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F I S C A L I M P A C T R E P O R T

SPONSOR Komadina

DATE TYPED 2/22/05

HB

SHORT TITLE Opiate Replacement Treatment Programs

SB 426/aSPAC

ANALYST Woods

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$250.0

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to the appropriation for the Corrections Department in the General Appropriations Act.

Relates to HB267

SOURCES OF INFORMATION

LFC Files

Responses Received From

New Mexico Corrections Department (NMCD)

New Mexico Department of Health (DOH)

SUMMARY

Synopsis of SPAC Amendment

Senate Public Affairs Committee amendment to SB426 amends the legislation as follows:

•

On page 1, line 18: After the word “program,” inserts the phrase, “for inmates

with a history of opiate dependence”

•

On page 1, line 23: After the period, inserts the sentence, “Priority shall be

given to inmates approaching release into communities with operational

methadone clinics.”

•

On page 2, line 5: After the period, inserts the sentence, “The criteria shall be

consistent with existing department of health guidelines.”

•

On page 2, line 7: Deletes the phrase, “and buprenorphine”

Senate Bill 426/aSPAC -- Page 2

•

On page 2, between lines 8 and 9: Inserts the following new subsection:

“E. The corrections department, in conjunction with the epidemiology and re-

sponse division of the department of health, shall collect the following out-

comes data:

(1) recidivism of methadone-treated inmates versus counseling-only

treated inmates;

(2) positive urine drug screens among methadone-treated parolees versus

counseling-only treated parolees, as followed by the adult probation and

parole division of the corrections department;

(3) the rates of newly acquired hepatitis B, hepatitis C, human immuno-

deficiency virus and methacillin-resistant staphylococcus aureus as a re-

sult of sharing needles during injection drug use, in methadone-treated

inmates versus counseling-only treated inmates; and

(4) the rate of reduced disciplinary infractions while incarcerated of

methadone-treated inmates versus counseling-only treated inmates.”

Senate Public Affairs Committee amendment to SB426 attaches no additional appropriation to

the legislation.

Synopsis of Original Bill

Senate Bill 426 – Relating to Health Care; Providing for Treatment; Making an Appropriation –

seeks to establish an opiate replacement treatment program in the state’s correctional facilities in

accordance with the following criteria:

•

The corrections department shall establish an opiate replacement treatment program.

•

The opiate replacement treatment program shall provide opiate replacement treatment in

New Mexico correctional facilities operated by the corrections department and publicly

or privately operated correctional facilities that house inmates lawfully committed to the

corrections department.

•

Participation in the opiate replacement treatment program shall be offered on a voluntary

basis to inmates lawfully committed in a New Mexico correctional facility. The correc-

tions department shall coordinate with the department of health to establish the criteria

for assessment and enrollment of an inmate in the opiate replacement treatment program.

•

Currently accepted treatment practices, including methadone and buprenorphine treat-

ment, shall be used in the opiate replacement treatment program.

The bill appropriates $250,000 from the general fund to the Corrections Department for expendi-

ture in FY06 for an opiate replacement treatment program. Any unexpended or unencumbered

balance remaining at the end of FY06 shall revert to the general fund.

The bill additionally addresses the regulation of methadone clinics by the Department of Health

in accordance with the following criteria:

Senate Bill 426/aSPAC -- Page 3

•

In compliance with federal requirements, the department of health shall regulate the

establishment and continuance of methadone clinics in the state.

•

In regulating methadone clinics, the department of health shall perform an assessment of

the need for clinics and develop clinical and administrative standards as required by fed-

eral law. The department may consider other factors it deems necessary to ensure the

provision of drug abuse treatment services and the protection of the health and safety of

state residents.

•

For the purposes of this section, “methadone clinic” means a public or private facility that

dispenses methadone for the detoxification or maintenance treatment of narcotic addicts.

Significant Issues

DOH indicates that Opioid addiction treatment is the generic term referencing various treatment

modalities employed to treat opioid dependent individuals. Opiate or opioid replacement treat-

ment refers to legally prescribed medications (methadone hydrochloride and buprenorphine) that

reduce or alleviate the craving for heroin, morphine and other opioid drugs, which include pre-

scription drugs such as Oxycontin, Percocet, Percodan, Codeine, and Darvon. Buprenorphine is

a Drug Enforcement Agency-approved daily oral medication that, when combined with

Naloxone, effectively blocks the action of heroin and other narcotics. People treated with Bu-

prenorphine/Naloxone feel normal and have no drug cravings.

