News & Promising Practices Archive

Opvee Nasal Spray Approved for Reversing Opioid Overdose

The Food and Drug Administration (FDA) has approved Opvee (nalmefene) nasal spray for the emergency treatment of known or suspected opioid overdose in patients 12 years of age and older, the agency announced in May. Opvee delivers 2.7 mg of nalmefene into the nasal cavity, is available by prescription, and is intended for use in health care and community settings.
Opvee was approved based on several studies. A confirmatory pharmacokinetic study comparing a 3 mg spray of the drug with a 1 mg intramuscular nalmefene hydrochloride injection in 68 healthy patients revealed that nasal nalmefene achieved higher plasma concentrations compared with the intramuscular injection.
A second study that found similar plasma concentrations of nalmefene whether the treatment was administered as a single dose in each nostril or as two doses in a single nostril. A third study found that the drug is noninferior to intranasal naloxone and that nasal nalmefene produced a greater reversal of remifentanil-induced respiratory depression that was nearly twice that produced by nasal naloxone at five minutes.
The FDA granted approval of Opvee to Opiant Pharmaceuticals Inc., which was acquired by Indivior in March.

Tennessee Department of Labor and Workforce Development Initiates a National Reentry Program Model

The Tennessee Department of Labor and Workforce Development is paying to put tablets in the states 112 jails to curb recidivism, provide education, and create a pipeline of qualified workers for employers when people are released from the jails. REAP, the Reentry, Employment, Adult Education Program, puts specially designed American Prison Data System computer tablets in jails, allowing incarcerated individuals to complete the required adult education coursework in preparation for the HiSET high school equivalency exam. In addition to Adult Education courses, the tablets can be used for career training, certification reentry preparation, resume building, job search support, mental health, and substance abuse wellness, as well as life skills and a recreational library with educational games, TED Talks, movies, and music at no cost to the users. The attached article describes the initial pilot launched a year ago. Found successful, REAP has since been expanded to all jails in the state. The REAP Program recently earned national recognition when it received the Pinnacle Award from the National Association of State Workforce Agencies (NASWA).

FDA Approves Over-the-Counter Sale of Narcan

The Food and Drug Administration has approved sales without prescriptions of the nasal spray Narcan to reverse opioid overdoses. This means that people will be able to buy it in supermarkets, gas stations, vending machines, etc. as well as online. The FDA has asked Emergent BioSolutions to make the nasal spray available as soon as possible at an affordable price. RSAT programs should educate participants about how to obtain and use Narcan in their communities as a harm reduction measure.

ADA Protects Correctional Officers Too

A former Tennessee correctional officer could receive $160,000 in back pay and damages after he was forced to resign for taking Suboxone to treat his opioid use disorder.

News from BJA: COVID-19 Detection and Mitigation in Confinement Facilities Update

FAQs about RSAT for State Prisoners Program

BJA's newly released Frequently Asked Questions (FAQ) for the Residential Substance Abuse Treatment (RSAT) for State Prisoners Program provides important guidance for grantees and subgrantees. The FAQ addresses questions regarding funding eligibility, use of funds for a variety of programming components, such as drug/alcohol testing, therapeutic communities, Medication Assisted Treatment, and more.

Idaho Mentor Program Benefiting Inmates Preparing for Community Reentry

Idaho DOC reports reentry peer mentors lowering recidivism by ten percent. The former prisoners work with participants 30 to 90 days before release and then once released.

The Americans with Disabilities Act and the Opioid Crisis: Combating Discrimination Against People in Treatment or Recovery

This guidance document provides information about how the ADA can protect individuals with OUD from discrimination—an important part of combating the opioid epidemic across American communities. While this document focuses on individuals with OUD, the legal principles discussed also apply to individuals with other types of substance use disorders.

BJA Brief: Managing Substance Withdrawal in Jails

The Bureau of Justice Assistance (BJA) just released a brief which focuses on withdrawal in jail settings, the scope of the challenge, an overview of key legislation and significant court cases related to withdrawal, and steps for creating a comprehensive response. Advocates for Human Potential, Inc. (AHP) developed this brief in partnership with the BJA and the National Institute of Corrections (NIC), along with the support of Georgetown University Law Center.

Recently Updated: Guidance on Management of COVID-19 in Correctional/Detention Facilities

The recent CDC COVID-19 updates provides guidance specific for correctional and detention facilities and consolidates previous CDC corrections-specific guidance documents. The updated guidance is based on what is currently known about the transmission and severity of COVID-19 as of February 10, 2022.

