Maryland must meet its commitment to address the overdose crisis in the criminal justice system

In our efforts to combat the overdose crisis, one area is too often overlooked: the criminal justice system, which accounts for more than a third of referrals to addiction treatment programs.

Approximately half of people incarcerated in the United States meet criteria for a substance use disorder (SUD). Incarcerated people are up to 40 times more likely to die from an overdose within two weeks of release, which is a leading cause of post-release deaths because tolerance to opioids decreases during incarceration if medication for opioid use disorder (OUD) is not administered. Furthermore, whether a person receives medication for OUD while incarcerated may be in the hands of a prison administrator with no medical training.

We know that receiving treatment during and immediately after release reduces the risk of death by up to 75%. Nationwide, medications for OUD are underused in the criminal justice system, even though barriers to buprenorphine have been lifted and licensed physicians can prescribe it without an X-waiver. Incarcerated individuals still face forced withdrawal after incarceration and lack of access to evidence-based, life-saving medications like methadone or buprenorphine.

What is Maryland doing about this crisis? The State Opioid Use Disorder Examination and Treatment Act (formerly House Bill 116, 2019) required local correctional facilities and the Baltimore Pretrial Complex to implement OUD screening, assessment, and treatment programs including methadone, buprenorphine, and naltrexone by January 2023.

Despite serious efforts, Maryland is lagging behind in meeting legal requirements.

COVID-19 initially delayed implementation efforts, so the Governor's Office of Crime Prevention, Youth and Victim Services provided grants to Health Care Access Maryland (HCAM) and Health Management Associates (HMA) to provide technical assistance to correctional facilities. In their FY 2023 report, only 19 of Maryland's 24 correctional facilities reported aggregated data on implementation status, and overall the number of inmates treated for OUD was well below national estimates of OUD prevalence in correctional facilities.

What are the obstacles to full implementation in Maryland's detention centers? Continued and sustainable funding is key.

In Maryland, access to insurance benefits is suspended during incarceration, so medical care is a state-funded endeavor provided by contracted medical providers, health departments, or facility staff. As a result, new treatment programs create new costs that require additional funding.

In Maryland's case, local funding opportunities were made available through the Opioid Operational Command Center, but the administrative burden associated with the grants and the restrictions imposed on the use of funds for new positions beyond the grant period were identified as barriers.

In January of this year, I testified as part of the Community Overdose Action Town Hall Series. Maryland's Office of Overdose Response hosted town hall meetings across the state to hear from residents about how to address the overdose crisis.

My testimony addressed ways to reduce the impact of SUD at the county level and in Maryland generally. While there are no easy solutions to this multifaceted problem, there are areas that urgently need funding now—including funding needed to meet the requirements of the State Opioid Use Disorder Examination and Treatment Act. We also need more robust data collection and more comprehensive health information sharing.

It is imperative that financial support for these programs is integrated into correctional budgets and not just provided as time-limited grant opportunities, particularly in the prison system where resources are so scarce.