John Klar: Transmissions of Suboxone and COVID in Vermont prisons

A recent COVID outbreak in a Newport, Vermont prison highlights a number of non-COVID issues that should concern Vermonters. Questions were raised about whether the Newport outbreak could have been caused by mouth-to-mouth transfers of synthetic narcotics prescribed to prisoners (at taxpayer expense) but then used as “currency” with fellow inmates. Further, media and other biases are evident in the way in which these issues are addressed.

Lest I be charged with insensitivity or prejudices against substance abusers, let me declare that I am greatly concerned about addiction and its myriad impacts on sufferers and society. I became a certified Vermont recovery coach, and have volunteered in the recovery community, because I care very much. I have known too many people who have lost children — or a parent — to narcotics overdose. Also, it is part of the declared ethic of the Vermont Recovery Coaching Academy that we coaches do not condemn Medically Assisted Treatment (MAT): I do not, and I am not here.

John Klar

The prescribing of MAT (usually suboxone) to Vermont prison inmates holds merit, but must be shielded from abuse. Is Vermont prison a place where inmates deprived of alcohol or marijuana can get their start on narcotics via suboxone or other MAT? What are the policies to help get inmates weaned from these drugs? Are adequate counseling services available? How many MAT drugs are used as “prison currency” in Vermont facilities, and how can that be corrected?

The latest COVID “prison outbreak” provides insights into these problems, but also into how biases warp critical assessment. Instead of trying to figure out how COVID was being transmitted, VTDigger’s reporting immediately launched into a criticism of Vermont officials who dared suggest that mouth-to-mouth conveyances of drugs could transmit the virus. VTDigger’s article, “Scientists discredit theory about mouth-to-mouth drug swapping at Newport Prison,” employed histrionic subheadings (“Preposterous theory” and “Scientifically bankrupt”) to discredit Human Services Secretary Mike Smith:

Smith noted that medically-assisted treatments prescribed to inmates struggling with drug addiction are sometimes not swallowed and instead sold to other inmates. These transactions, he said, often happen with mouth-to-mouth exchanges that could perhaps spread Covid at the same time. … Infectious disease experts, however, say the second theory couldn’t be more wrong.

The rest of the story argues that it is “preposterous” to suggest that COVID could be transferred mouth-to-mouth. (So I guess masks are preposterous?) VTDigger’s reporter had to reach all the way to Atlanta to craft a refutation:

Anne Spaulding, an infectious disease researcher at Emory University in Atlanta, said the mouth-to-mouth swapping of diverted narcotics would ‘certainly be an unusual route of transmission’ — if that was, in fact, the case … ‘Usually a more mundane process is responsible — close contact in the same airspace as an infected individual,’ Spaulding said.

We know that MAT is used as prison currency. I had clients doing so 20 years ago when I was a criminal defense attorney. Seven Days also described it back in 2017:

The cloaks, the waiting, the water, the hands and the mouth checks are all intended to prevent prisoners from “diverting” meds. Prisoners still find ways to circumvent these measures, said Jennifer Sprafke, assistant superintendent of security at Chittenden Regional, which is Vermont’s only women’s prison. … One tactic is to vomit up the medication, and then sell it, Sprafke noted. … Bupe, which can provide a muted high, is the most common form of contraband in Vermont prisons, according to [DOC Commissioner Lisa] Menard. … Many see bupe’s prevalence in prison as a sign that inmates are self-medicating, and even Menard is willing to entertain the theory that the black market for it would dry up if everyone seeking treatment could get it.

But that raises the question that is avoided — is the goal to help get substance abusers on long-term care, or just give MAT to anyone who wants it? The answers are right here, and they are disturbing.

By 2018, MAT was made widely available in Vermont prisons: suboxone was the No. 1 largest prescription drug expense for the state ($13.3 million). The chief motivation behind this shift was concern that arrests put those in MAT through withdrawal, and their medications should be maintained, which would also help them upon release. Not just those already on MAT, but those addicted to street drugs, can be prescribed this pharmaceutical treatment. If the goal is to get people off drugs with taxpayer funded synthetic narcotics, it would be a perverse irony if in fact these drugs were initiating troubled inmates into abuse. Some Vermonters could become inducted into this Huxleyan dependency in prison.