U.S. Justice Department Directive to Supreme Court of Pennsylvania, February 2, 2022

The U.S. Justice Department Civil Rights Division ordered PA Supreme Court to “promptly implement corrective measures” to adopt or revise “written policies to explicitly state that no court within the (state’s courts) may discriminate against, exclude from participation, or deny the benefits of their services, programs, or activities- including county court proceedings, probationary programs, and treatment courts – to qualified individuals with disabilities because they have OUD.” Compliance will allow RSAT participants to be released to probationary supervision and other programs who have either continued to be on prescribed OUD medication or were inducted on these medications while incarcerated.

Lawsuit Brought Against San Diego Jails Asserts Failure to Adhere to Minimums Standards for Managing Drug and Alcohol Withdrawal

In a lawsuit filed in February 2022, a team of civil rights attorneys is asking a federal judge to force the Sheriff to implement a host of new practices aimed at preventing in-custody deaths and improving care for mentally ill and physically disabled inmates. In the 200 page complaint, the plaintiffs charge that jailers often fail to follow even the minimum standard of care for inmates going through drug and alcohol withdrawal. The lawsuit blames a rise in fentanyl overdoses on the lack of a robust medication-assisted treatment program. It also cites the case of Saxon Rodriguez, a young man who struggled with opiate addiction who died from a fentanyl overdose four days after he was booked into jail.

How to Use the DEA 72-Hour Emergency Rule for Methadone and Buprenorphine in Jails

This Health Management Associates issue brief provides an excellent description of how jails and prisons can provide methadone and buprenorphine to at-risk persons within the first 72 hours after admission.

Resources for Correctional and Detention Facilities Preparing for the Release of People with Substance Use Disorder during COVID-19

Linking people with substance use disorder (SUD) to care and treatment as they return to their communities is an important consideration for correctional and detention facilities during the COVID-19 pandemic. Many studies report that the time following release from a correctional facility is an especially common time for fatal drug overdoses, particularly from opioids.

Mortality in Local Jails, 2000–2019 – Statistical Tables

A total of 1,200 persons died in local jails in 2019, a more than 5% increase from 2018 (1,138 deaths) and a 33% increase from 2000 (903), when the Bureau of Justice Statistics (BJS) began its Mortality in Correctional Institutions (MCI) data collection. The Bureau of Justice Statistics released this data in December 2021 which includes substance use-related deaths, suicide, and race/ethnicity statistics.

Naloxone in Correctional Facilities for the Prevention of Opioid Overdose Deaths

Drug overdose deaths, primarily from opioids, rose nearly 30% from December 2019 to December 2020, reaching an all-time of high of 92,183. Emergency medical response data show that overdose-associated cardiac arrests increased by more than 40% in 2020 compared to the two previous years, with the largest percentage increases among Black and Latinx individuals. The National Commission on Correctional Health Care supports increased access to naloxone in correctional facilities. NCCHC supports promotion of naloxone use in correctional facilities.

American Rescue Plan Act of 2021: Guide to Advancing Justice-Related Goals

In March 2021, Congress provided $1.9 trillion federal stimulus to respond to the economic and public health consequences of COVID-19. The American Rescue Plan offers an unprecedented opportunity for prisons and jails to finance critical reforms and increase services for incarcerated persons to reduce recidivism and put them on the path to recovery. This publication from the Council of State Government provides a breakdown to potential uses of these funds.

SAMHSA Treatment Improvement Protocol (TIP) 33: Treatment for Stimulant Use Disorders

SAMHSA TIP 33: Treatment for Stimulant Use Disorders was first published by SAMHSA in 1999, but 2021 updated version now addresses recent research on stimulant use disorders, the increasing number of overdose deaths, and the rise in the use and misuse of prescription stimulants.

Half of Adults With ADHD Have Struggled With Alcohol, Drug Use

People with ADHD with history of depression or anxiety particularly vulnerable to SUD or AUD. May be self-medicating. Underscores need for SUD/AUD treatment for those with ADHD. Suggested therapy? cognitive therapy has been shown to have a very positive effect on ADHD symptoms, SUD/AUD, and depression and anxiety.

Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019, From the HEALing Communities Study

Opioid overdose rates increased among non-Hispanic Black individuals between 2018 -2019 despite having leveled off overall according to study results published in the American Journal of Public Health. One of the researchers, Marc R. Larochelle, MD, MPH from Boston Medical Center stated the communities involved in the study “…are trying to improve equity in access to highly effective medication for opioid use disorder, and we are seeking to reach non-Hispanic Black individuals with overdose education and naloxone distribution.”

COVID-19 Vaccine FAQ's

This FAQ fact sheet put out by the Addiction Policy Forum is an informative resource that may be beneficial for RSAT programs to share with unvaccinated participants, especially participants reintegrating into the community and reuniting with family.

