Roughly 500 inmates are receiving medication for opioid addiction, according to Vermont Department of Corrections officials. That makes the prison system one of the largest drug treatment providers in the state — a dramatic change from just a few months ago when hundreds were still awaiting medication. Today, more than a quarter of the prison population housed in Vermont has a prescription for addiction meds.

Problems remain, however: Prison officials say they're struggling to contain the illegal diversion of treatment drugs, and inmates and advocates contend that some prisoners are still being denied proper care.

The expansion of treatment behind bars is the result of a law that took effect July 1, requiring that the department provide ongoing addiction medication, including buprenorphine and methadone, to addicted inmates. These drugs, which relieve opioid withdrawal symptoms and suppress cravings, were previously provided for no more than 120 days, and only to inmates who had a prescription before entering prison.

Lawmakers, emphasizing that addiction is a disease, decided that all addicted inmates were entitled to the medication. They were particularly concerned about those poised to be released from prison, who are at a high risk of dying from an overdose.

The rollout of the new law was rocky. A deluge of hundreds of requests for medication overwhelmed correctional staff, and inmates became increasingly frustrated as months passed without a response.

But last month the department and its private health care provider, Centurion, made significant strides. Since early September, they have roughly doubled the number of inmates getting treatment.

Since July 1, more than 900 have received treatment. That figure is much higher than the current 500 or so, because inmates cycle in and out of prison.

As of December 14, 75 inmates were still waiting for medical assessments to see whether they qualified. Most of those requests were filed within the last 30 days, according to Benjamin Watts, the department's health services director.

Only 18 inmates have had their requests for medication turned down, according to department officials. That amounts to roughly 3 percent of those who've been screened to determine whether they qualify. The department also recently started providing bridge medication to inmates about to be released to help them stay clean until they're able to see a doctor on the outside.

"I'm hearing a lot of people report that having access to medication-assisted treatment is making a huge difference for them, and we're already seeing success as people transition from the correctional facilities back into the community," said Tom Dalton, executive director of Vermonters for Criminal Justice Reform.

"I feel like we're really close to having a law that's implemented as those of us who worked really hard on it intended," said Rep. Selene Colburn (P/D-Burlington), who pushed for the new law. "I think it's going to make a huge difference."

Managing such a large amount of medication has created challenges, however. "Candidly, it's difficult," said outgoing Corrections Commissioner Lisa Menard.

Two inmates who were not addicted to opioids recently overdosed after obtaining buprenorphine illegally, she said. Both had to be revived with the overdose-reversing drug Narcan. Buprenorphine, which is itself an opioid, can be used to get high, though its potential for abuse is much lower than that of heroin and other more potent opioids.

"We had heard initially that there was a very low risk for overdose with buprenorphine, but unfortunately we found out quite quickly that although it is a low risk, it certainly exists," Menard said. "We're very concerned about it."

A third inmate punched a correctional officer in the head when the officer tried to take away his buprenorphine. The inmate had been caught diverting the drug, according to Menard.

The commissioner said she's encouraged, however, by a decline in complaints from inmates seeking treatment. Formal grievances reach her desk when inmates are dissatisfied with the response from lower management. Menard had been receiving three to five a week but is now getting "very few," and she observed that the nature of the complaints is less serious. Of the two most recent grievances, one came from an inmate who wanted to get his buprenorphine back after he'd diverted it. The department did reinstate his prescription before releasing him, Menard said. The other came from an inmate requesting the medication in a grape flavor.

"It's a good indicator that things are working well," Menard said.

Dalton said he, too, has been receiving fewer complaints from inmates who aren't getting any treatment at all. But he's still hearing a number of concerns. During an interview last Thursday afternoon, his cellphone rang repeatedly as inmates called to discuss problems with the treatment program.

