Expand the Use of MAT/MAR in Correctional Facilities

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Introductory Paragraph

Individuals with opioid use disorder have higher risk of being involved in the criminal legal system. [1] Those who are incarcerated have very high risks of opioid overdose upon release. [2] 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. [3] [4] [5]

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. [6] 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.[7] Some criteria that have been applied by correctional facilities to determine who should receive MAT include:

  • 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

Benefits

  • Reduces return to use of illicit opioids [8]
  • Reduces risk of opioid overdose death
  • Increases retention in treatment
  • Reduces recidivism[9]
  • Reduces risk of suicide during incarceration
  • Legal imperative -Increasing judicial recognition that MOUD should be standard care in jails and failing to provide MOUD violates individuals’ rights [10]

Relevant Research

Addiction Treatment Within U.S. Correctional Facilities: Bridging the Gap Between Current Practice and Evidence-Based Care [11]

This article titled "Release from prison - A high risk of death for former inmates," documents the higher risk of overdose death post-release. [12]

Pew Study Opioid Use Disorder Treatment in Jails and Prisons [13]

Impactful Federal, State, and Local Policies

Massachusetts passed Chapter 208, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction, authorizing a four-year pilot administering all three FDA-approved medications to treat OUD[14]

Support Act for Patients and Community Act[15]

State Based Medicaid may provide funding for MAT Medicaid Coverage of Medication Assisted Treatment (MAT): A 50-state overview[16]

Joint Public Correctional Policy on the Treatment of Opioid Use Disorders for Justice Involved Individuals [17]

Available Tools and Resources

Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings [18]

Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field [19]

Prison/Jail Medication-Assisted Treatment Manual [20]

The Bureau of Justice Assistance RSAT TTA program offers training and technical assistance to county and states[21]

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons- A Planning and Implementation Toolkit[22]

Opioid Response Network- Medications for Opioid Use Disorder (MOUD) in Corrections [23]

Your Safe Solutions also includes additional information on Medication-assisted Treatments (MAT). [24]

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.[25]

Prison/Jail Medication-Assisted Treatment Manual[26] Includes Training and Technical Assistance

Pennsylvania Department of Corrections MAT[27]

SAMSHA Medication Assisted Treatment for OUD in Criminal Justice Settings [28]

Sources

  1. ↑ https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system
  2. ↑ https://pubmed.ncbi.nlm.nih.gov/30024795/
  3. ↑ https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  4. ↑ https://pubmed.ncbi.nlm.nih.gov/29913516/
  5. ↑ https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411
  6. ↑ https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
  7. ↑ https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  8. ↑ https://pubmed.ncbi.nlm.nih.gov/29913516/
  9. ↑ https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411
  10. ↑ https://www.aclu.org/press-releases/federal-judge-rules-jail-must-allow-access-medication-assisted-treatment
  11. ↑ https://pubmed.ncbi.nlm.nih.gov/26076211/
  12. ↑ https://pubmed.ncbi.nlm.nih.gov/17215533/
  13. ↑ https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons
  14. ↑ https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208
  15. ↑ https://www.congress.gov/bill/115th-congress/house-bill/6
  16. ↑ https://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx
  17. ↑ https://www.asam.org/docs/default-source/public-policy-statements/2018-joint-public-correctional-policy-on-the-treatment-of-opioid-use-disorders-for-justice-involved-individuals.pdf?sfvrsn=26de41c2_2
  18. ↑ https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matusecjs.pdf
  19. ↑ https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  20. ↑ https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf
  21. ↑ https://www.rsat-tta.com/
  22. ↑ https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/
  23. ↑ https://opioidresponsenetwork.org/MOUDCorrections.aspx
  24. ↑ https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)
  25. ↑ https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  26. ↑ https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf
  27. ↑ https://www.cor.pa.gov/About%20Us/Initiatives/Pages/Medication-Assisted-Treatment.aspx
  28. ↑ https://store.samhsa.gov/product/Use-of-Medication-Assisted-Treatment-for-Opioid-Use-Disorder-in-Criminal-Justice-Settings/PEP19-MATUSECJS
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