41 7. Provide medication-assisted treatment to inmates On a national basis, 65 percent of all incarcerated offenders meet the criteria for suffering from a substance use disorder.65 Research has shown that medication-assisted treatment (MAT), including with buprenorphine, methadone and extended-release naltrexone, can decrease opioid use, opioid-related overdosedeaths,criminalactivityandinfectiousdiseasetransmission–whileincreasingsocialfunctioning and retention in treatment.66 Numerous studies have shown that the provision of MAT has long-term impacts on preventing both continued substance use disorder and criminal behaviors, thereby both preventing such disorders and reducing crime.67 In one recent study, a MAT program resulted in a 60 percent reduction in opioid overdose deaths among individuals who were recently incarcerated.68 Goals and Objectives The overriding goal of a MAT program in jails is to prevent the relapse to opioid use upon the offender’s release from incarceration. Specific objectives for such a program could include: (1) a specific percentage reduction in overdose deathsforinmatesafterrelease,ascomparedtothosenotinvolvedwithMAT;andapercentagereductioninrecidivism, as compared to a cohort not involved in MAT. Theory of Change Incarceration for offenders with opioid use disorders comes most often with the hard detoxification experience and the effects of withdrawal. The consequences of this "immediate end to addiction" while incarcerated can be very damaging to offenders after release. At that point, they can be more-seriously impacted by returning to drug use, and may be more likely to experience overdoses that lead to death. The operational theory of change in instituting a MAT program is that if this discontinuity is erased, the offender is less likely to return to drug addiction behaviors or criminal activity. An expected outcome of the introduction of a MAT program is a reduction in the number of overdose deaths. Examples The Rhode Island Department of Corrections recorded a 61 percent reduction in overdose deaths in less than a year after implementing a MAT. A new model of screening was instituted in July 2016 in the Department, which is a unified prison/jail, to implement MAT upon intake and to follow up after release into the community. Individuals arriving while receiving MAT were maintained on their respective medications regimens without tapering or discontinuing their use. A system of 12 community-located centers of excellence in MAT were established to promote transitions and referrals of released inmates.69 The Medication Assisted Treatment and Directed Opioid Recovery (MATADOR) program, introduced by the Middlesex County Sheriff’s Office in Massachusetts, has had striking results. It combines the MAT concept with pre- and post- release counseling and other services, resulting in a non-recidivism rate of 82 percent.70 In 2018, MATADOR program was recognized by the National Sheriffs’ Association and the National Commission on Correctional Health Care as one