Abstract
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, whereas those reentering 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.
Highlights
Medication assisted therapy (MAT) is underutilized in the treatment of alcohol- or opioiddependent, criminal justice populations[1,2,3,4,5,6,7] despite substantial evidence of its effectiveness in reducing opioid and alcohol use,(8,9) criminal behavior and arrest,(10–13) and HIV risk behavior.[14,15] Medication-assisted treatment (MAT) here refers to the addition of pharmacotherapy to traditional substance abuse counseling in order to attenuate withdrawal symptoms, craving and/or the reinforcing euphoria resulting from alcohol or drug use
Expansion of the drug-involved correctional population.[21,22] The potential role of MAT for criminal justice populations is germane today as numerous drug-involved inmates return to the community, and state budget crises provide impetus for evidence-based interventions like MAT to reduce the costs of rearrests and re-incarceration as well as the societal, human and health care costs associated with chronic substance dependence
Almost three-quarters of the jails and prisons surveyed provide opioid pharmacotherapy for pregnant inmates and 60% use it for the management of opioid withdrawal
Summary
Medication assisted therapy (MAT) is underutilized in the treatment of alcohol- or opioiddependent, criminal justice populations[1,2,3,4,5,6,7] despite substantial evidence of its effectiveness in reducing opioid and alcohol use,(8,9) criminal behavior and arrest,(10–13) and HIV risk behavior.[14,15] MAT here refers to the addition of pharmacotherapy to traditional substance abuse counseling in order to attenuate withdrawal symptoms, craving and/or the reinforcing euphoria resulting from alcohol or drug use. It includes ten Research Centers, their criminal justice partner organizations, and NIDA scientists. In preparation for the design of a multisite implementation trial, the MAT Working Group of CJ-DATS administered a preliminary planning survey to understand the availability of, need and readiness for, and barriers to MAT among partnering criminal justice agencies
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