DEA Releases Final Rule for Mobile OTP Vans

The DEA lifted the moratorium that had been in effect since 2007 on registration of new mobile vans for delivery of Narcotic Treatment Program (NTP) services (also known as Opioid Treatment Programs or OTPs). Jails and prisons can offer access to all three FDA approved medications by collaborating with OTPS with mobile vans.

SAMHSA TIP 63: Medications for Opioid Use Disorder

The Treatment Improvement Protocol (TIP) series contributes to SAMHSA’s mission by providing science-based, best-practice guidance to the behavioral health field. This TIP reviews the use of the three FDA-approved medications used to treat OUD and the other strategies and services needed to support recovery for people with OUD.


Amid nationwide spike in overdose deaths, L.A. County jail program gives lifesaving medicine directly to inmates

The LA County Jail provides Naloxone in common areas of jail to prevent overdoses within the facility. If an individual sees another overdosing, containers can be removed from the wall and used to prevent ODs. Calls of officers for ODs have reported to have been reduced.

Increasing Rates of Buprenorphine Diversion in the United States, 2002 to 2019

Since 2010 thru 2019, buprenorphine diversion for non-medical use has risen at a statistically significant rate of 0.28 cases each quarter year. During this period, almost 10,000 cases of buprenorphine were diverted.

DEA Approved Mobile Vans to Provide Agonist Medications to Jails/Prisons

The DEA has relaxed requirements allowing mobile vans to provide access to MAT agonist medications. This has implications for jails and prisons. They can collaborate with a community NTP/OTP with vans to come to their facilities every day to provide these medications to incarcerated persons. If the facility is not licensed to be an OTP or equipped to become a certified satellite OTP, inmates can be escorted to the van parked in a secure area to receive their daily medication or monthly naltrexone or buprenorphine injection. In such a manner, the prison or jail does not have to be certified to handle these medications, but individuals in need are still able to receive them.

Require access to Rx for opioid-use disorder in prisons, jails

The American Medical Association declares medication for OUD to be the standard of care for persons with OUD who are incarcerated. It supports mandates that correctional facilities increase access to evidence-based treatment of OUD, including initiation and continuation of medication for OUD in conjunction with psychosocial treatment. The AMA also supports the repeal of the 1965 Social Security Act “inmate exclusion,” barring Medicaid funding for correctional health care.

Drug Overdose Deaths Up 30% in Pandemic Year, Government Data Show

Data from October 2019 to October 2020 shows that mortality from overdoses from all types of drugs increased 30%, from 70,669 deaths in October 2019 to 91,862 deaths in October 2020. Among those overdose deaths in both years, more than half came from synthetic opiates, fentanyl being the most notable. There was also a 46% increase in overdose deaths from other psychostimulants, mainly methamphetamine, and a 38% increase in deaths from cocaine overdoses.

CDC Updates List of Health Conditions that Increase the Risk of Severe COVID-19 Illness for Persons with SUD, Urges Vaccinations

The Centers for Disease Control (CDC) recently updated the list of at-risk underlying health conditions for COVID-19 to include substance use disorders. Why is there an increased risk of COVID-19 infection and complications for individuals with an addiction? Chronic substance use can harm or weaken the body, including the immune system, and make an individual more vulnerable to infection. The effect of certain types of substances used may present greater risks as well, particularly opioids, alcohol, nicotine, methamphetamines present greater risks for patients to develop severe illness from COVID-19. There are several ways to access the Vaccine Navigator project for the addiction community:
CDC COVID-19 Resources: COVID-19 and People Who Use Drugs or Have Substance Use Disorder. Correction staff in need of vaccinations can submit a support request form and a navigator from the Addiction Policy Forum and the Foundation for Opioid Response Efforts will reach out to assist you. Call the helpline at 833-301-HELP and a navigator will help. Hours of operation are 9am - 5pm ET, Monday through Friday. Text 833-301-HELP and our navigators will provide resources and support.

Vermont DOC medical/mental healthcare provider provides many models/provisions for both prisons and jails

Vermont DOC Contract with its Medical/Mental Health Provider contains provisions many notable provisions. For example, it requires the Provider to train correctional officers to recognize the need for emergency treatment, acute manifestations of chronic illnesses, signs and symptoms of detoxification and withdrawal, and more. The contract also specifies in some detail the withdrawal and detoxification services that must be provided, including trained, and competent healthcare professionals to supervise withdrawal and detoxification services. Also, as clinically indicated, provide treatment, including medications, to improve comfort and address unnecessary suffering for patients who are under the influence of, or undergoing withdrawal from, alcohol, opioids, or other substances. Appendix 5 (p. 134) provides MAT Program Clinical Guidelines. They revolve around the requirement that all persons with a diagnosis of OUD will be offered treatment for as klong as medically necessary and that treatment will consist of the following modalities: 1) Buprenorphine; 2) Methadone; 3) Naltrexone; and 4) Evidence-based behavioral health services for SUD. The Vermont DOC has also its integrated its medical/mental health services with community providers. For example it relies on community OTPS for methadone induction assessments, induction and dose adjustments, clinical treatment support, reentry support, and guest dosing for individuals entering facilities.

