MAT: What's In It For Me?

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By National Commission on Correctional Health Care

Published: 11/12/2018

The National Commission on Correctional Health Care and the National Sheriffs’ Association have produced a new resource for sheriffs and jail administrators. Jail-Based Medication-Assisted Treatment: Promising Practices, Guidelines, and Resources for the Field guides jails in developing effective MAT programs for the treatment of people with opioid use disorders. The following is an excerpt from the report, courtesy NCCHC and NCA. For a copy of the complete report, go to http://www.ncchc.org/jail-based-MAT or call 773-880-1460.

MAT: What’s In It for Me as a Criminal Justice Executive?

Medication-assisted treatment (MAT), utilizing the U.S. Food and Drug Administration (FDA)-approved medications methadone, buprenorphine, or naltrexone, is considered a central component of the contemporary standard of care for the treatment of individuals with opioid use disorders (OUDs). It may also be used for individuals with co-occurring mental illnesses, in consultation with a physician.

Evidence strongly supports that the use of MAT increases the likelihood of successful treatment for individuals with OUDs and reduces morbidity and mortality. Research has begun to show that adding MAT to the treatment of those involved in the criminal justice system confers the same benefits and also reduces recidivism.

These findings are particularly relevant for criminal justice decision makers—including sheriffs and corrections department officials—given that Bureau of Justice Statistics surveys found that nearly two-thirds (63 percent) of people in jail meet criteria for drug dependence or abuse. Many of these individuals have OUDs and could benefit from access to MAT, a combination of behavioral interventions and medications that have been shown to decrease opioid use, increase treatment retention, reduce overdose, and reduce criminal activity.

By thoughtfully and carefully including MAT, when appropriate, as a tool in the range of jail-based treatment options, the value proposition to criminal justice executives may include:

Stemming the cycle of arrest, incarceration, and release associated with substance use disorders (SUDs), as individuals with SUDs return to the community without connection to treatment.
Contributing to the maintenance of a safe and secure facility for inmates and staff.
Reducing costs: Comprehensive drug treatment programs in jails are associated with reduced system costs. According to the 2018 Substance Abuse and Mental Health Services Administration (SAMHSA) TIP 63: Medications for Opioid Use Disorders, “Data indicate that medications for OUD are cost effective and cost beneficial.”

Most important, MAT can help rebuild and save the lives of those with substance use disorders:

By facilitating continued access to MAT for individuals who are on prescribed FDA-approved MAT, correctional agencies can minimize the risk of postrelease overdose and death. For individuals with OUDs who were not receiving MAT prior to arrest, correctional facilities can offer MAT prior to release, taking into account individual preferences and clinician judgment. Importantly, facilities should offer all three MAT options.
When MAT is not feasible (e.g., the individual is facing transfer to a facility that does not offer MAT), FDA-approved medications (e.g., methadone or buprenorphine) should be used to provide medically managed opioid withdrawal.
Considering that the criminal justice system is the largest source of organizational referrals to addiction treatment, justice leaders have a unique and valuable opportunity to facilitate the path to recovery.

Notwithstanding the increasing evidence and formal support from many prominent public health and public safety organizations (including the National Sheriffs’ Association and the National Commission on Correctional Health Care), substance use treatment providers—both inside and outside of the criminal justice system—have been slow to add MAT to their treatment regimens. In 2011, the Washington County, Maryland, jail became the first to introduce MAT for nonpregnant women and for men. Other county jails and state departments of corrections (DOCs) in Missouri, Pennsylvania, and Massachusetts followed suit.

However, as of January 2018, 20 state DOCs did not offer MAT in their drug treatment programs for incarcerated individuals beyond limited methadone maintenance for pregnant women. Out of several thousand local and county jails, fewer than 200 in 30 states provide MAT, and the protocol is primarily limited to the provision of injected naltrexone immediately before individuals are released back into the community. Jails that provide MAT for pregnant women typically discontinue it postpartum, although this is not the recommended standard of medical care.

To download Jail-Based Medication-Assisted Treatment: Promising Practices, Guidelines, and Resources for the Field, go to www.ncchc.org/jail-based-MAT or call 773-880-1460.

Comments:

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