began to verbally abuse Costello, hurling “homophobic slurs and profanity" at him, the suit alleged. Several sheriff's officers set upon the 5-foot-9-inch, 145-pound Costello, punching and kicking him in the head, face and body and knocking out one of his front teeth, according to the lawsuit.

Oklahoma

The Oklahoma State Department of Health wants the Oklahoma Supreme Court to order the Oklahoma County jail trust to let its inspectors in without notice, although District Attorney Vicki Behenna argues that the department has no such authority and that surprise inspections are disruptive to operations. The department went to the high court after the jail trust sued in district court, asking a judge to permanently block surprise inspections. The trust says inspections can take three davs and involve a dozen jail staff to follow inspectors' directions while maintaining security. The Health Department wants the justices to declare that inspectors can enter the jail at 201 N Shartel Ave. downtown, "even when unannounced."

Vermont

The political debate about plans to replace Vermont’s only women’s prison, Chittenden Regional Correctional Facility, is marked by calls for reform, fiscal responsibility and abolitionism. But for those who are incarcerated at or work inside the 50-year old facility originally built for short term confinement, the debate centers on quality of life.

Reentry

A recent study that formerly incarcerated people had double the rate of suicide mortality compared to the general population three years after their release, with the highest risk of suicide occurring within the first two weeks of their release. These findings underscore the acute vulnerability and fragility that many face as they transition from carceral settings to community living. The new data underscore the urgent need for long-term support and systemic reforms that promote “equity, justice, and human dignity” for formerly incarcerated individuals’ during and after their return to their communities.

Correctional Officers

Louisville Metro Department of Corrections has installed a tribute to its officers lost to suicide in honor of Law Enforcement Suicide Awareness Day. The department formally unveiled a wall honoring the service of the officers it has lost. LMDC brought in mental health providers for the current officers, staff and families on hand. Corrections Chief Jerry Collins said the point of the event is to let prospective and current officers know there's nothing wrong with getting help when you need it.

Proprietary Correctional Health Care Vendors

Wellpath

The Pitt County Board of Commissioners in July authorized the sheriff’s office to seek proposals for jail medical services after WellPath requested a fee increase that was 22 percent higher than the 5 percent annual increase allowed in its contract, which is in place through 2025. Sheriff Dance said her office and WellPath, which has provided medical services at the detention center since 2021, continued contract negotiations even when the company indicated in the spring it would exercise its right to cancel the existing contract if its requested increase was not met.

Turn Key Health Clinics

Avery James Borkovec who had staph bacteremia and was repeatedly denied proper care for about a month, died after staff "didn’t even do the bare minimum to treat him," according to a lawsuit filed Friday. None of Borkovec's conditions — which the lawsuit said included "an elevated (white blood count), positive blood cultures, a persistently high pulse, ongoing signs of infection" — were reported to medical staff at the Boulder County Jail. "Turn Key workers’ conscious choice not to convey this information to Boulder was a complete and total dereliction of their gatekeeping duties," the lawsuit reads.

PrimeCare Medical

The details of how medication through the MAT program is administered at the Clearfield County (PA) Jail was a main topic of discussion during the Prison Board meeting. Tom Weber, the chief executive officer of PrimeCare Medical, explained a letter sent to the board stating that the group is going to stop the support program. “Our nurses now are spending hours a day handing out prescriptions,” he said, adding this is not what they are contracted to do. The original medication was an injection only done once a week, but because they are very expensive, they switched to Suboxone, which is given daily. The jail is required by the state to include the MAT program for inmates who are already in a drug treatment program when they become incarcerated. Eventually it may become mandatory to also cover any inmate with an addiction.

With free legal support from attorneys at the Reporters Committee for Freedom of the Press and Cornell Law School’s First Amendment Clinic, Pennsylvania newspapers are uncovering wrongful-death settlements involving a private health care provider that receives millions of taxpayer dollars each year to service county prisons. In just the past couple of years, the York Daily Record and Bucks County Courier Times have successfully challenged the sealing of three settlements reached between the estates of people who have died in local prisons and PrimeCare Medical, a private contractor that has faced allegations of providing inadequate medical care to inmates. And their effort to chip away at the secrecy concealing wrongful-death settlements isn’t finished.

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