Legislators move to expand substance use treatment in county jails

(The Center Square) – Lawmakers are hoping to expand and improve upon a 2015 law that offers grants to county jails treating inmates experiencing substance use disorders.

Act 80 provides funding for the use of naltrexone, or Vivitrol, an injectable extended-release drug that blocks the effects of opioids. Since the passage of the act, several other medications for opioid use disorder, or MOUD, have proven to be better options for many patients.

“A substance use disorder is a chronic medical condition. It is a disease, a family disease which we need to normalize and integrate care for,” said Secretary Dr. Latika Davis-Jones of the Department of Drug and Alcohol Programs. “A substance use disorder is not a crime. It is not a moral failing, and it cannot be addressed with a one-size-fits-all approach.”

Davis Jones expressed her support for House Bill 561, introduced by Rep. Maureen Madden, D-Tobyhanna. It would open up the current legislation to fund additional options like methadone, buprenorphine and its extended-release injectable form, Sublocade.

Unlike Vivitrol, these medications do not require the user to go through a full detox before beginning medication, allowing active drug users to have a more comfortable and less dangerous transition during incarceration.

Advocates say that the benefits of offering MOUD aren’t limited to inmates’ experiences while incarcerated. Proper use of medication assisted treatment leads to fewer overdoses once they are released. This is largely because periods of abstinence lower a user’s tolerance for the drug, causing what may have once been an average dose to become a lethal one and making them 150 times more likely to overdose.

Legislators are also hopeful that expanded treatment will lead to less recidivism. James Egler, administrator for Franklin/Fulton Drug and Alcohol Program, said that medication assisted treatment helped give him the tools he needed to heal and build his life back.

“That stability and ability to focus on treatment instead of withdrawal and cravings was essential to my success,” said Egler, emphasizing that incarcerated people should have the same opportunity.

The Pennsylvania Commission on Crime and Delinquency has been tasked with administering the grant program, which they say 32 counties have utilized. They say that inflexibility of current funding is one factor contributing to underutilization of the program, though they also attribute their surplus to the influx of federal funding for Covid-19.

Act 80 funding can be used to support treatment beyond MOUD, including creating the staffing and security needed to successfully operate treatment programs in a carceral context.

Some legislators have expressed concern over the potential for abuse and overdose with drugs like methadone and buprenorphine.

“I think there’s a misconception about for example buprenorphine, ‘Oh people are using it just to get high,’” said Su Ming Yeh, executive director for the Pennsylvania Institutional Law Project. “Well our clients constantly tell us, ‘It’s not to get high. It’s really because it makes me feel normal. It makes me feel like I can function like a human being.’”

At this time, nothing prohibits county jails from offering MOUD on their own. Each of the state’s 62 county jails operates independently under the supervision of county commissioners and prison boards. Some have contracted with outside services to provide MOUD to their inmates, while some incorporate the use of Act 80 grants. The Pennsylvania Department of Corrections uses the full array of MOUD options to treat state prisoners.

A 2022 breakdown of practices across the state from the Pennsylvania Institutional Law Project revealed a variety of approaches – or lack thereof – in the state’s 62 county jails. According to the report, 15% of jails offer no MOUD and 18% offer it exclusively to pregnant people. Twenty-six percent offer naltrexone only, 26% offer continuation of already prescribed medication, and 11% offer likely no continuation.

Just 5% offer induction, or the initial prescription of MOUD to inmates during their incarceration.

“Most of the individuals incarcerated will ultimately be released and be all of our neighbors, our coworkers, and our children are going to play together on the playground,” said Franklin County warden Heather Franzoni. “This house bill amendment will ensure that I can continue to offer a choice to those in our care.”