Expand the Use of MAT in Correctional Facilities

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Introductory Paragraph

Several prisons are working towards implementing Mediation-assisted Treatment (MAT) to individuals struggling with mental health and substance use disorders. Individuals with mental health and substance use disorders may revolve in and out of prison and correctional facilities with a release back into the community where their substance use cycle continues if they have not received treatment. Medication-assisted treatment is utilized as an intervention in a controlled, safe environment and provides an opportunity to help individuals with substance use disorder.

Treatment for SUD including MAT, has been shown to reduce drug use, overdose, and reduce mortality rates and reduce recidivism rates. [1]


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 systems are also 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 and other drugs such as heroin.[2]

Those in the criminal justice system transitioning back into the community after incarceration have greater rates of returning to the criminal justice system or of relapsing when returning into their community. Medication-assisted treatment (MAT) could 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 (OUDs). MAT may also be used in conjunction with behavioral health therapy.[3] Your Safe Solutions also includes additional information on Medication-assisted Treatments (MAT). [4]

Medication and counseling in jails and prisons can lower overdose deaths after release. Studies have shown the importance of treatment while incarcerated and have shown that people who are incarcerated are at higher risk of overdose death post-release.[5]

Many of the resource guides for implementation and best practices surrounding Medication-assisted Treatment (MAT) in correctional facilities recognize the importance of support and buy in from correctional facilities leadership, support staff and community to be a success.[6]

Who should receive MAT in correctional facilities?

Suggested guidelines from the National Council of Behavioral Health provide the following guidelines [7]

Criteria that some jails have applied include

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

Why Implement MAT in Prisons?

  • Individuals who are incarcerated have very high risks of opioid overdose upon release[8]
  • Individuals with opioid use disorder (OUD) have higher risk of being involved in the criminal legal system[9]

Benefits

  • Reduces return to use of illicit opioids [10]
  • Reduces risk of opioid overdose death
  • Increases retention in treatment
  • Reduces recidivism[11]
  • 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 [12]

Relevant Research

Addiction Treatment Within U.S. Correctional Facilities: Bridging the Gap Between Current Practice and Evidence-Based Care[13]

Release from prison- A high risk of death for former inmates[14]

Pew Study Opioid Use Disorder Treatment in Jails and Prisons[15]

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[16]

Support Act for Patients and Community Act[17]

State Based Medicaid may provide funding for MAT Medicaid Coverage of Medication Assisted Treatment (MAT): A 50-state overview[18]

Joint Public Correctional Policy on the Treatment of Opioid Use Disorders for Justice Involved Individuals [19]

Available Tools and Resources

Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings [20]

Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field [21]

Prison/Jail Medication-Assisted Treatment Manual [22]

The Bureau of Justice Assistance RSAT TTA program offers training and technical assistance to county and states[23]

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons- A Planning and Implementation Toolkit[24]

Opioid Response Network- Medications for Opioid Use Disorder (MOUD) in Corrections[25]

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.[26]

Prison/Jail Medication-Assisted Treatment Manual[27] Includes Training and Technical Assistance

Pennsylvania Department of Corrections MAT[28]

SAMSHA Medication Assisted Treatment for OUD in Criminal Justice Settings [29]

Sources

  1. https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  2. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
  3. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
  4. https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)
  5. https://pubmed.ncbi.nlm.nih.gov/17215533/
  6. https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  7. https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matbriefcjs_0.pdf
  8. https://pubmed.ncbi.nlm.nih.gov/30024795/
  9. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system
  10. https://pubmed.ncbi.nlm.nih.gov/29913516/
  11. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2671411
  12. https://www.aclu.org/press-releases/federal-judge-rules-jail-must-allow-access-medication-assisted-treatment
  13. https://pubmed.ncbi.nlm.nih.gov/26076211/
  14. https://pubmed.ncbi.nlm.nih.gov/17215533/
  15. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2020/04/opioid-use-disorder-treatment-in-jails-and-prisons
  16. https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208
  17. https://www.congress.gov/bill/115th-congress/house-bill/6
  18. https://www.ncsl.org/research/health/mat-opiate-50-state-table-medicaid.aspx
  19. 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
  20. https://store.samhsa.gov/sites/default/files/d7/priv/pep19-matusecjs.pdf
  21. https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  22. https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf
  23. https://www.rsat-tta.com/
  24. https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/
  25. https://opioidresponsenetwork.org/MOUDCorrections.aspx
  26. https://www.sheriffs.org/publications/Jail-Based-MAT-PPG.pdf
  27. https://www.rsat-tta.com/Files/RSAT_Prison_Med_Treat_FINAL.pdf
  28. https://www.cor.pa.gov/About%20Us/Initiatives/Pages/Medication-Assisted-Treatment.aspx
  29. https://store.samhsa.gov/product/Use-of-Medication-Assisted-Treatment-for-Opioid-Use-Disorder-in-Criminal-Justice-Settings/PEP19-MATUSECJS