Tyler Orvis, a 35-year-old incarcerated at Northern State Correctional Facility in Newport, had been taking buprenorphine and participating in a prison work program run by Vermont Correctional Industries for months without incident. He earned 95 cents an hour operating a printing press. But Orvis said he was suspended from work on December 3 after his boss found out he was taking buprenorphine. The inmate said he was told that he would need clearance from Centurion medical staff to return to his job.

While he waits for a medical appointment, Orvis estimates he's lost more than $100 in wages. He said he knew of at least six others in the print shop who were in the same situation.

Incoming commissioner Mike Touchette wrote in an email that "all inmates who wish to be employed are required to go through a medical screening prior to employment ... This is to ensure that the individual is physically capable of meeting the demands of the work."

He suggested it was unlikely that inmates would lose their jobs, noting that doctors outside of prison rarely put work restrictions on patients taking buprenorphine.

Inmates have also complained that they've received insufficient doses, in some cases significantly less than what they were prescribed on the outside.

Bruce Lamell's 16-milligram prescription for buprenorphine was terminated when he arrived at Northwest State Correctional Facility in St. Albans last year. This past October, he got a prescription again, but this time only for four milligrams.

"Four milligrams is nothing," he said during a phone interview. To stave off the withdrawal symptoms and opioid cravings, the 44-year-old inmate turns to the black market. "It makes it so you have to join the illegal Suboxone trade, is what it does." (Suboxone is a common brand name for buprenorphine.)

"There are a significant number of people who are not yet at a therapeutic dose, and therefore the treatment is not as effective as it could be," Dalton said.

Annie Ramniceanu, the department's addiction and mental health systems director, contended that such cases were "very rare." She and other corrections officials insisted they weren't aware of any policy in the prison system establishing a maximum dose.

However, records from a December 3 stakeholder meeting, which included corrections staff and Centurion doctors, suggest otherwise. The minutes state, "Max doses will likely be 8mg in most cases."

In practice, that doesn't appear to be a firm cap. Touchette said last week that 59 inmates were receiving more than nine milligrams.

James Monette, a 38-year-old with more than two and a half years left on his sentence, told Seven Days he's still not receiving any medication. Monette, who said he's been addicted to opioids for more than a decade, is racking up "dirty urines" — positive drug tests, which come with penalties — while he waits. "Without [medication] in here, I'm screwed," he said.

Dalton suggested the buprenorphine black market that officials are concerned about will dry up once Monette and others get the medication they need.

In the meantime, inmates say the process of receiving their medications has become increasingly demeaning as officials try to prevent them from stashing away the drugs.

Prison staff started crushing the pills last week, according to Orvis. After swallowing the powder, "You gotta stick your fingers in your mouth, and drink, like, four glasses of water." He said correctional officers and medical employees continue to refer to him as a "junkie."

Lamell noted that inmates receiving buprenorphine at the St. Albans prison have to wear gray sweatshirts when they go to get their medication. "It makes the whole facility know," he said, suggesting the practice violated medical privacy protections. Touchette said the sweatshirts, provided to all St. Albans inmates, must be worn when inmates line up for their meds because they don't have pockets where drugs can be hidden.

There's a perverse effect to this precautionary measure: The conspicuous uniforms make inmates easier targets for people seeking the drug illegally. "We have [other inmates] bugging us for medication," Lamell said.

Dalton said that in some cases, inmates caught diverting medication are simply attempting to save some of their dose for later in the day "because at the low dose [being prescribed], they're going into withdrawal or feeling sick before their next dose."

A handful of inmates dissatisfied with their treatment regimen have taken their complaints to the courts. Jill Martin, an attorney with the Prisoners' Rights Office, said it currently has approximately 25 such cases. Martin said she couldn't discuss specific cases, but "I can tell you that we are vigorously pursuing them."

Rep. Colburn said she and others are monitoring the situation closely.

"The reason really that we've seen progress," the Burlington lawmaker said, "is people on the inside having the courage to talk about their experience and the tenacity to argue about what they need." Colburn continued, "That's the ultimate test for how this is working."