Few correctional facilities in the United States have treatment programs for individuals with opioid use disorder (OUD), despite clear evidence that certain medications reduce the risk of overdose and death. Even in facilities where treatment is available, the COVID-19 pandemic has complicated efforts to provide such care. But an article recently published in the Journal of Substance Abuse Treatment demonstrates how one Minnesota jail has continued providing access to medications for OUD, especially buprenorphine, amid difficult conditions.
Since the pandemic started early this year, jails and prisons—where infectious diseases can easily spread—have acted to reduce potential exposure and protect individuals who are incarcerated and staff by reducing their populations. But with efforts focused on ensuring appropriate physical distancing and providing COVID-related care, staff members may be less able to provide other essential health services.
Officials at the Hennepin County jail in Minneapolis, however, have worked to make sure that people in the facility can still get the treatment they need for OUD. The county reduced its jail population by 43%, which helped ensure that the staff has adequate resources to continue providing OUD treatment to individuals in need. That included all three Food and Drug Administration-approved medications: methadone, buprenorphine, and naltrexone.
More importantly, the staff has been able to make buprenorphine, which is strictly regulated, more readily available than before, thanks to relaxed federal regulations. Before the pandemic, buprenorphine could be provided to patients only after an in-person consultation with a health care provider licensed to prescribe the drug.
As part of the federal government’s public health emergency declaration in March, licensed prescribers can now initiate buprenorphine treatment via telemedicine visits, even in correctional facilities, to reduce potential exposure to COVID. Hennepin County took advantage of this change to offer lifesaving medication to individuals in need of OUD treatment in its jail while maintaining safety measures and physical distancing through telemedicine visits with a clinician. The jail’s medical staff can now offer buprenorphine via telemedicine to patients already being treated with the drug, individuals who want to start treatment, and people who are not interested in initiating treatment but who may struggle with withdrawal symptoms upon entering the facility.
The Hennepin County jail serves as an example of how correctional facilities can continue to provide OUD treatment during a pandemic that has exacerbated the opioid overdose crisis. Nationwide, policymakers should prioritize efforts to increase access to FDA-approved medications proven to help people manage their disease—especially in correctional facilities.
Making the relaxed telemedicine regulations for buprenorphine treatment permanent after the pandemic subsides would help accomplish this goal. By continuing these practices, clinicians working in correctional settings would have increased flexibility to treat patients, particularly on weekends, when many facilities do not have an on-site prescriber.
Correctional facilities should continue to offer buprenorphine to all patients who could benefit, whether they are already being treated with this medication, starting treatment, or need help managing withdrawal symptoms. Such support should be provided immediately after individuals enter jail. It should be continued throughout their stays and be available if they are referred to community providers upon release. Such flexibility—and attention to the need for sustained treatment—will save lives.
Alex Duncan works on Pew’s substance use prevention and treatment initiative.