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RSAT Forum > Monthly Discussion > November 2020: Is MAT the best option for inmates with OUD's? View modes: 
skeller - 11/13/2020 10:02:30 AM
November 2020: Is MAT the best option for inmates with OUD's?
We know MAT is recommended and is part of the US Justice Department’s RSAT Promising Practices Guidelines, but by the time inmates are referred to our RSAT program, they have already gone through withdrawal, mostly for opioids, although often mixed with other drugs.  It seems counter productive to then get them back on drugs. Isn’t that a backwards step?


You raise some very valid considerations. Let’s begin, however, with differentiating between heroin, fentanyl and illicit use of pain pills and the agonist medications buprenorphine (usually combined with naloxone) and methadone.  The latter two are not equivalent to the former drugs.  If taken appropriately, they don’t have the same detrimental effects.  They control craving, allow users to function normally, and take back their lives.  They sustain recovery and prevent persons from relapsing and, too often, overdosing on opioids.  There is also naltrexone, the third FDA approved opioid medication. As you know, before persons can take naltrexone, they must be detoxified for a week or so.  The injected version blocks opioid receptors in the brain for 28 days.  Naltrexone is not an agonist drug so it can be prescribed by any physician. So naltrexone can be an alternative for RSAT participants who have already undergone withdrawal and don’t want to be inducted onto available agonist medications.  Often prisons and jails don’t offer injectable naltrexone until the person is about to leave prison or jail.  However, to control craving, many jails and prisons provide generic naltrexone on a daily basis pending release to assist individuals with OUD.  Naltrexone also addresses alcohol craving and prevents the euphoric effects of alcohol. There is research that suggests the agonist medications may reduce alcohol consumption, although the FDA warns against any alcohol consumption with buprenorphine/naltrexone.

But, the provision of agonist medication after an inmate or detainee has been forced to go through withdrawal does not represent a backwards step in recovery.  While persons can and do maintain abstinence in a correctional environment, that unfortunately does not mean they will do so as soon as they are released.  The challenge and goal of RSAT programs is to address post-release recovery.  The research is quite overwhelming that the provision of all three opioid medications, buprenorphine, methadone and naltrexone, will significantly increase abstinence from opioids after release as well as significantly reduce chances of overdose deaths as well as promote law abiding behavior. You can research this yourself.  This website includes a manual, Recent Medication-Assisted Treatment Studies Relevant to Corrections, that summarizes the latest studies on MAT.  In reviewing this research, it is important to note that while there is a general consensus, studies still vary as persons with OUD vary.  Many of the studies that examine older, employed persons who are addicted to painkillers, for example, will come up with different findings than persons addicted to fentanyl or heroin who end up in prison or jail. That is why the Promising Practices Guidelines recommend access should be available for all three medications if they are medically appropriate and if they are accessible to persons post-release.  As you know, access to methadone is limited because it may only be provided at OTPs and the nearest OTP may be too far for persons to go.  While buprenorphine may only be prescribed by specially trained medical providers, as a result of COVID-19, buprenorphine may now be prescribed through telemedicine.  Individuals do not have to be examined in person to receive prescriptions.  The challenge may be finding pharmacies available to fill these prescriptions. The same may apply for naltrexone although any doctor can prescribe naltrexone. RSAT program personnel should inform inmates what is available to them after release.  That should be known before they opt for a specific medication.  Thanks for your question.