National Drug Threat Assessment, March 2021

This assessment provides a run down of the current availability and threats posed by illicit and prescribed medications provides a view of what we will be treating in jail and prison RSAT programs in the near future.

Buprenorphine, Suboxone and the Treatment of Opioid Use Disorder (OUD) in 2020

This article focuses on buprenorphine in the treatment of opioid use disorder and offers a comprehensive overview of all forms of the medication. It provides updated links to information and research including phases of treatment, diversion and abuse of buprenorphine, length of time in treatment and detoxification, and barriers and stigma associated to access and treatment.

Congratulations to Rhode Island Correctional Officers

More than 70% have been vaccinated, protecting them, their loves ones, inmates and the community. The President of the Brotherhood of Correctional Officers is aiming for 100%. Last year he contracted the virus in the prison and infected his family. Happily they all recovered but he lost a coworker at the prison.

Use of Codeine, Oxycodone, and Other Opioids: Information for Employees

While making clear that current illegal drug use is not a covered disability, the US Equal Employment Opportunity Commission document clarifies that individuals who are lawfully using opioid medication, are in treatment for opioid addiction and are receiving Medication Assisted Treatment (MAT), or have recovered from their addiction, are protected from disability discrimination. In addition, the document answers questions about reasonable accommodations that may be available to employees who currently legally use opioids, as well as what to do if an employer has concerns about the employee’s ability to safely perform his or her job.

AMA: Prescription opioids eclipsed by illicit drugs in US overdose epidemic

Prescribed opioids are down, use of naloxone and PDMPs are up, but so is illicit opioid use, resulting in increasing OD deaths.

Methadone Patients' Data Poised to Be Entered Into PDMPs

SAMHSA now allows opioid treatment programs (OTPs) to put patient information into prescription drug monitoring programs (PDMPs). It will be up to each state whether this will be done. Persons on methadone maintenance should be alerted to ask if their data is being entered.

Leaving Jail, Addicts Face a Growing Opioid Crisis During a Pandemic

Describes the added challenges facing persons with substance use disorders upon release.

AMA report shows overdose epidemic evolving, becoming deadlier

Between 2015 and 2019, fentanyl OD deaths increased from 5,766 to 36,509, stimulants, like Methamphetamine, from 4,402 to 16,279, cocaine from 5,496 to 15,974 and heroin from 10,788 to 14,079. Prescription opioid ODs decreased from 12,269 to 11,904.

Expanded access to treatment in prisons can reduce overdose deaths by more than 31%, study finds

Based on the results of the MAT program in Rhode Island’s unified correctional system, study finds providing inmates and detainees with naltrexone, methadone or buprenorphine reduces post release OD deaths, especially for those previously incarcerated.

Beneath Tragic New US Overdose Figures, There Are Wide Regional Variations

ODs were up 4.9% in 2019. This article describes regional differences and theorizes that harm reduction strategies may account for them.

New Peak of 71k US Overdose Deaths in 2019 Dashes Hopes

Lest we forget, nearly 71,000 died of drug overdoses last year setting a new record that predates the COVID-19 crisis. The increase is attributed to fentanyl which accounted for more than half of the deaths according to the CDC. ODs went up in more than 30 states. A rare bright spot was declining OD rates in northeast credited to expanded treatment. We would also add active prison and jail medication-assisted treatment enrollments pioneered by the these states’ RSAT programs!

Depot Antipsychotic Delays Hospitalization in Early-Stage Schizophrenia

New research suggests that long acting injectable antipsychotic medication typically reserved for chronic illness should be considered earlier to avoid lapses in taking medication and need for hospitalization.

Treatment of Stimulant Use Disorders

The use of stimulants, Cocaine and Methamphetamine, is way up, including causing 40% of overdose deaths in 2018. This SAMHSA guide identifies evidence-based treatment, finding strong evidence for motivational interviewing, contingency management, community reinforcement approach, and cognitive behavioral therapy. The guide includes practice resources for each of these treatment approaches and examples and resources for evaluation and quality improvements.

