Week 14 - April 3rd to April 6th

Medication Assisted Treatment (MAT)

MAT related bills and research

We've settled down a bit. The day's work has fallen to a more normal pattern without any long sessions stretching into the evenings. We generally start at 8:30 in Committee, then an hour or so of floor time and back into Committee until 4:30 or 5:00. Friday we were done by 1:00 PM. Other committees are working longer hours and there are hearings and meetings that individuals attend. I sat in on the minimum wage bill hearing Thursday evening and had an 8:00 IT Advisory Committee meeting that morning. For those that like the chatter and thrive on the social aspects of politics there are receptions, breakfasts and lunches. This week there was also a dance party fund raiser for the Make A Wish Foundation. Not being a dancer or very social, I spent the evening summarizing what S.55 (that gun bill) contained and posted it to my website.

Guns

We did have another gun related bill come to the House floor this week. That was H.422, related to the removal of firearms from a person arrested or cited for domestic assault. We had passed it earlier in the session and sent it to the Senate. The Senate made some changes and sent it back to us. After only a little debate, it passed 133 to 0 and is on its way to the Governor. Here's the official purpose of the bill:

This bill proposes to require a law enforcement officer to confiscate a dangerous or deadly weapon from a person who is arrested or cited for domestic assault if the weapon is (1) in the immediate possession or control of the person being arrested or cited; (2) in plain view of the officer; or (3) discovered during a consensual search.

Drug Addiction in Prisons

Much of my committee work this week centered on the treatment of drug addiction in Vermont's prisons. We have at least three bills on the wall that deal with this issue. We are combining them into one by amending S.166.

A few questions that comes to mind is: Why are you dealing with this? Isn't that up to someone else to decide? Maybe a doctor?  Or a prison superintendent? What do you know about how to treat drug addiction?

I asked those same questions of my committee chair and vice-chair. The answer was, "Get used to it. It's your job." (Though they were more polite than that). That's part of being on Corrections and Institutions. We are the policy committee for Corrections and the medical care of prisoners is a policy we regulate. I was also told that we would check with House Committee on Human Services before we are finished with it. So, that means I need to learn about drug addiction and treatment. I'm on it!

The treatment of drug abuse has changed a lot in the past 10 years or so. The opioid crisis, with its enormous economic and safety impact, has brought about much of this change. Drug addiction, like alcoholism, is being looked at as a public health issue rather than a public safety issue. The goal is no longer to lock up addicts and force them to withdraw from their addiction. Rather it is to treat the illness and thereby reduce the criminal behavior that supports it. I hesitate to quote numbers about which I know little but . . . for every dollar spent on substance abuse programming in prisons, Missouri reported saving $1.03 to $3.76, and Kentucky reported saving $4.46.

Medication Assisted Treatment is nearly as complicated as the Opioid Use Disorder it addresses. In the non-incarcerated community is varies from state to state. Vermont has developed a Hub and Spoke system that has proven very effective, but providing that type of treatment and programming within Corrections is not easy. There are several drugs used within MAT: buprenorphine (a.k.a suboxone), methadone  and Naltrexone (a.k.a  Vivitrol).  And there are federal guideline for each, particularly methadone.

Keep in mind that there are many people being held within corrections facilities who have not been convicted of a crime. They may be charged with a crime, but are being held for lack of bail. They may be charged but judged not mentally able to stand trial. In addition, the Department of Corrections may not know exactly how long a person may be in prison. It may be an overnight visit, or a weekend awaiting arraignment, or weeks awaiting psychiatric evaluation, or years until a person is mentally able to stand trial.

The bill we are working on addresses several different situations.

1. A person who is already on a MAT program outside Corrections is suddenly within the corrections system. How is that treatment which, may include the provision of methadone, continued? Who is the primary physician? The one inside or outside Corrections?
2. A person with a Substance Use Disorder comes into Corrections and is not on a MAT program. Should we start treatment for that person? What kinds of treatment will it be? What medications might be used? Who will prescribe them? What behavior programming or counseling will it include? Can/Should it be mandatory? How long will it be provided?
3. A person is about to leave the corrections facility, how does that effect treatment. There have been many overdoses of inmates who have recently left corrections. How do we prevent that? How do we continue care outside corrections so the person is not right back in after committing another crime in order to buy street drugs?
4. An inmate suddenly shows signs of addiction and wants treatment. Drugs do get smuggled into prisons. Inmates do get addicted. Do we start treatment? 

These issues intertwine with our need to provide for the safety of Corrections staff, for the protection of prisoners against those seeking drugs, and for the general health and welfare of the facility and society.

But somehow, we are almost finished with this and hope to vote it out of committee next week.

