Medications for opioid use disorder (MOUD) are the only empirically based treatments for OUD and substantially reduce the risk of overdose and death. Initiation and use of MOUD during incarceration is especially beneficial to prevent relapse and promote engagement in treatment during the high-risk period after incarceration. Thus MOUD for people who are incarcerated is crucial to engage people with OUD in treatment and prevent overdose and death.
The Vermont legislature signed Act 176 in May of 2018 to mandate all three FDA-approved MOUDs (buprenorphine, methadone, and naltrexone) to all residents of correctional facilities with OUD. More recently, the onset of COVID-19 resulted in substantial changes in protocols within correctional facilities and changes in access to treatment in the community. This evaluation aims to assess the impact of MOUD implementation and COVID-19 in Vermont’s correctional facilities.
The aims of this study are twofold: a) evaluate the recent statewide implementation of MOUD in Vermont’s correctional facilities and b) assess the impact of COVID-19 on MOUD for people incarcerated or recently released in Vermont. The proposed evaluation will be comprised of a) retrospective analysis of statewide VT Department of Corrections (DOC) data on correctional facility residents, b) retrospective analysis of Medicaid claims data for the year immediately following release from incarceration, and c) qualitative analysis of interview data from a sample of VT DOC healthcare providers and administrators.
The study has three specific aims and one exploratory aim:
- Specific aim 1: To compare treatment utilization and characteristics of engagement in MOUD in Vermont’s correctional facilities (e.g., medication type, adherence, and duration) a) before versus after MOUD implementation and b) before versus during Vermont’s COVID-19 state of emergency.
- Specific aim 2: To compare MOUD utilization during the year following release from incarceration a) before versus after MOUD implementation and b) before versus during Vermont’s COVID-19 state of emergency.
- Specific aim 3: To compare the percent of fatal and non-fatal overdoses within 1 year after release from incarceration in Vermont a) before versus after MOUD implementation and b) before versus during Vermont’s COVID-19 state of emergency.
- Exploratory aim 4: To qualitatively describe VT DOC healthcare providers’ and administrators’ experiences with a) the process of implementing MOUD and b) the impact of COVID-19 on treatment for OUD.
Study Settings: Jails/Prisons
Elias Klemperer, PhD
Vermont Center on Behavior and Health; University of Vermont Larner College of
J-RIG Award, State Policy Rollout