Resurgent Methamphetamine use at Treatment Admission in the United States

Methamphetamine use has been on the rise and is linked to the increase in opioid use. By 2017, 50.4% of methamphetamine overdose deaths involved opioids, suggesting that the rise in methamphetamine-related harms is linked to the ongoing opioid overdose epidemic in the United States.

Addicts at High Risk of Contracting Coronavirus

Homeless, those sleeping in crowded shelters or people with other health conditions — such as hepatitis C, HIV or lung disease — are high risk, said Dr. Daniel Solomon, an infectious disease physician who works at the Brigham Health Bridge Clinic for patients with substance use disorders. For recovering addicts, anxiety about COVID-19 can have a “triggering effect” that can lead to relapse, said James McKowen, a psychologist and clinical director of the Addiction Recovery Management Service at Massachusetts General Hospital, which is moving toward treatment via telemedicine, phone calls and group-based video conferencing to reduce the risk of transmission.

SAMHSA Letter to Mental Health Commissioners

ALERT! SAMHSA clarified that state Community Mental Health Services Block Grants (MHBG) can be used for the care and treatment of incarcerated persons with serious mental illness in prison and jail. RSAT programs serving persons with co-occurring mental illness might qualified for this funding.

Naloxone Videos You Can Use

Here are some helpful videos on Naloxone administration. The first is for Law Enforcement Roll Call, the next is Instructions for Administering NARCAN, and the last is whole series of short videos on Naloxone Training & Education.

Drug Tests Shed Light on Meth and Fentanyl Use in America

Not only is use of methamphetamines and fentanyl increasing but in 19 western states, methamphetamine OD deaths topped fentanyl and other opioids.

The Number of US Alcohol Deaths per Year has Doubled Since 1999

Lest we forget, more died in 2017 from alcohol than opioid use disorder and it is getting worse.

Reintegration Barriers Lead to Poorer Physical and Mental Health for Formerly Incarcerated

Reentry efforts need to expand beyond focusing on recidivism, but address the many needs of persons reentering the community, including housing, employment, child care and behavior health. Increasing depression following release can increase reintegration barriers which, in turn, increase poor health, constituting a “negative feedback loop.”

Integrating Treatment for Co-Occurring Mental Health Conditions

This article reviews the prevalence of co-occurring Alcohol Use Disorder and MHCs, screening tools to identify individuals with symptoms of AUD and Mental Health Conditions, and subsequent assessment of co-occurring disorders. Types of integrated treatment and current challenges to integrate treatment for co-occurring disorders effectively are reviewed. Innovative uses of technology to improve education on co-occurring disorders and treatment delivery are also discussed. Systemic challenges exist to providing integrated treatment in all treatment settings, and continued research is needed to determine ways to improve access to treatment.

Social Factors Are Primary Impediments To Managing Care For High-Cost Medicaid Beneficiaries

This report reminds us that successful medical care, including drug treatment, will be undermined by social factors. The biggest barriers are reported to be transportation to medical appointments, lack of stable housing and inconsistent access to food and basic resources. All of these should be addressed in reentry planning.

Latest Information on Methamphetamine

SAMHSA’s 2018 National Survey on Drug Use and Health showed that methamphetamine is becoming an increasingly used substance across the US, with alarming escalations of use among individuals 26+ years and older. According to these same statistics, methamphetamines was being used by almost twice as many men as women in 2017 but women have increased their use in 2018. To find out more about the growing problems of methamphetamine, check out NIDA’s website.

10 Warning Signs of Suicidal Inmates

CorrectionsOne lists 10 signs for suicidal incarcerated persons. The 4th is substance abuse, including those with strong fear of withdrawal.

Geographic Distribution of Opioid-Related Mortality in the Third-Wave Opioid Epidemic

The opioid epidemic is a devastating public health crisis. Emerging research suggests that the narrative of the current crisis is not so simple – that in fact there are multiple co-occurring and distinct epidemics – characterized by different types of opioids as well as geographical footprints. Mortality rates are doubling every two years in some states. This articles includes maps that include discussion of Life Expectancy Lost (LEL) due to increased opioid-related deaths and future state responses.

Medication-Assisted Treatment (MAT) In The Criminal Justice System: Brief Guidance To The States

This SAMHSA publication details the barriers to MAT within the criminal justice system and then how they can be overcome. Brief but handy guide.

New Opioid Epidemic 'Hot Spots' Emerge in U.S.

