Medication-Assisted Treatment in Criminal Justice Agencies Affiliated with the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS): Availability, Barriers, and Intentions

Abstract

Medication-assisted treatment (MAT) is underutilized in the treatment of drug-dependent, criminal justice populations. This study surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of MAT and factors influencing use of MAT. A convenience sample (N=50) of criminal justice agency respondents (e.g., jails, prisons, parole/probation, and drug courts) completed a survey on MAT practices and attitudes. Pregnant women and individuals experiencing withdrawal were most likely to receive MAT for opiate dependence in jail or prison, while those re-entering the community from jail or prison were the least likely to receive MAT. Factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. Differences across agency type in the factors influencing use and perceptions of MAT were also examined. MAT use is largely limited to detoxification and maintenance of pregnant women in criminal justice settings. Use of MAT during the community reentry period is minimal. Addressing inadequate knowledge and negative attitudes about MAT may increase its adoption, but better linkages to community pharmacotherapy during the reentry period might overcome other issues, including security, liability, staffing and regulatory concerns. The CJ-DATS collaborative MAT implementation study to address inadequate knowledge, attitudes and linkage will be described.

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

“…For example, although the concept of narcotic blockade has been repeatedly documented since Vincent Dole's work with methadone in the 1960s (Dole et al, 1966;Kleber, 2007;Tetrault and Fiellin, 2012), less than half of respondents agreed, and 45-56% were uncertain, that agonist medication reduces or blocks the effects of heroin. These responses are consistent with previous findings both in other criminal justice dispensations (Nunn et al, 2009;Friedmann et al, 2012) and among community treatment providers (Kang et al, 1997;Kayman et al, 2006) and serve as a disquieting reminder that the stigma and uncertainty with which the public regards MAT stubbornly prevails even among experienced drug court professionals.. Numerous reasons were cited for why agonist medication was either not available or had limited availability to opioid-dependent drug court participants.…”

Adoption of Injectable Naltrexone in U.S. Substance Use Disorder Treatment Programs

“…Further, SUD treatment programs within correctional institutions are often unwilling to adopt the use of medications to treat opioid use disorders (Kubiak et al, 2009;Rich et al, 2005;Smith-Rohrberg et al, 2004). In particular, the use of agonist SUD medications is limited by its being viewed in the criminal justice system as drug substitution (Friedmann et al, 2012;Marlowe, 2011;McMillan & Lapham, 2005;Walters et al, 2007). Other studies using samples of prisons, jails, or community corrections agencies indicate that MAT is rarely used (Friedmann et al, 2012;Matusow et al, 2013;Taxman et al, 2007).…”

“…In particular, the use of agonist SUD medications is limited by its being viewed in the criminal justice system as drug substitution (Friedmann et al, 2012;Marlowe, 2011;McMillan & Lapham, 2005;Walters et al, 2007). Other studies using samples of prisons, jails, or community corrections agencies indicate that MAT is rarely used (Friedmann et al, 2012;Matusow et al, 2013;Taxman et al, 2007). As a result, a treatment center's connection with the criminal justice system has been shown to be associated with both less adoption and less sustained use of medications for AUD and opioid use disorder (Abraham et al, 2011;Ducharme et al, 2006;Knudsen & Roman, 2012).…”

An historical review of racial bias in prison-based substance abuse treatment design

“…Barring comprehensive health insurance coverage or involvement in a state sponsored carceral program, poor drug abusers of color currently do not have the same access to more effective MAT care as their White counterparts. Moreover, regardless of whatever pharmacological developments emerge in the expansion of MATs in general, treatment provision evaluation data suggest that opioid dependent individuals who are referred to MAT by the criminal justice system are more likely to face delays in admission than other types of referrals (Friedmann et al, 2012;Gryczynski, Schwartz, Salkever, Mitchell, & Jaffe, 2011).…”