Why are so few former Virginia inmates receiving treatment for substance abuse disorders?

Posted at 5:52 PM, Apr 22, 2024

RICHMOND, Va. -- National data suggests about 85% of people in the incarceration system struggle with substance use disorder.

According to a new research study released by VCU, over 4,600 adults were released from county jails and state prisons in 2022. About 85% of that population were enrolled in Medicaid.

However, only about 17% had received a diagnosis or treatment for substance use disorder while on Medicaid, including opioid use.

"Almost 80% of all Medicaid members with an opioid use disorder have been receiving medication-assisted treatment, but that's only about a fourth among those who are recently released from incarceration," said Dr. Peter Cunningham with VCU's Department of Health Policy.

Dr. Peter Cunningham

The research was done as part of a study with the Virginia Medicaid Agency and Department of Medical Assistance Services (DMAS), using data from the Department of Corrections and Medicaid.

Dr. Cunningham said the findings are likely caused by a multitude of barriers people coming out of the incarceration system face.

"A lot of times they don't have a stable place to live, a lot of time there's a gap between when they're enrolling in Medicaid and when they can sort of get the right set of providers to initiate treatment," Cunningham said. "When they're released, it's kind of a very vulnerable and high-risk time, and if they're not currently in a treatment program, then there's a risk. For example, they're going to start using again, their tolerance has gotten lower, and it's going to increase the risk of an overdose."

Under federal law, Medicaid will only cover emergencies for someone who is incarcerated. There are some alternative treatment options offered in some jails or prisons, like Chesterfield County Jail's HARP program, which helps those currently incarcerated who have struggled with substance use disorder.

Based on VCU's research, Cunningham said getting an inmate medication-based treatment through Medicaid while they're awaiting release could prevent overdoses or reentry into a jail or prison.

"I think one of the barriers is that the prisons have often just been reluctant to allow those kinds of substances into those settings," Cunningham mentioned, citing treatments that would include the use of methadone or buprenorphine. "But that is the evidence-based standards for treating an opioid use disorder."

Cunningham said some states have sought waivers for pre-release treatment through the Centers for Medicare and Medicaid Services. CBS 6 asked DMAS if a waiver-based program could come to Virginia and is awaiting a response.

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