Opioid overdose deaths climbed fastest in the District of Columbia, more than tripling every year since 2013. Eight states -- Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire, and Ohio -- had opioid-related mortality rates that at least doubled every 3 years. Two states -- Florida and Pennsylvania -- had opioid-related mortality rates that at least doubled every 2 years. The increase in mortality rates in the east seemed driven primarily by synthetic opioids, which followed a distinctive geographic pattern across the country. Synthetic opioid deaths now outnumber heroin deaths, suggesting that drugs like fentanyl have contaminated the production process of street drugs like cocaine and methamphetamines and is no longer limited to heroin.

Prescription Mobile Medical App cleared as component of Opioid Use Disorder Treatment

The U.S. Food and Drug Administration cleared a mobile medical application (app) to help increase treatment retention in an outpatient program for individuals with opioid use disorder (OUD). The reSET-O app is a prescription cognitive behavioral therapy intended to be used in addition to outpatient treatment under the care of a health care professional, in conjunction with treatment that includes buprenorphine and contingency management. Although reSET-O did not reduce positive drug screens, it did significantly increase treatment retention. Using internet-based or mobile apps in conjunction with treatment for substance use disorders is not a new idea. There are many studies going back over 10 years that have shown promising outcomes in using technology based cognitive-behavioral treatment sessions and/or community reinforcement approach to enhance as well as reduce traditional counselor based treatment sessions. Evidence-based interventions will continue to be designed to improve executive function and be delivered through the use of mobile apps and, coupled with their high program consistency and participant enjoyment, appear to be a logical choice for repairing cognitive dysfunction.

amfAR's Opioid & Health Indicators Database

This free web platform is designed to support communities, lawmakers and advocates in making informed decisions about the opioid epidemic and its impact on HIV and hepatitis C. It provides local to national statistics using reliable data sources on new HIV and hepatitis C infections, opioid use and overdose death rates, and the availability of services like drug treatment programs and syringe exchange services. In addition, users can examine data at the state or the county levels to see the differential impact of the opioid epidemic by state or within states.

Comparative Efficacy and Acceptability of Psychosocial Interventions for Individuals with Cocaine and Amphetamine Addiction

This meta-analysis is the most comprehensive synthesis of data for psychosocial interventions in individuals with cocaine and/or amphetamine addiction. The findings provide the best evidence base currently available to guide decision-making about psychosocial interventions for individuals with cocaine and/or amphetamine addiction and should inform patients, clinicians, and policy-makers. Researchers used meta-analysis to analyze 50 clinical studies (6,943 participants) on 12 different psychosocial interventions for cocaine and/or amphetamine addiction. They found that the combination of 2 different psychosocial interventions, namely contingency management and community reinforcement approach, were the most efficacious and most acceptable treatment both in the short and long term.

Bias Against Agonist Treatment for Incarcerated People Continues

Responding to Klein’s article in Commonwealth pointing out the real challenges of implementing jail/prison MAT programming, Alcoholism Alcohol Weekly interviews both Klein and a physician involved in the Riker Island New York City jail agonist MAT program to vindicate “mainstream” support for MAT. The latter dismisses low retention rates of persons provided MAT in prison/jail and focuses on forcing people to withdraw from drugs when incarcerated.

Medicaid Coverage of Medication-Assisted Treatment for Alcohol and Opioid Use Disorders and of Medication for the Reversal of Opioid Overdose

This SAMHSA publication details coverage for MAT medications and Naloxone. All states reimburse for at least some of the MAT medications although 8 don’t cover methadone for MAT, just for pain relief. Fewer than 70% cover implant and injectable buprenorphine. Many include certain constraints on obtaining the medication. Some innovative programs are highlighted such as Missouri which has begun the process of integrating MAT into all SUD treatment in the state, requiring any SUD treatment provider that contracts with the state to offer MAT either directly or by referral. The state of Washington has implemented a pilot involving a telemedicine project, Flex Care, so that 200 patients in rural coastal Washington who previously had no access to MAT for their opioid dependence disorder now receive MAT under the Flex Care treatment model.

Fentanyl Now The no. 1 Opioid OD Killer

Although cocaine and heroin remain most popular street drugs, fentanyl is involved in more overdose deaths. Between 2013 and 2016, overdose deaths involving fentanyl increased 113% per year. Over the past several years, heroin and cocaine mixed with fentanyl have become more common, which may account for the combination of drugs seen on death certificates. methamphetamine. In 2011, oxycodone ranked first. From 2012 to 2015, it was heroin, and in 2016, fentanyl. Cocaine consistently was the second or third drug most common in overdoses during the entire period.

Best Practices for Successful Reentry for People Who Have Opioid Addiction

This new publication from Council of State Government Justice Center outlines major reentry activities. It describes best practices for correction departments, community-based behavioral health agencies, and probation and parole to ensure reentry is safe and successful for people with opioid addictions.

Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States

Overshadowed by opioids, meth is back with a vengeance. Study finds amphetamine use is skyrocketing in United States. Hospitalizations up 245% from 2008 to 2015. Poses renewed challenge for RSAT programs.

MA Jail Ordered to Continue Methadone for Entering Inmate

Order from Federal District Court requiring Massachusetts jail to continue methadone for individual entering jail for 60 day sentence for operating after suspension. Defendant had failed to remain abstinent on buprenorphine and naltrexone but had succeeded for past two years on methadone. Sheriff had argued that medical detox and in house drug treatment as well as access to naltrexone was sufficient to address defendant’s needs without compromising institutional security by allowing the introduction of methadone the jail was not equipped to dispense.

Long Stigmatized, Methadone Clinics Multiply in Some States

Access to methadone maintenance is growing, but Alabama, Arkansas, Idaho, Illinois, Iowa, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, Texas and Wyoming do not allow Medicaid reimbursement for methadone treatment. Much lower number of doctors prescribe buprenorphine of opioid addiction than anticipated. Many obtain licenses to prescribe buprenorphine (requires 8 hour course) but treat only existing patients and are not interested in adding new patients with opioid use disorder. This means that jail and prisons that institute MAT programs that provide agonist medications have to do their homework to connect exiting individuals with available methadone clinics or physicians and medical personnel willing to treat them with buprenorphine.

Large randomized trial finds disappointing effects for federally-funded (Second Chance) programs to facilitate the re-entry of prisoners into the community. A new approach is needed.

Study says it is very possible that some reentry programs were effective but their effect was diluted by others that were ineffective or harmful, resulting in an average effect near zero. It suggests evidence-based reforms to Second Chance Act that focus on a central goal: identifying a subset of specific re-entry strategies rigorously shown to produce important effects on recidivism and other key outcomes.

Managing Comorbid Opioid and Alcohol Use Disorder

Lest we forget, more people die from alcoholism every year than opioids (88,000 vs 49,000). Because both alcohol and opioids have central nervous system depressant effects, so that comorbid AUD and OUD have a greater chance of inducing respiratory depression and overdose than either disorder alone. Article discusses need to treat both.

Prescription Databases May Miss Opioid-Benzo Combinations

A new 2018 Quest Diagnostics analysis revealed that prescriptions databases may be missing concurrent opioid and benzodiazepine in patients drug tests. Among a selected sample of patients whose drug test indicated concurrent benzodiazepine and opioid use, 64% had at least one benzodiazepine or opioid that was not prescribed. The Quest Diagnostics analysis was based on 456,675 sets of test results from 276,953 patients in 50 states and the District of Columbia in 2017.

Why You Shouldn’t Dismiss The Risk of Marijuana Addiction

The National Survey on Drug Use and Health (NSDUH) from 2016 found that about 4 million people 12 and older meet the classification for a marijuana use disorder. That’s nearly 11 percent of the 37.6 million people 12 and older who reportedly used marijuana in 2016.

As America’s Jails Become Warehouses For Mentally Ill

No other country in the world is using its jails as its primary response to mental illness.

NASTAD - Pharmaceutical Company Patient Assistance and Cost-sharing Assistance Programs: Hepatitis

This NASTAD website describes Patient Assistance and Cost-sharing Assistance Programs for medication to treat Hepatitis for people with low incomes who do not qualify for Medicaid, Medicare or AIDS Drug Assistance Programs.

Pre-release Injectable Naltrexone Improves HIV treatment too.

A new study finds that those released on injectable naltrexone are more likely to maintain or improve their HIV viral load suppression, indicating all important HIV medication compliance. Typically, the period of time right after persons are released from jail is chaotic, associated with both opioid overdoses and loss of HIV care. The injection, by reducing cravings during this critical period, appears to allow individuals to concentrate on self-care in general. Springer, S. A. et. al. (2018). Extended-Release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living With HIV With Opioid Use Disorders Transitioning to the Community: Results of a Double-Blind, Placebo-Controlled Randomized Trial, Journal of Acquired Immune Deficiency Syndromes. 78(1):43-53

California Reentry Guide

Reentry Health Policy Project’s Meeting the Serious Health and Behavioral Needs of Prison and Jail Inmates Returning to the Community identifies state and county-level policies and practices to deliver effective care to people who are reentering California communities. It focuses on the following issue areas: 1) Eligibility establishment to receive care; 2) Care coordination; 3) Maximizing federal financial participation, primarily through the Affordable Care Act; 4) Release of information; 5) Residential and outpatient treatment capacity; 6) Housing; and 7) Evaluation.

Medicare Doesn’t Cover Methadone for MAT

Brief summary of Medicare coverage and challenges faced by those on methadone maintenance when they reach 65 years.

