This week, our In Focus section discusses an issue brief prepared by Health Management Associates (HMA), Optimizing Capacity for Prescribing Buprenorphine in Jails and Prisons, authored by HMA Principals Shannon Robinson, MD and Donna Strugar-Fritsch, BSN, MPA, CCHP.
Buprenorphine is one of three FDA-approved medications for treatment of Opioid Use Disorder (OUD). It is sold under various formulations and trade names including Subutex, Suboxone, Zubsolv, Bunavil, Sublocade, and Probuphine. Currently, a provider must obtain special waiver from the federal Substance Abuse and Mental Health Services Administration in order to prescribe buprenorphine for OUD, and the waiver limits the number of patients the prescriber can treat at any one time. These patient limits can seriously constrain the treatment capacity of prisons and jails and can compromise the integrity and outcomes of treatment of OUD in these and other settings.
The Bureau of Justice estimates that 17 to 19 percent of persons incarcerated in prisons and jails have OUD, and many jails today report much larger numbers. In addition, all jails and many prisons regularly receive detainees who suffer acute opioid withdrawal. Both withdrawal and on-going treatment of OUD can be readily managed with buprenorphine. However, not all facilities have access to a waivered provider, and in many instances the patient limits a provider has requested may be less than is needed. It is crucial that providers who prescribe buprenorphine in correctional settings receive the highest patient limit allowed.
In addition, patient limits apply to the number of patients under treatment with buprenorphine by a waivered provider on a given day. Detainee populations change constantly in jails and prisons, making the tracking of daily buprenorphine patient limits challenging. Waivered providers who practice in correctional and community settings face even more challenges in documenting daily patient prescribing.
It is essential that prisons and jails optimize buprenorphine prescribing capacity. HMA has prepared the issue brief, Optimizing Capacity for Prescribing Buprenorphine in Jails and Prisons, to help all waivered providers and correctional health administrators understand how to maximize prescribing capacity, comply with reporting requirements, and expand prescribing limits as allowed and additionally during emergency circumstances. The brief has implications during the current COVID-19 public health emergency and as many correctional settings expand their treatment of OUD.