Weekly Summary

• Tuesday 
• 10:00 On the floor for a half hour
• 10:30 - Noon - Public caucus - Discussion and explanation of H.422 
• 1:00 In committee to hammer out legal definition of Medication Assisted Treatment - The problem being that we want the legal definition with DOC to match the definition in the outside world. Does it include counseling and programming as well as medications?
• 2:00 - Senator Benning testifies to the committee on S.179 about restorative justice. This bill is trying to clean up the language in statute and have it more accurately reflect what is being done in the real world. Restorative Justice started out as a pilot program but has been found to be very successful at reducing the number of incarcerated people.
• 3:00 - Back to MAT
• 4:05 - Basically done, but some more committee discussion.
• Wednesday
• 9:00 In committee for more Restorative Justice testimony: Derek Miodownik, Restorative and Community Justice Executive. He presented a comprehensive history of the program in Vermont. Also explained the funding. It is state grants to municipalities or organizations. It is far cheaper and more effective to use Restorative Justice than it is to lock a person up with other criminals. There are now 20 Community Justice Centers in Vermont. They administer two basic programs:
• Re-entry to society for people leaving the Corrections system. This is the Circle of Support and Accountability (CoSA).
• Court Diversion where a panel of community volunteers helps a person understand the implications of their crime (usually petty) and atone for it by some action or process. The goal is to have the person realize that they are part of a community.
• 10:05 Break
• 10:13 Monica Weever - Director of Administrative Services, DOC to talk about inmate access to their files. This is a long standing controversy. What records should be made available to inmates? DOC resists because of the cost of copying and time consumed redacting information. The controversy is in the rule making process. DOC seems unable to develop the rules that determine what is provided to the inmate.
• 11:00 Back to MAT
• 12:00 Break
• 1:00 On the floor for about an hour
• 2:15 Back to Community Justice Centers - Beth Tanzman, Executive Director, Blueprint for Health, Department of Vermont Health Access with more explanation of how the Centers work. There is close cooperation with Probation and Parole.
• 3:25 break
• 3:35 Back to MAT - We're picking through the language of S.166 with our Legislative Council  lawyer - Katie McLinn
• 4:30 - Back to Inmate Records controversy.
• 5:00 - Done
• Thursday
• 8:15 - Meeting with IT Advisory Committee - We're trying to straighten out the organization of IT within the Capitol. There are several competing interests and personalities and no clear paths of authority.
• 9:00 In Committee for random discussion 
• 9:30 Vice-chair went through the House proposed budget, pointed out the portions that pertain to our Capital Budget and also Corrections. We'll see what the Senate does with those portions.
• 9:55 break
• 10:00 in Committee for discussion of Youthful Offenders. This is the issue of how we will work with 18 to 25 year olds within Corrections. The age limits are changing. Currently, the Woodside Juvenile Rehabilitation Center in Essex handles those under 18 (I think). The goal is, again, to avoid incarceration and criminal records yet protect community safety. This is also tied up with the Family Court system. I need to look into this more carefully.
• 11:10 Done with Youthful Offenders
• 11:15 Back to inmate files issue - Monica Weever and legal council
• 12:05 Lunch
• 1:00 On the floor
• H.422 came to the floor and passed unanimously.
• 3:37 In committee with MAT
• 4:45 Done - but some additional discussion outside committee about Clean Water Funding bill (S.260) that should come to us in a week or so. It will be considerably changed by the House Natural Resources Committee.
• 5:30 Attended the hearing in Rm 11 of the Capitol about a Minimum Wage bill (S.40).
• 6:30 Done
• Friday
• 9:00 In committee with MAT and language clean up
• 9:30 On the floor
• 10:00 Back in Committee - for more MAT - This turned out to be a long, detailed discussion that went around and around until we finally gave up and decided we were as close as we could get to a perfect bill. There are still some minor problems but the steps forward make it worth while.
• 12:30 Done for the Week.
• Weekend
• While writing this review I found further problems with our MAT bill. We'll see what happens.

Next Week

Behind the scenes two things are going on. The Colchester Charter Change bill  (H.926) is in the Government Operations committee. Friday of next week I have to go testify about the bill and see if I can push it through that committee and get it out on then House floor for a vote. This should not be difficult. The bill makes it so our Town Clerk is appointed rather than elected. The current clerk has announced her retirement, as of June 31st, so we need to get this bill signed by the governor before then.

Also behind the scenes a Leg Council lawyer is putting together two House resolutions: one for our retiring town clerk and the other for our retiring town manager. I'm the lead on the Town Manager one. So I need to push that along.

The Clean Water funding bill may come out of committee this coming week. That will be controversial.