Expand the Use of MAT/MAR in Correctional Facilities

Introductory Paragraph

The opioid epidemic has become a national public health crisis, and those in the criminal justice system are significantly impacted by this epidemic. 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

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. Medication, in conjunction with behavioral health therapy, 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 opioid use disorder
• 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.

Findings from the Justice Community Opioid Innovation Network (JCOIN). In a 2023 study, JCOIN researchers (from the Massachusetts Clinical Research Center, the University of Massachusetts at Amherst, the University of Massachusetts Chan Medical School, Baystate Health, and Tufts University) outline key steps MOUD program treatment staff can implement in order to prevent diversion. The study also provides guidance to corrections and lawmakers as they consider establishing and expanding MOUD treatment in correctional settings."

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, there is now a legal precedent which 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.

Medicaid provides for Medication Assisted Therapy (MAT) to individuals in the criminal justice system. Several states are working to address the opioid epidemic by utilizing Medicaid 1115 Demonstration Waivers.

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.

New York passed legislation to allow MAT to individuals in diversion programs. The legislation ensures that who those participate would not face charges due to MAT medications/drug screens.

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 an issue brief titled "Medication Assisted Treatment in Criminal Justice Systems." and a report titled "Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings"

BJA has published the "Prison/Jail Medication-Assisted Treatment Manual."

SAFE Project:

• "Frequently Asked Questions about Medication Assisted Treatment (MAT)" is a SAFE Project written article that explores frequently asked questions about MAT, dispelling any myths and/or stigma associated with the treatment.
• "Medication Assisted Treatment (MAT) Explained" is a SAFE Project written article that explores what Medication Assisted Treatment is and who it's used for.
• See the wiki titled "Expand Access to MAT" for more information on Medication Assisted Treatment (MAT) and it's benefits.

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."

The National Sheriffs Association published "Jail-based Medication-Assisted Treatment Promising Practices, Guidelines, and Resources for the Field."

The National Conference of State Legislatures provides a 50-state index of Medicaid Coverage of MAT.

The Opioid Response Network has a resource page titled "Medications for Opioid Use Disorder (MOUD) in Corrections."

The Pennsylvania Department of Corrections has an extensive resource page on MAT. It has also created a one-page promotional paper on MAT.

Promising Practices

Pennsylvania The Department of Corrections is promoting MAT. The results of a 2019 Pilot program led to the assignment of at least one MAT Specialist for each of the state's 24 prisons.

Case studies from California, Kentucky, Massachusetts, Rhode Island, and Washington are highlighted in this report by the National Sheriffs Association.

Pew Charitable Trusts published a study titled "Opioid Use Disorder Treatment in Jails and Prisons" that includes positive case studies in Colorado, Massachusetts, Pennsylvania, and Vermont.