As reported in the Sacramento Bee, Physicians at the California Department of Corrections and Rehabilitation (CDCR) have been voicing serious concerns about the rollout and implementation of a Medication Assisted Treatment (MAT) program for incarcerated patients.
Union doctors support the use of MAT for substance abuse in an incremental, controlled environment, but they do not believe CDCR is prepared to provide those conditions. There are widespread reports from prison doctors, nurses, and pharmacists that inmates abscond and divert suboxone. Even if the inmate has no suboxone in his/her urine screen, CDCR headquarters continues to encourage UAPD doctors to continue prescribing this medication. Inmates falsely claiming addiction sometimes sell the drug, inject it, snort it, smoke it, or hoard it. MAT has become a cottage industry in CDCR, and suboxone is its currency.
Besides obvious liability to their medical licenses, doctors are feel that they are being pressured to violate the Hippocratic oath to do no harm to patients. The rapid, mismanaged expansion of the MAT program will inadvertently create new addicts in the prisons.
Reducing narcotic addiction is a noble and attainable goal when implemented in a thoughtful and scientific manner. But it has become political and bureaucratic football within CDCR.
TOP 10 RECOMMENDATIONS TO IMPROVE THE MAT PROGRAM
1. Make the X-waiver voluntary. Use carrots and not sticks to create provider buy-in.
2. Incentives. This should include additional training, cognitive and psychiatric support to achieve the community standard of care.
3. Provide additional compensations for the anticipated higher workload and liability.
4. Hire more physicians for the unmet needs of chronic care and more addiction specialists for MAT program support
5. Ask for a complete and accurate accounting from the state of all money allocated and spent on the MAT program for the last three years and then annually.
6. Control runaway Suboxone demand and diversion with better intake screening and depot injections.
7. Consistent with suspended CBI and supportive housing suspend MAT rollout until mass staff and inmate vaccinations are complete and the pandemic is better controlled.
8. Designate individual prisons as centers of excellence with appropriate staffing, CBI, and housing.
9. Recommend better parole discharge follow-up for inmates and their families.
10. Medical providers, who risk their licenses, not politicians, bureaucrats, and administrators should participate in the development and steering of the MAT program.