Yes – upon release. We currently provide all Naltrexone and Buprenorphine products at release. Patients are screened by substance use or mental health professionals and referred to medical for prescription and administration prior to release. This has been phase 1 of our expansion. Further expansion begins next month.
Yes, beginning Aug. 1 we will provide all naltrexone/buprenorphine products to all residents with an OUD diagnosis, an opioid-related conduct violation, overdose, use of Narcan, etc., following the same process as above. Phase 3 will start Nov. 1 and this will allow all residents to self-refer for any reason and at any time, again following the above process. In all cases, the department does not make clinical decisions and all prescription and medical viability are left to the department’s contracted health care provider (Centurion Health).
The department fully supports MOUD and expansion in our institutions. The current biggest barrier is ensuring continuity of care upon release due to lack of availability or long waitlists for MOUD in some parts of the state.
We work closely with MO Dept. of Mental Health and MO Behavioral Health Council to ensure continuity of care as much as possible. Our substance use treatment contractor (Gateway Foundation) is invaluable in providing prerelease education and a warm handoff with providers at release.
We’re currently pursuing a 1115 Medicaid Waiver to help expand coverage. The opioid settlement is funding most of our program and the expansion. Additional community resources and state funding would be helpful. Expansion at all local/county jails and sheriff departments would be very helpful. We are also working toward being certified to prescribe and dispense Methadone—any easing of restrictions or regulations in this area would be extremely helpful. Methadone is currently only used for pregnant females or for those coming in on Methadone, but obtaining and providing doses from the community, or having to take residents out to a community clinic, can be very difficult and disruptive for a correctional setting.
MOUD is available at all 19 MO Dept. of Corrections facilities and our two transition centers (Probation and Parole facilities). All facilities also have Narcan available (all nurses carry it and doses are available in high-traffic distribution points for all staff) and we distribute Narcan to all residents at release.
With our expansion, I think MOUD availability is better in DOC facilities than it is in the community. This tends to be true for all behavioral health and psychiatric treatment. We can always do better but are striving to make all MOUD available.