MAT in Criminal Justice Settings and Upon Release

In this intervention, MAT should be available as a standard of care for incarcerated individuals with opioid use disorder. Those receiving MAT when they enter a criminal justice setting may continue receiving this treatment, and those who are not on treatment may initiate and continue this form of care while incarcerated and then be linked with appropriate care providers to continue MAT upon release.

Why this Strategy works

MAT is one of the most effective forms of treatment available for opioid use disorders. MAT has been shown to lower rates of illicit drug use, lower risk of overdose, lower rates of drug-related crime, and increase engagement with many other essential forms of healthcare.

Providing MAT in jails and prisons not only brings healthcare in correctional facilities in line with current medical standards for the treatment of this medical disorder, it also improves the likelihood that incarcerated persons will engage in care in the future and lowers the likelihood of relapse, problem opioid use, and risky opioid use after release.

MAT in criminal justice settings works best when:

MAT is uninterrupted for those who were receiving care prior to incarceration.

MAT can be initiated in criminal settings.

Individuals have access to all available forms of MAT medication.

An effective system for referral and linkage to care is in place so that individuals on MAT can receive a "war, handoff" to providers who are able to continue to their care upon release. Otherwise, recently released individuals are forced to choose between enduring painful opioid withdrawal and quickly finding another source of opioids. The quickest and easiest sources of opioids are illicit ones.

MAT in criminal justice settings and upon release-What the research says

Multiple studies have found that MAT in correctional facilities is associated with decreased heroin use, decreased levels of syringe sharing, decreased criminal activity, and a significantly higher probability of engaging with treatment upon release.

A study conducted among 300 incarcerated persons in Rhode Island concluded that forced withdrawal from methadone upon incarceration (among those who were receiving methadone prior to incarceration) reduces the likelihood that an individual will engage in care after release. Forced withdrawal is required in correctional facilities where MAT is not available.

A study conducted at Rikers Island found that individuals given buprenorphine-based MAT during a 10-90-day incarceration were more likely than those given methadone-based MAT to continue treatment after release.

A Baltimore study found that incarcerated individuals who received methadone stayed in treatment for an average of 166 days in the year following their release, whereas those who received only counseling but no MAT engaged in treatment for an average of 23 days following release and were more likely to test positive for opioids at 12 months after release.

Within one year of initiation new MAT program in all state adult correctional facilities, the state of Rhode Island observed a 60% decrease in proportion of recently incarcerated individuals who suffered a fatal overdose. The state also observed fatalities compared to the previous year, which can be attributed to the deaths prevented by the prison's MAT program.