More than 80 percent of incarcerated individuals with a history of opioid use do not receive treatment and are at a high risk of overdose death after their release. Timely access to evidence-based medication for opioid use disorder reduces the risk of overdose death and recidivism among justice-involved individuals.
The National Council for Behavioral Health and Vital Strategies’ newly released Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit (with support from the Centers for Disease Control and Prevention and Bloomberg Philanthropies) is a Call to Action for correctional administrators and health care providers to adopt medication-assisted treatment (MAT) programs in correctional settings.
Developed by a national team of multidisciplinary experts, including faculty from Johns Hopkins University, the toolkit provides real world examples, resources and tools to:
Below is a quick Q&A with Shannon Mace, JD, MPH, who is a Senior Practice Improvement Advisor with the National Council for Behavioral Health. Mace served as the Project Director for the development of the toolkit.
Why is it important to provide MAT in correctional settings?
There are a lot of important reasons to provide medications for opioid use disorder (OUD) in correctional settings. First, individuals who are incarcerated have very high risk of having OUD and dying from an overdose. A study from a Washington state prison showed that individuals released from prison were 129 times more likely to die of drug overdose in the first two weeks after release compared to the general public. FDA-approved medication for OUD is the gold standard of care for individuals with OUD and these medications save lives. Failing to offer these medications to people with OUD can be seen as equivalent to failing to provide insulin to individuals who have diabetes. There is also an increasingly recognized legal imperative by which courts are ruling that failing to provide medication for OUD is a violation of individuals’ rights under the Eighth Amendment and Americans with Disabilities Act. Over time, we're going to see more courts rule that these medications must be part of the standard of care for individuals who are incarcerated. Some of these medications have also been shown to reduce risk of recidivism, interrupting the cycle that individuals with addiction go through repeatedly entering and exiting correctional settings. There are studies that also show additional positive benefits, including reducing the risk of suicide in jails, which is a serious problem that many local jails face. Anecdotally, we have also heard from correctional administrators that security staff have benefited from implementing these programs by decreasing adverse events and incidents in their facilities. I think there's a multitude of benefits by offering these programs.
How is a Medication-Assisted Treatment program different in a correctional setting?
One realization I had interviewing experts for the toolkit is that a lot of the challenges associated with implementing these programs in correctional settings are rooted in the misunderstandings and myths stemming from stigma that continues to persist today. The challenges that exist related to offering medications for OUD in general, also apply to correctional settings, but we are seeing that jails and prisons can successfully plan and implement these programs regardless of the size of the facility. I think the biggest hurdle to implementing these programs is overcoming to myths related to medication for OUD, and substance use disorders in general. We have heard from correctional administrators and security staff who previously believed that these medications “replaced one drug for another,” a common myth, but once they were educated on the medications and how they work, they became true believers and champions for the program. We encourage correctional administrators and health care providers to think about implementing medications for OUD as they would any evidence-based treatment for any disease.
Correctional facilities are unique health care settings, though, with unique considerations. One challenge to providing any health care services in corrections is funding, since there is a federal inmate exclusion that prohibits the reimbursement of Medicaid during incarceration. It is important that jails are assisting individuals with obtaining insurance prior to their release and helping to connect them to ongoing treatment and services in the community.
Correctional facilities must also prioritize safety and security, therefore, each facility needs to determine its own needs related to how, when, and where to administer medications. Having health care and security staff work together to plan the best way to design and implement these programs is critical to their success.
Who do you think would benefit the most from having access to this tool kit?
People who provide health care in correctional settings and correctional administrators — wardens, sheriffs, and correctional officers who are frontline staff. This toolkit should help them gain a better understanding of how these medications actually work and what these programs are designed to do. The toolkit is also applicable to community-based behavioral health programs and treatment providers so that they can gain an understanding of how correctional models are operating and to identify ways to better link with jails and prisons to ensure a continuity of care for individuals. There are several different models of programs within correctional settings, including partnerships with community-based providers, so there is a wide audience for the information provided by the toolkit.
To learn more about the toolkit and to hear from three experts in the field, please join the webinar on February 25 at 2pm ET. If you are interested in learning more about this project, please contact Shannon Mace at [email protected].
Click here to learn more about the Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit.