Receiver announces plan for medication assisted SUD treatment in CA prisons

This week Clark Kelso, the federal receiver for the California Correctional Health Care Services, announced a plan to provide medication assisted substance use disorder treatment to inmates in the state prison system. The proposal is aimed at reducing fatal drug overdoses among inmates which killed a reported 39 inmates last year.

Citing the success of recent treatment pilots, recommendations from the courts, prison system experts, and SUD treatment providers, Kelso stated,

“I have decided to direct my staff to plan for the implementation of a comprehensive substance use disorder treatment program, including the use of Medication Assisted Treatment (MAT), to reduce the substantial number of patients within California Department of Corrections and Rehabilitation (CDRC) who have substance and/or opioid use disorders (OUD)”

The plan will focus on:

  1.  Reducing opioid overdose deaths within CDCR;
  2. Improving continuity of treatment for inmates coming into and leaving CDCR; and,
  3. Developing a system wide SUDT program, based in the chronic disease management and complete care programs, including MAT, with an ultimate goal of providing treatment for all patients in CDCR with chronic OUD who wish to participate in the program.

In his announcement, Kelso noted that though overall death rates in California prisons have fallen, the death rate from drug overdose has actually grown in the last 10 years from 5.3/100,000 in 2007 to a high of 22.5/100,000 in 2016 compared to 14.7/100,000 nationally.

This increase comes as at the same time as the system began a $15.3 million dollar crackdown on prison contraband in 2014 aimed at stemming the flow of drugs into the prisons, which had some success, but was criticized for not addressing the real issue, demand from addicted prisoners.  A new report on Substance Use Disorder in the CDCR system, states that an estimated 80 percent of inmates, or approximately 100,000, are affected by Substance Use Disorder. Of the 100,000 inmates with SUD, approximately 26 percent are dependent on opioids.

Up until 2016, California prisons did not use any medication assisted treatment for inmates with opioid use disorder, but that year Governor Brown approved SB 843, which required that the CDCR, develop and implement a three year MAT pilot program at one or more institutions. The program was implemented on January 2017 at the California Institution for Men in Chico and in September 2017 at the California Institution for Women in Corona.  A recent evaluation of the program showed reduced rules violations, a decrease in the need medical and mental health care after receiving medications, and no reports of positive drugs tests alcohol or opioids for inmates who have started medication.

The current proposal will likely be costly, perhaps upwards of $250 million. Kelso states that a more detailed plan will emerge in the next four to six months with the goal of presenting a plan to the Administration and Legislature in time for inclusion in the 2019- 2020 budget.