Yes. Buprenorphine, naltrexone, and methadone.
2 major changes coming. (1) we will be opening a Methadone medication unit in 1 facility (currently meds are brought into the facility via a chain of custody agreement between the OTP clinic and the carceral facility. This change will have the OTP hire the dispensing nurse and embed them into the carceral facility. (2) VT was approved yesterday for an 1115 Medicaid Waiver demonstration grant which will allow for individuals in the facility to received Medicaid during their last 90 days of incarceration thereby improving transitions of care from prison to community as well as cost offsets for MAT medications by having health insurance the last 90 days.
Nothing at this point as we treat a little over 50% of our correctional population with MOUD. Cost of care had been the biggest challenge, but the Medicaid 1115 helps that.
Individuals leaving the carceral setting fold into the VT Hub and Spoke provider system, our state system of MOUD services. VT has the highest capacity to treat in the USA and provides more MOUD per capita than any other state in the US. For detainees, who are subject to release without any prior notice, we offer open community access 6 days a week at all VT Hubs (opioid treatment programs that offer all 3 FDA meds) as well as individuals abruptly released can call back to the facility and the state will call in a bridge prescription for the patient, paid for by the state healthcare contractor. Additionally, all but 1 VT hospital Emergency Dept will offer buprenorphine from the ER with predefined clinical pathways to community providers who will continue the ongoing MOUD care.
The 1115 waiver will support in-reach of providers and recovery coaching staff to support transitions of care from prison to community. The biggest issue is the workforce, we have open positions available throughout the state in all areas of the care continuum.
100%
Biggest difference is the % of folks in treatment. VT treats just under 3% of its total population 18-64 with MOUD, while in the carceral setting we are treating roughly 50% with MOUD.