Expand the Use of MAT/MAR in Correctional Facilities

Introductory Paragraph

Individuals with opioid use disorder have higher risk of being involved in the criminal legal system. Those who are incarcerated have very high risks of opioid overdose upon release. Individuals struggling with mental health and substance use disorders may revolve in and out of correctional facilities, especially if they have not received treatment and they are released back to the community where their substance use cycle may continue. Several prisons are working towards implementing Medication-Assisted Treatment (MAT) and Medication-Assisted Recovery (MAR). MAT is utilized as an intervention in a controlled, safe environment and has been shown to reduce drug use, overdose, and mortality and recidivism rates.

Key Information

The opioid epidemic has become a national public health crisis with an increase in overdose and overdose deaths. Those in the criminal justice system are significantly impacted by this epidemic. A National Survey on Drug Use and Health indicated the odds of being involved in the criminal justice system increase for those using opioids. Those in the criminal justice system who transition back into the community after incarceration have high rates of returning to the criminal justice system or of relapsing. MAT can assist those with substance use disorder and reduce the rate of relapse.

The FDA and SAMSHA identify MAT medications as Methadone, Buprenorphine, or Naltrexone for use for treatment of individuals with opioid use disorders. MAT may also be used in conjunction with behavioral health therapy. Medication and counseling in jails and prisons can lower overdose deaths after release. Best practices surrounding MAT in correctional facilities emphasize the importance of support and buy-in from correctional facilities leadership, support staff and community.

The National Council for Wellbeing lists criteria that have been applied by some correctional facilities to determine who should receive MAT:

• Individuals previously on MAT in the community prior to arrest
• Individuals diagnosed with a moderate or severe OUD
• Individuals identified in a validated risk assessment to be at the highest risk of return to use or overdose
• Individuals who are within a few weeks of release to the community
• The capacity of the correctional facility to deliver the resources needed

Relevant Research

This article titled "Release from prison - A high risk of death for former inmates," documents the higher risk of overdose death post-release.

This literature review documents the effectiveness of MAT in prison and jail settings, including increased retention in treatment.

This White Paper summarizes research on a variety of benefits of MAT in correctional facilities, such as reduced risk of suicide during incarceration.

Impactful Federal, State, and Local Policies

Federal Rights. In a landmark decision, a federal judge ordered a county jail to provide a woman with access to MAT) for her opioid use disorder during her jail sentence. Thus, thee is now a legal imperative that is increasing judicial recognition that MAT should be standard care in jails and failing to provide it violates individuals’ rights.

The SUPPORT Act for Patients and Community mandated Medicaid coverage for MAT.

Massachusetts passed Chapter 208, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction. This authorized a four-year pilot administering all three FDA-approved medications to treat opioid use disorder.

The American Correctional Association (ACA) and the American Society of Addiction Medicine (ASAM) issued a joint policy statement on the treatment of opioid use disorders for justice involved individuals. It delineates specific recommendations for the following four domains:

• Screening and Prevention
• Treatment, with several points on MAT
• Reentry and Community Supervision Considerations
• Education

Available Tools and Resources

SAMHSA has published a report titled "Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings." and a guidance brief for states titled "MAT in the Criminal Justice System."

BJA manages the Residential Substance Abuse Treatment Program (RSAT) which offers training and technical assistance to county and states and which has published the "Prison/Jail Medication-Assisted Treatment Manual."

SAFE Project has an additional wiki page titled "Expand Access to MAT."

The National Council for Wellbeing has published a report titled "Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons - A Planning and Implementation Toolkit."

Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field

Opioid Response Network - Medications for Opioid Use Disorder (MOUD) in Corrections

Pew. Study titled "Opioid Use Disorder Treatment in Jails and Prisons" provides positive case studies in Pennsylvania ///

State Based Medicaid may provide funding for MAT Medicaid Coverage of Medication Assisted Treatment (MAT): A 50-state overview

Promising Practices

Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field-Includes promising practices and specific states with case studies including KY, RI, MA, WA.

Prison/Jail Medication-Assisted Treatment Manual Includes Training and Technical Assistance

Pennsylvania Department of Corrections MAT

SAMSHA Medication Assisted Treatment for OUD in Criminal Justice Settings