Medical treatment for opioid use disorder in prisons: committee hears benefits, logistical and budget concerns on H.32 (MOUD)

The House Corrections & Institutions Committee on April 16 heard testimony and questions on H.32, a bill addressing medication for opioid use disorder (MOUD) in correctional settings. Dr. Frederick Lord, medical director at Connecticut Valley Addiction Recovery and assistant clinical professor of psychiatry at Dartmouth, described how MOUD works in Vermont’s hub-and-spoke treatment system and recommended operational steps to reduce gaps in care for people released unexpectedly from court.

Dr. Lord praised Vermont’s Department of Corrections implementation and described better coordination than he has seen in some other states: “Vermont DOC has really done a very good job,” he told the committee. He said the system is far more consistent now than past practices in which people were released without medication or follow-up.

Why it matters: MOUD in corrections affects overdose risk, continuity of care and recidivism. Committee members focused on detainees released from court with little notice, the costs and use cases for long-acting injectable buprenorphine, and whether the state should require or facilitate contact with community providers at release.

Key testimony and committee concerns Dr. Lord distinguished between sentenced inmates (who generally have scheduled releases and for whom clinics can set appointments and bridge prescriptions) and detainees awaiting court outcomes. He said sentenced people can be referred and provided an interim prescription so clinic intake occurs smoothly; detainees released from court can leave with no notification to facility medical staff and therefore may miss medication and referral.

On outcomes, Dr. Lord said most people who connect to treatment after release do well; he estimated that about “80% of the people that we get from the incarcerated setting stay in treatment,” and said, based on clinical impressions and research meta-analyses, those who remain in treatment have lower recidivism rates.

Costs and injectables Committee members raised cost concerns about long-acting injectable buprenorphine. Dr. Lord and Division of Substance Use Services staff discussed price differentials: “At $1,500 a shot, that's considerably more than sublingual pills,” Dr. Lord said, while agency staff noted generic sublingual tablets are now available at roughly under $1 per 8‑mg tablet (about $2 per day at a 16‑mg daily dose), per Medicaid pharmacy pricing.

Dr. Lord recommended injectables for two groups: clinically stable patients who reliably attend follow-up and people at high risk of diversion. He warned that injectables are expensive and that using them for people likely to be lost to follow-up after release could worsen continuity of care. He noted the practical compromise: provide clear contact information at release and a facility-level contact so a released detainee can be linked quickly to a community provider.

Safety and overdose risk Dr. Lord emphasized overdose risk after release: people who have been abstinent while incarcerated have reduced opioid tolerance and face a substantially higher risk of fatal overdose on re-exposure to street drugs. He said treating opioid use disorder in custody and ensuring prompt linkage to community care are public-health imperatives.

Next steps Committee members asked the Division of Substance Use Services and medical directors to compile outcome data and to meet with DOC about procedural fixes (for example, ensuring detainees receive provider contact information at court release and a facility contact to help schedule intake). No formal vote on H.32 occurred on April 16.

Ending Committee leaders said they would follow up with DOC and treatment providers, and thanked Dr. Lord and Division staff for testimony and an offer to provide data and technical assistance.