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DOC officials describe how MOUD is delivered in Vermont correctional facilities, flag diversion and staffing hurdles
Summary
Department of Corrections and contractor clinicians reviewed how medications for opioid use disorder are identified, started and managed inside Vermont prisons. Officials described screening practices, a move to faster treatment starts using buprenorphine, diversion risks and planned operational changes to med lines and staff training.
Department of Corrections officials and clinical staff told a legislative committee that Vermont correctional facilities have provided medications for opioid use disorder (MOUD) since 2018 and are moving toward faster, more standardized treatment while confronting diversion, staffing and logistics challenges.
Dr. Jim Muelliger, State Medical Director for Wellpath, told the committee that "MOUD began, by law in Vermont Correctional Facilities in 2018" and described how intake screening, diagnostic interviews and withdrawal assessments determine who is started on medication while in custody.
Why it matters: Committee members said they plan to consider H.32, proposed legislation on MOUD, and asked for a clear baseline of current clinical practice before debating statutory changes. DOC officials urged the panel to hear both clinical realities and operational constraints such as med-line logistics and staffing.
What officials said about how people enter treatment: Muelliger and DOC staff described three main entry points: (1) people arrive already receiving MOUD in the community and staff verify prescriptions with the state prescription monitoring system; (2) people presenting with opioid withdrawal are assessed using the Clinical Opiate Withdrawal Scale (COWS) and may be started on buprenorphine when clinically appropriate; and (3) people who report prior use but are not currently taking medication are reassessed and offered treatment if they meet diagnostic criteria.
"We ask them. They get a formal... the TCU screen," Muelliger said, referring to the Texas Christian University screening instrument the facilities use. He added that because many detainees initially deny use at booking, staff re-screen and rapidly reassess when withdrawal becomes clear.
On treatment-first and diagnostic timing: Muelliger told the committee that federal guidance and recent DEA flexibility allow clinicians to begin buprenorphine to treat withdrawal before a full diagnostic interview, with a diagnostic interview to follow within three days. "The DEA now allows us to begin buprenorphine to treat opioid withdrawal in advance of a more thorough evaluation to diagnose somebody with opioid use disorder," he said.
Dose titration and clinical updates: Officials said new local protocols use higher initial doses to reach effective levels faster for fentanyl-exposed patients: an initial 8 mg, then 12 mg, then 16 mg if symptoms persist. Muelliger said clinicians are retraining to avoid treating patients who do not meet opioid use disorder criteria and to use DSM criteria when deciding on longer-term treatment.
Diversion and med-line logistics: Committee members heard that diversion is common in correctional settings because of scarcity and inmate power dynamics. Muelliger described prior responses that could remove people from medication after diversion, and emphasized a clinical-first approach: "The first step to addressing diversion is not having their dose because that makes it harder to stay sober," he said, citing American Society of Addiction Medicine guidance. DOC facilities described long med-line procedures — mouth checks, 10–15 minute observation times and rechecks — that create operational burdens and, members said, sometimes require waking people in the early morning.
Travis Denton, facilities director, said DOC has worked to separate medical autonomy from security responses and to reduce punitive cycles tied to diversion: "We've been intentional about really not encroaching on medical autonomy, and really divorcing the process of our response from a security and disciplinary standpoint, from the medical necessity and medical need," he said. DOC and contractor staff said they are training security staff and bringing external partners into academy training to reduce stigma and improve consistent practice across facilities.
Operational changes under consideration: Officials outlined several near-term policy and operational changes: normalizing MOUD medications into the general med line (rather than a separate line), changing tablet handling practices (they are currently crushed at some sites), consulting with the state Department of Health, UVM experts and the DEA about safe alternative dispensing strategies, increasing provider coverage so diagnostic interviews can occur within 72 hours, and deploying a lead nurse practitioner to manage complex diversion cases with increased counseling and monitoring rather than automatic removal.
Committee process and next steps: Committee members asked DOC to attend a follow-up session when legislative counsel presents H.32. DOC said it had not drafted that bill but would review and comment. Officials also said they expect to present updated policies and operational changes in roughly three to six months.
Ending: The committee scheduled a legislative-counsel briefing on H.32 and asked DOC to return with policy details and metrics the committee can use to compare proposed statutory changes with current clinical practice.
