Sam Marullo ’20 Champions New Bill on Opioid Medication in CT Prisons

Solomon Center student Sam Marullo ’20 has taken his interest in health care policy and advocacy to the Connecticut General Assembly. Marullo, who was the policy director for Rhode Island Governor Gina M. Raimondo prior to coming to Yale, leveraged his expertise and the resources at Yale Law School to champion proposed legislation that would require Connecticut to provide its prisoners with access to medication-assisted treatment, the gold standard treatment for opioid-use disorder. The bill made it out of committee and is working its way through the appropriations process. Below is a Q & A from Marullo.

Can you describe the bill (for someone who knows nothing about it)?
Opioid overdose is now the leading cause of death for Americans under 50. In Connecticut last year, there were over 1,000 deaths — that's almost three every day. More Connecticut residents now die from overdose than car accidents, homicides, and suicides combined.

What a lot of people don't realize is that more than half of opioid overdose deaths in Connecticut are among former prisoners. Research shows people can be 10 times more likely to overdose in the first few weeks after release. Despite this, most prisoners in Connecticut today have no access to evidence-based treatment for opioid-use disorder. In fact, most people who arrive on treatment are actually taken off treatment while they're incarcerated. Almost no one has the opportunity to use their time in prison to get started on treatment.

The bill would change that. Over the next four years, the bill would require that Connecticut provide prisoners with access to what's called medication-assisted treatment (MAT) — the gold standard for opioid-use disorder and the same treatment that people have access to in the community.

There's a lot of evidence that treatment works. In the community, MAT has been shown to save lives, save money, and reduce crime. In prison, the results are even more dramatic. Under Gov. Gina M. Raimondo ’98, Rhode Island was the first state in the country to create a comprehensive MAT program in its prisons. In the first six months of the program, it saw an incredible 60% decrease in post-incarceration overdose deaths. In Connecticut, that could be more than 100 lives saved every year. 

How did this bill come about/how did it get off the ground? 
During my first semester, I was looking for a way to stay involved in policy while at Yale. I had the good fortune of having Professor Abbe Gluck ’00, the Solomon Center faculty director, as my Civil Procedure professor in the fall. She encouraged me to write an op-ed on opioid issues, and helped me get it published in the Hartford Courant.

I reached out to Patrick Hulin '20, who was born and raised in New Haven and knows the local politics. Over winter break, Professor Gluck connected us with local leaders in addiction medicine. We got a warm reception for our proposal, and there was a lot of interest in a bill like this, so Patrick and I decided to try to make it happen. I drafted bill language, and together we cold-emailed as many state legislators as we could. Sen. Terry Gerratana, one of the co-chairs of the Public Health Committee, was interested. She agreed to have her committee introduce the bill, and we've been working on it since.

What is the hope for the legislation?
We're hoping to get something passed this year! The bill was just voted out of committee unanimously. We had a great public hearing, with support from the Public Health Commissioner, the Senate President, a coalition of mayors, the leaders of the Rhode Island program, and others. The next step is going to be the appropriations process, which may be difficult. Connecticut is in the middle of a significant budget crisis, with a deficit in the hundreds of millions of dollars. Even though this program will save money in the long run, it would be a new expense in the short term. 

We're going to keep pushing for comprehensive access to treatment, but we would be happy with a down payment on a comprehensive program. If we're not successful this year, we'll try again next year. The national tide on this is clear. It's not a matter of if Connecticut will start offering treatment, it's a matter of when.

Do you think there are specific things that helped the legislation move along that you uniquely had access or support to do because you’re at YLS?
In addition to Prof. Gluck's initial push to get started, two things have been helpful. First, the faculty has been very generous in connecting us to local leaders. We've been able to get support from the heads of opioid-treatment programs, the experts who designed Connecticut's opioid response strategy, mayors, academic leaders, and others. Their support was crucial during our public hearing.

Second, this semester Patrick and I have been able to work on the bill through the Legislative Advocacy Clinic. Professor Jay Pottenger ’75 and Clinical Lecturer in Law Shelley Geballe ’76, and the other leaders of the clinic, are very well connected in state politics. Working through the clinic helps create a structure around the project and has enabled us to get academic credit for our work. The clinic has also helped us recruit additional people to help out from the Law School, the Yale School of Public Health, and the Yale School of Medicine. 

Did you expect to get to do this type of work in the spring of your 1L year?
Coming to Yale, one of my fears was that I would get too wrapped up in school work, and I wouldn't be able to work on policy issues. I'm really glad that I've been able to work on this bill, especially during my first year. It's also been great that Patrick and I have gotten so much help from within Yale. We wouldn't be able to do this without the support we've gotten from the faculty and other students.