Play 7: Provide medication-assisted treatment to inmates

Summary
Nationally, 65 percent of all incarcerated offenders meet the criteria for suffering from a substance use disorder. Research has shown that medication-assisted treatment (MAT), including with buprenorphine, methadone and extended-release naltrexone, can decrease opioid use, opioidrelated overdose deaths, criminal activity and infectious disease transmission – while also increasing social functioning and retention in treatment.

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. In one recent study, a MAT program resulted in a 60 percent reduction in opioid overdose deaths among individuals who were recently incarcerated.

Example: The Medication Assisted Treatment and Directed Opioid Recovery program in Middlesex County, MA, has
had striking results, with a non-recidivism rate of 82 percent.

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 deaths for inmates after release, as compared to those not involved with MAT; and (2) a percentage reduction in recidivism, 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.