This is a very real threat. VTDigger’s article unwittingly reveals this:

Al Cormier, facilities director for the corrections department, said Monday that medication diversion is something that his agency ‘battles every day.’ He said the one unit of the prison where Covid has continued to spread in recent weeks is the same unit where the staff recently found an ‘excessive amount’ of prescription medication that had been diverted. … ‘We know that that’s a prime conduit to spread the virus,’ he said. … Cormier said the idea that the virus is largely airborne wouldn’t stop the spread through saliva. … ‘If it goes in your mouth, it’s going to get in your lungs, plain and simple,’ he said. … However Josh Barocas, an infectious disease specialist at the Boston Medical Center, said that’s a ‘preposterous theory’ that only serves to blame inmates. Barocas said there is some MAT diversion in prisons, but ‘it’s not very common.’ He said if there is a widespread diversion problem, that’s almost more concerning, because it means the people incarcerated at that facility aren’t getting the help they need.

‘I think a big thing to ask ourselves is, if there is diversion, why are people diverting their medications for opioid use disorder within a correctional facility anyways? The answer is because the people there need treatment,’ he said.

Translation: everyone who wants to be on drugs should be provided MAT. “The answer” is that all demand must be satisfied as a “need.” This faraway Bostonian has not addressed the motivation to receive and transfer medications as a means of obtaining sex, or protection from assault, or for cigarettes, money, drugs/goods, etc.

How can the specific, factual observations of a Vermont corrections official (they “battle it every day”) be negated by the disconnected, preposterous claims of an infectious disease specialist? If Health Commissioner Levine says something that irks VTDigger, will it get a “specialist’s” opinion from a prison official in Utah?

But the article goes further, replacing Al Cormier’s specific factual assertion that “the one unit of the prison where Covid has continued to spread … is the same unit where the staff recently found an ‘excessive amount’ of prescription medication that had been diverted” with the speculative conclusion of yet another foreign specialist:

‘(Covid-19) spreads through the air really readily in poorly ventilated indoor environments, and prison is sort of the optimal environment for transmission, really,’ [Anne Sosin, policy fellow at the Dartmouth College Nelson A. Rockefeller Center] said. ‘I think it’s not only a scientifically bankrupt theory, it’s also a totally stigmatizing claim that really undermines efforts to address substance use in highly vulnerable populations,’ Sosin said.

Anne Sosin is an expert in “rural health equity,” as can be seen by the immediate politicization of this supposedly scientific inquiry. Instead of determining how the virus spread in Vermont prisons, this is a demonization of prison officials for daring to state the truth. This “specialist” refutes prison officials by arguing COVID spreads through the air, and labels it a “scientifically bankrupt theory” to suggest the virus could be spread by swapping foamy mouth spittle (despite commands we wear masks to avoid spreading microscopic droplets).

It is disturbing that public officials invoke “victimizing stigma” to avoid critical assessment of these very real problems — that “really undermines efforts to address [disease spread and] substance use in highly vulnerable populations.” Shall Vermont put anyone who wants MAT on it as they come in the prison door, or wait until they get it in a spit-swap to prove their “need” and then prescribe it? Would it stigmatize anyone to observe that non-users can swap a mouth-dose to users who then double-dose? It’s called “drug abuse” (not “substance use”) for a reason.

MAT is defined as “an addiction treatment program that pairs therapy with medication to treat substance use disorders.” The Vermont Legislature has funded widespread use of MAT drugs in its prison system without ancillary (important) therapy. All the studies that demonstrated MAT is effective included therapy as a component. These Vermont inmates (whom we’re told should receive drugs on demand) are denied sufficient counseling services — that would arguably be a better investment than limitless drugs.

Presently, it appears Vermont’s progressive program is the perfect process to transition convicted criminal offenders into lifetime public dependence on extremely addictive synthetic narcotic pharmaceutical drugs. Now that’s a story worth digging into.

John Klar is an attorney and farmer residing in Brookfield, and the former pastor of the First Congregational Church of Westfield. © Copyright True North Reports 2021. All rights reserved.

Image courtesy of Wikimedia Commons/Jr de Barbosa