Medication-assisted treatment in county detention centers has a serious implementation problem with the funding mechanism devised to get the job done.
An expert panel of state and local officials, and consultants working specifically in Maryland detention centers shared insights on the status and future of medication-assisted treatment in local detention centers. While all counties are providing services, some remaining barriers are out of local control. This panel shared thoughts on what next steps can help.
Funding continues to represent the predominant challenge facing full and effective implementation. While legislation required the State to pay for the implementation and ongoing operations of the programs, the grant mechanism for getting those funds to the locals has proven to be overly burdensome and insufficient relative to the actual costs. While some state agencies have made a significant effort, like the Governor’s Office of Crime Control and Prevention, other responsible state agencies have chosen not to participate despite the law.
As noted by a panelist, even in light of the funding issues, some counties have made the effort to fund the programs themselves. But this cost adds to the already mounting state responsibilities that keep falling on counties, such as care for delayed mental health transfers and costs associated with housing state inmates in local facilities. Counties continually picking up slack for the state has made the current circumstances highly unsustainable.
Stakeholders at every level can agree the programs are important but to really have an impact on the opioid crisis, especially as it relates to justice-involved individuals, resources must be streamlined, starting with continuous and sufficient funding from the state as enacting legislation intended. Another barrier highlighted is access to methadone across the state is limited, particularly in rural areas. Even for facilities with methadone, diversion of the medication by inmates in the program is becoming an ongoing challenge, while injection versions of the medicine are aggressively cost restrictive – one injection can cost upwards of $1200.
A major takeaway of the day was, inmates in need can not afford to wait. Although the current progress is significant, stakeholders at every level believe the program needs to work and the time for legislative changes is now. For the people who need these services, a waiting game is a matter of life and death.
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