DOH is the federally designated State Methadone Authority and Single State Agency for sub-

stance abuse services. It received statutory authority to regulate Opiod Treatment Programs

(OTPs) in the 2003 legislative session. The draft regulations have been to public hearing and are

waiting for final approval from the DOH Office of the General Counsel.

1

The regulations include

both clinical and administrative standards. All OTPs operate under federal law as well.

2

An OTP located in any NMCD facility would be required to operate under the State of New

Mexico regulations, Drug Enforcement Administration (DEA) regulations and the federal 42

CFR Part 8. This will apply to the NMCD or any contractor who may provide OTP services in an

NMCD facility.

FISCAL IMPLICATIONS

The appropriation of $250,000 contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to the gen-

eral fund.

ADMINISTRATIVE IMPLICATIONS

NMCD notes that this bill places several “significant and onerous administrative requirements on

the Corrections Department in administering and assessing the treatment program” including:

1

Statutory Authority: Department of Health Act, NMSA 1978 section 9-7-6 (e). title 7: Requirements for Opioid

Treatment Programs, Chapter 32 Alcohol and Drug Abuse, Part 8: Regulations for opioid treatment programs.

2

Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 42 CFR

Part 8: Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction.

Senate Bill 426/aSPAC -- Page 4

•

It will probably take many manpower hours to determine the relevant recidivism rates

and related requested information, and may take Department staff away from their nor-

mal duties.

•

Staff may well need extensive training on how to administer and assess the pilot project.

•

New policies and procedures would need to be developed and implemented for adminis-

tering and assessing the pilot project.

•

The department will need to draft and implement a written memorandum of understand-

ing with the Department of Health to properly administer that portion of the pilot project.

NMCD states that implementation of this legislation, “…would be a major administrative under-

taking for the Corrections Department.”

CONFLICT, DUPLICATION, COMPANIONSHIP OR RELATIONSHIP

Relates to the appropriation for the Corrections Department in the General Appropriations Act.

Relates to HB267 in that HB267 seeks to appropriate appropriates $250,000 from the general

fund to the Corrections Department for expenditure in FY06 and FY07 for the creation of an opi-

ate replacement therapy pilot project – utilizing buprenorphine-naloxone – for thirty women with

a history of heroin or other opiate addiction who are incarcerated at and later released on parole

from the New Mexico women’s correctional facility in Grants. HB267 also requires the Correc-

tions Department to collaborate with the Department of Health to:

•

administer the opiate replacement therapy and to contract for the services of a qualified

physician to evaluate and treat the women participants;

•

evaluate and determine the recidivism rate for the women participants as compared with

the recidivism rates for women not treated with the designated drug;

•

evaluate and determine the use of psychotropic medication by women participants as

compared to women with opiate dependence who are not treated with the designated

drug;

•

evaluate and determine the number of opiate-positive urine drug screens among women

participants as compared to women with opiate dependence who are not treated with the

designated drug;

•

evaluate and determine the rate and frequency of infection, self-inflicted injury and the

need for medical care for women participants as compared to women with opiate depend-

ence who are not treated with the designated drug; and

•

report independently to the appropriate interim legislative committee on the evaluations,

treatments and outcomes of the pilot project participants by December 1, 2006 and De-

cember 1, 2007.

Senate Bill 426/aSPAC -- Page 5

The pilot project is proposed to run from July 1, 2005 through June 30, 2007, and any unex-

pended or unencumbered balance remaining at the end of FY07 shall revert to the general fund.

OTHER SUBSTANTIVE ISSUES

With respect to this legislation, DOH suggests the following items merit additional attention:

•

It may be possible for DEA to grant a waiver to provide methadone in the prisons, but,

under current law, each facility providing methadone will have to become a Narcotic

Treatment Program. This can be costly.

•

If the Corrections Department contracts a methadone clinic, the cost will be in excess of

the $250,000 allocated.

•

There are 5 private prisons and 5 public prisons. The cost of treatment for all units could

be far more than the $250,000 allocated.

