Act 176, enacted July 1, 2018, directs Vermont correctional facilities to provide medication-assisted treatment (MAT) to incarcerated individuals receiving MAT prior to entering a correctional facility for as long as medically necessary. Additionally, the law requires that Vermont correctional facilities assess and commence buprenorphine-specific MAT if it is deemed medically necessary by a provider authorized to prescribe buprenorphine.  The incarcerated individual shall be authorized to receive the medication as soon as possible and for as long as medically necessary. Lastly, the law requires correctional facilities to transfer incarcerated individuals from buprenorphine to methadone if methadone is determined to be medically necessary by a provider authorized to prescribe methadone and the individual elects to do so. In the months following enactment, this policy change created a large increase in the number of incarcerated individuals receiving buprenorphine-specific MAT.

The criteria for being prescribed one of the 3 FDA- approved MAT medications are:
1. Meeting medical necessity for treatment as determined by an X-waivered qualified medical provider.
2. Electing to accept treatment as per the MAT Patient Agreement.

Unlike FY2020 and FY2021, the monthly number of incarcerated individuals receiving MAT within Vermont correctional facilities in FY2022 remained fairly consistent, with a monthly average of 684 individuals receiving MAT.  

There was a total of 1,383 unique incarcerated individuals who received MAT while incarcerated in FY22. Of those, 57.2% were initially inducted by the VT DOC and 42.8% were initially continued on MAT with a community prescription. Of these 1,383 unique individuals, the vast majority (82.4%) were prescribed Buprenorphine, 15.6% were prescribed Methadone, and 2.0% were prescribed Naltrexone.

When analyzing the type of medication prescribed by those initially inducted versus initially continued MAT while incarcerated in FY22: of the 791 unique individuals initially inducted on MAT while incarcerated in FY22, 93.8% were prescribed Buprenorphine, 3.4% were prescribed Methadone, and 2.8% were prescribed Naltrexone. Of the 592 unique individuals who were initially continued on MAT while incarcerated in FY22, 67.2% were prescribed Buprenorphine, 31.8% were prescribed Methadone, and 1.0% were prescribed Naltrexone.

In providing MAT to incarcerated individuals in Vermont facilities, the DOC has partnered with the Vermont Department of Health (VDH) and the Vermont Hub and Spoke System.

Also, the DOC has partnered with the Department of Vermont Health Access (DVHA) to assist in the longitudinal evaluation of treatment retention post release.

Vermont's Act 176 requires an evaluation of MAT with a report due to legislature by January 15, 2022. The goal of this evaluation is to determine the effectiveness of the MAT program in Vermont correctional facilities. This report can then inform best practices for MAT policies and programs in our facilities in the future. The MAT evaluation analyses and reporting work are being completed in partnership with researchers at the University of Vermont (UVM) with continuity of care analyses being conducted by the Department of Vermont Health Access (DVHA).