Rhode Island Model of MOUD in Corrections Withstands COVID…

Written by Linda Hurley, President/CEO – CODAC

Pre-COVID 19

In 2016, Rhode Island Department of Corrections (RIDOC), in collaboration with CODAC Behavioral Healthcare, became the first state correctional system to initiate a comprehensive program to screen all individuals for opioid use disorder, offer treatment with all three FDA approved medications (methadone, buprenorphine, and naltrexone) to all medically eligible incarcerated people, to provide linkage to care in the community after release and to co-locate a DEA, CSAT approved opioid treatment program within the correction facility. The General Assembly of the State of RI approved $2 million in funding, primarily to expand RIDOC’s MAT program.  RIDOC continued to contract the treatment on the inside and the transition to care on the outside to CODAC, Inc., a state-certified Center of Excellence in the treatment of opioid use disorder. For individuals reporting current MAT during commitment, nursing staff obtain written consent to confirm medication and dose with current prescriber/pharmacy and MAT is continued. If MAT is not confirmed, individuals are referred to the program. Individuals are assessed according to ASAM criteria and referred to a medical provider for further evaluation and treatment initiation. The decision of which MAT to offer a patient is determined clinically, based primarily on past experiences, patient preference and logistical considerations. Group counseling, individual counseling, discharge planning services, and pre-release enrollment in health insurance are all part of the comprehensive treatment services. If needed, CODAC staff provides community health insurance enrollment  post-release. CODAC also provides facilitation of the transition to opioid treatment to the provider and in the community of the patients’ choice post -release.  In 5 years, these pillars of success have not been changed. The relative risk of overdose death for those recently incarcerated and released has significantly, remarkably declined.

Though the principles of care have not been changed the number of patients served, where they have been served and expansion of services provided has shifted dramatically.  Growth in all three areas of number people served,  length of care and medication, counseling and wrap-around services – provided both inside and in the community – dramatically increased pre-COVID 19.

 

COVID 19

COVID 19 shifted our services in a natural experiment that hopefully will have long lasting results and are as follows:

1. Regulation to increase availability of Take-Home medication to mitigate exposure. Take Home medications particularly methadone have historically been highly regulated.  CODAC increased the availability for medication management and self-administration.   Letters were written to city leadership and police chiefs to inform communities of this increase in medication. To date, according to RI State Police there has been no increase in found prescribed methadone, confiscated methadone or Medical Examiners reports of unauthorized methadone.  This may have been another example of regulatory stigma. We hope to continue this relaxation of regulation.  Patients being released from the Department of Corrections did not see any higher amounts of adverse events than others receiving buprenorphine or methadone.

2. Again to mitigate exposure, telehealth services were introduced.  Telemedicine including telephonic, provider meetings, medication management services, health home services, and counseling services and recovery services actually increased
patient utilization of care. (Soon to be released in the Journal of Addiction Medicine)

3. Methamphetamine and fentanyl have continued to increase, contributing dramatically to fatal overdose here in Rhode Island.

4. We are currently exploring funding for  a pilot program to fund re-entry transitional  housing for those with opioid disorder, inclusive of those utilizing Sublocade as their medication

The Numbers:

From July 2016 to April 2020, the average daily dose of MOUD increased by 80%.
In the year prior to COVID – overage daily dose was approximately 300.
After COVID the average daily dose was 200, representing a 33% reduction.

Since December 2016 through December 2020 CODAC has provided MOUD to over 18,000 commitments to RIDOC.

59% methadone
40% buprenorphine
1% extended release naltrexone

40% new inductions at commitment
57% continued from the community
3% pre-release induction of sentenced population

Diversion:

Incredibly rare. Over 14-month period, 22 instances of MOUD diversion. During the same period over 125,000 doses were given out.

 

Brown University School of Public Health research faculty are subcontracted by CODAC to evaluate the program by tracking metrics such as number of individuals receiving treatment, post-release treatment follow-up rates.

This initiative has been operationalized for 5 years. It is in Rhode Island and western Massachusetts among other states.   It continues to grow and sustain lives. Once again we continue to repeat the statement nationwide that it is not if we can do this, it is how quickly.

@aatod1984
  • Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
  • Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
  • Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
  • Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
  • Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET.

To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091.

We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
  • Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU

The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system.

Conference Objectives:
1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions.
2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities.
3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices.
4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them.
5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
  • We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023.

We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. 

https://conta.cc/3PiV5ck
  • August 31st is International Overdose Awareness Day 
💜 #IOAD2023 
💜 #NaloxoneSavesLives 
💜 #EndOverdoseNow

Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. 

 Full Video 🎥 bit.ly/3ElzdYD
  • Research shows methadone maintenance is more effective when it includes counseling—and even more so with medical or psychosocial services, like employment or family assistance. This is a key piece of #MAT for #OUD. More info: https://lnkd.in/ehYFCRvu 
#PNAP #ProgramNotaPill
  • Quick Reminder - Our committee deadline for #aatod2024 Conference related presentations is fast approaching on Monday, September 18th. We are encouraging you to submit your presentations since it will certainly contribute to an information-packed conference event.
Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
Patient access to OTPs saves lives every day. AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
3 days ago
View on Instagram |
1/10
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. “Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA Read More ➡️ bit.ly/3tKb1gy
1 month ago
View on Instagram |
2/10
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery. Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1 For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
2 months ago
View on Instagram |
3/10
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. Register ➡️ bit.ly/461CkkG
2 months ago
View on Instagram |
4/10
Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET. To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091. We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
2 months ago
View on Instagram |
5/10
Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system. Conference Objectives: 1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions. 2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities. 3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices. 4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them. 5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
2 months ago
View on Instagram |
6/10
We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023. We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. https://conta.cc/3PiV5ck
3 months ago
View on Instagram |
7/10
August 31st is International Overdose Awareness Day 💜 #IOAD2023 💜 #NaloxoneSavesLives 💜 #EndOverdoseNow Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. Full Video 🎥 bit.ly/3ElzdYD
3 months ago
View on Instagram |
8/10
Research shows methadone maintenance is more effective when it includes counseling—and even more so with medical or psychosocial services, like employment or family assistance. This is a key piece of #MAT for #OUD. More info: https://lnkd.in/ehYFCRvu 
#PNAP #ProgramNotaPill
Research shows methadone maintenance is more effective when it includes counseling—and even more so with medical or psychosocial services, like employment or family assistance. This is a key piece of #MAT for #OUD. More info: https://lnkd.in/ehYFCRvu #PNAP #ProgramNotaPill
3 months ago
View on Instagram |
9/10
Quick Reminder - Our committee deadline for #aatod2024 Conference related presentations is fast approaching on Monday, September 18th. We are encouraging you to submit your presentations since it will certainly contribute to an information-packed conference event.
3 months ago
View on Instagram |
10/10

For this #GIVINGTUESDAY, please consider making a tax-deductible gift to AATOD, so that we can continue to expand access to quality #OUD treatment services, which has been our hallmark since 1984.
DONATE --> http://bit.ly/3uDOeDC
Patient access to #OTPs saves lives every day.

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2024 Conference Las Vegas

2024 Conference

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