Maryland lawmakers approved legislation Saturday that would require every county jail and Baltimore’s state-run detention facility to provide addiction screening, counseling and treatment with three federally approved medications.
The bill would make Maryland one of just two states to offer methadone, buprenorphine and naltrexone inside jails, if Gov. Larry Hogan signs it. The Republican governor is spending record amounts to combat the state’s opioid overdose crisis, including a $378 million plan to build a therapeutic treatment center attached to Baltimore’s jail, and he has budgeted more funds for medication treatment in jails.
The state corrections department scaled back the legislation devised by Del. Erek Barron, a Prince George’s County Democrat who wanted it to apply to state prisons, as well. However, Maryland officials would study the possibility of expanding the effort into prisons, depending on the progress of the initiative.
The first programs would start by January in Baltimore and at jails in Howard, Montgomery, Prince George’s and St. Mary’s counties. Baltimore County has already started a similar effort under a federal grant. All jails would have programs running by Jan. 1, 2023, at an estimated cost of $8 million.
“I had to focus on where the greatest need was,” Barron said. “It’s a huge first step. It has the potential to make a huge impact on the opioid crisis.”
People suffering from opioid addiction who are sentenced to shorter stays in county jails and Baltimore’s pretrial detention center often endure painful withdrawal, and studies show that soon after they are released from custody, they are more at risk of fatal overdoses than the general population.
There were about 7,400 people incarcerated in jails around Maryland last year and about 18,600 in state prisons.
According to the Maryland Department of Public Safety and Correctional Services, approximately 70 percent of individuals who enter the system suffer from substance abuse or dependence.
“Drug overdose is among the leading causes of death for individuals re-entering the community, with a majority of these overdoses involving opioids,” according to a report by the U.S. Substance Abuse and Mental Health Services Administration. “The field of criminal justice has been slow to incorporate Food and Drug Administration-approved” medications for opioid use disorder into routine practices.”
“In the midst of the opioid epidemic, states should consider the use of federal and state funding to create or expand evidence-based treatments, including [medications], in criminal justice settings,” the report stated.
The House of Delegates on Saturday voted 138-1 to pass a Senate-approved version of the bill.
The program would require jails to have a medical professional screen incoming inmates for substance abuse disorder and allow use of methadone, buprenorphine-based Suboxone and naltrexone-based Vivitrol.
One of the only other states that has rolled out the use of three medications in prisons is Rhode Island, which like Maryland has one of the nation’s worst per-capita rates of fatal opioid overdoses.
A Brown University analysis of the program, which started in 2016, showed a 61 percent decrease in overdose deaths after people left prison. The decline “contributed to an overall 12 percent reduction in overdose deaths in the state’s general population,” the study reported. Providing such treatment in prison, “with linkage to treatment in the community after release, is a promising strategy for rapidly addressing the opioid epidemic nationwide,” the researchers wrote in February.
Treatment proponents have been calling on state government to provide medications behind bars for years.
From January through September last year, 1,648 Maryland residents died of opioid-related overdoses, a nearly 10 percent increase over the same nine-month period in 2017. While heroin overdoses dropped 23 percent during that time, fentanyl has eliminated any progress. The increase in Baltimore during that time was steeper: The 607 people who died of opioid-related overdoses amounted to 16 percent more than over the same nine months in 2017.
The need for the legislation is necessary because “correctional facilities are often the first point of contact for treatment within high-risk populations,” Karen Stokes, director of government relations for Baltimore, wrote in her letter supporting the measure. “This is often the time that individuals are the most receptive to receiving treatment and prevention messaging surrounding substance use and addiction. Many prisoners have access to regular health care services only when they are incarcerated.”
Opponents of the bill raised concerns about the potential for the medications to be used as contraband.
In January, the Maryland State Prosecutor’s Office concluded a two-year corruption and bribery investigation that led to the conviction of 18 people, including two correctional officers, for their roles in smuggling drugs — including Suboxone strips — into the Jessup Correctional Institution.
Some correction officials testified in favor of the effort. Mary Lou McDonough, corrections director in Prince George’s County, said at a committee hearing that the county volunteered to be among the first to start a program because they are “very excited about it.”
“The thing to remember,” she said, “is that the effort requires counseling and peer support in addition to the various medications.”
“They have to be willing to participate in all of that,” McDonough said.
Barron said he expects Hogan to sign the legislation, given the governor’s call to increase funding to fight opioid overdoses.
“The governor looks forward to reviewing this legislation when it reaches his desk,” a spokeswoman said.