•

Inmates are transferred from facility to facility as their levels change and would need to

have the opiod replacement medications available to them at each facility.

DOH further observes that prison and jail facilities in other states and in other countries that pro-

vide opiate replacement with buprenorphine/naloxone or methadone show a statistically signifi-

cant reduction in transmission of infectious diseases, inappropriate drug seeking from medical

personnel, and less violence and aggressive behavior toward prison staff and other inmates.

Safety of correctional officers and other inmates did improve with introduction of opiate re-

placement with buprenorphine/naloxone.

3

DOH notes that the proposed legislation includes the opiate treatment drug buprenorphine as

well as methadone. Methadone is a synthetic agent that works by “occupying” the brain receptor

sites affected by heroin and other opiates. In 1997 the US National Institutes of Health (NIH)

determined that “methadone maintenance treatment (MMT) is effective in reducing illicit opiate

drug use, in reducing crime, in enhancing social productivity and in reducing the spread of viral

diseases such as AIDS and hepatitis.” DOH provides the following as background information

on the issue:

•

Among heroin addicts not on methadone, there are more than 250,000 arrests per year.

4

The MMT inmate treatment program would provide the first medical intervention to

break the cycle of repeated crimes to support persistent drug addiction.

•

Methadone treatment began in the Canadian Correctional System in 1998 and was ex-

panded nationwide in 2002 due to Department of Justice decisions and effective out-

comes. Inmates treated with methadone showed lower prevalence of heroin injection,

needle sharing, and lower HIV-related risky behavior. Within 12 months, Canadian in-

mates started on MMT were shown to be 28 percent less likely to return to prison and

were less likely to be unlawful or use alcohol while on parole. Parolees showed a 50 per-

cent reduction in burglaries and thefts, with even greater reductions in drug dealing.

3

Lind, Chen, Weatherburn and Mattick 2004.

4

Corrections Professional, Jan.7, 2005.

Senate Bill 426/aSPAC -- Page 6

•

A frequently posed question asks if treatment with methadone is just substituting one ad-

dictive drug for another. There are major differences between use of illegal heroin use

and medically administered methadone. Heroin lasts 4-6 hours and used in ever-

increasing doses by dangerous injection, snorting or smoking. Methadone lasts 24 to 36

hours and is swallowed safely as a liquid. 95 percent of heroin users admit to criminal

behavior to obtain money to buy drugs. Participants in abstinence-oriented programs

were much more likely to fail and return to drug use. The U.S. Substance Abuse and

Mental Health Services Administration (SAMHSA) refers to MMT as the most effective

treatment for opiate addiction. Well-run MMT programs, with appropriate drug monitor-

ing, counseling services, vocational resources and referrals have been demonstrated to

decrease heroin use and related crime, increase employment, and improve physical and

mental health.

5

•

The World Health Organization supports the use of MMT for inmates to prevent the

spread of HIV and AIDS among intravenous-drug users, noting in a 2004 policy brief:

Prisoners on methadone maintenance prior to imprisonment should be able

to continue this treatment while in prison. In countries in which methadone

maintenance is available to opiate-dependent individuals in the community,

this treatment should also be available in prisons.

•

Health care providers have documented episodes of ongoing heroin use in New Mexico

prisons, despite efforts by security to confiscate drugs. Heroin use in NM prisons has re-

sulted in deaths, serious overdoses, Hepatitis C infections and life-threatening staph in-

fections requiring surgery, prolonged hospitalization, and expensive antibiotic therapy.

6

•

Buprenorphine is used nationwide in community-based drug treatment programs. The

medication can be prescribed in an office setting by any certified physician. New Mexico

presently has 20 certified physicians and 30 eligible for certification. The medication is

also available through Opioid Treatment Programs. The availability of the medication

means that prisoners returning to their communities can continue treatment, which sig-

nificantly reduces the opportunities for relapse and /or overdose.

DOH suggests that the program detailed in the present legislation could be proposed as a pilot

project, with a small population. Outcomes will be easier to evaluate for expansion to the larger

system. Further, that it is advisable that inmates be assessed for possibility of relapse upon dis-

charge and enrollment in a pilot project to begin opiate treatment prior to discharge and ensure

that they continue treatment in the community.

BFW/lg:yr

5

McClellan et al.

6

McGuire 2005.