The Opioid Epidemic and Medicaid's Role in Facilitating Access to Treatment

Among nonelderly adults with opioid addiction, those with Medicaid were twice as likely as those with private insurance or no insurance to have received treatment in 2016. Medicaid facilitates access to treatment by covering numerous inpatient and outpatient treatment services, as well as medications prescribed as part of medication-assisted treatment. States use Medicaid Section 1115 waivers and other program authorities to expand treatment options for enrollees with opioid addiction. This study shows the critical importance of enrolling RSAT participants in Medicaid if eligible.

Drug Overdose Deaths in the United States, 1999–2016

U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics. Latest grim statistics.

Shatterproof National SUD Principles of Care

Sixteen health insurers, responsible for a combined 248 million consumers, recently announced that they are adopting eight National Principles of Care for Substance Use Disorder (SUD) Treatment, as developed by the non-profit, Shatterproof. If implemented fully, this will constitute standard of care treatment for those with Substance use disorders. Note, principle # 7 includes Medication Assisted Treatment.

Addressing the Substance Use Treatment and Aftercare Needs of Incarcerated Individuals: Challenges and Solutions Identified in the 2017 RSAT Evaluation

This article summarizes a Justice Department Study of RSAT aftercare programs. It includes a good description on how RSAT is funded across the country as well as barriers and solutions to linking to aftercare.

Analysis of Disparities and Factors that Elevate Overdose Fatality Risk among Women: Implications for RSAT Programs and Re-entry Planning

Women recently released from jail or prison face an even greater risk of drug overdose fatality than re-entering men. This article suggests why that may be so that countermeasures may be constructed.

Prison Health Care Costs and Quality

The PEW Charitable Trust and VERA Institute of Justice surveyed state corrections to review what each was doing about health care for those incarcerated. They found that collectively, state correctional departments spend over $8 billion a year on prison health services (FY 2015), about 20% of all prison costs. Costs per individual vary dramatically, from just $2,173 in Louisiana to $19,796 in California. Treating chronic conditions has emerged as a growing challenge and expense, made worse as the prison population ages. 35 states systems monitor for quality of care, but only a handful indicate they take steps to require quality monitoring and build in compliance oversight. More departments are recognizing the importance of linking released individuals to health care in the community. The study concludes that (w)ell-run, forward-thinking prison health care systems are vital to state aims of providing care to incarcerated individuals, protecting communities, strengthening public health, and spending money wisely.”

Study: Most people referred for opioid treatment by criminal justice system don't receive optimal care

This study found that more than 95% of people referred for opioid treatment from the criminal justice system were directed to non-optimal drug treatment programs that failed to provide medication assisted treatment. In contrast, 40% of clients referred from other sources were directed to drug treatment programs conforming to current standards of care.

Cooking them to Death: The Lethal Toll of Hot Prisons

The Marshall Project reports on prison and jail deaths associated with rising temperatures in unairconditioned cells. Adding to the risk of increasing temperatures, many inmates are especially vulnerable if they are on psychotropic medications or medications for high blood pressure or elderly. Some individuals stop taking medication to cope with the heat, but then suicide risks increase. In Texas prisons, suicide attempts rose form 93 in March to 130 in August. More than 20 incarcerated have died from heat-related causes since 1998 in Texas where most prisons lack air conditioning. Texas has also paid out ½ a million dollars to correctional officers in workers comp claims for heat-related illness and injuries over the last decade.

Experiences of three states implementing the Medicaid health home model to address opioid use disorder—Case studies in Maryland, Rhode Island, and Vermont

These states use the Medicaid Health Home model specifically to address opioid use disorder, integrating agonist treatment with health care and social services. Reported as challenging but successful. These models may inform other treatment initiatives.

Top Mental Health Researcher Suggests Link Between Opioid Overdoses and Suicides

The director of the National Institute of Mental Health writes that there may be a stronger link between the opioid epidemic and suicides than previously realized. He writes: “There is a lot of concern that many of the overdose deaths could be suicides. We need to learn more about the prevalence of suicidality amongst opioid addicted individuals.” It may not be enough to encourage sobriety, some may need encouragement to live!

The Life-Threatening Reality of Short Jail Stays

Suicide rates in jails exceed those in state prisons or the general population. And they are increasing. The higher rates can be explained by increase in individuals jailed who have substance use or mental health disorders. A disproportionate number of these deaths occur within the first few days of commitment underscoring the necessity of immediate assessment of individuals as soon as initial screening reveals substance use or mental disorders.

FDA Drug Safety Communication: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks

Based on our additional review, the U.S. Food and Drug Administration (FDA) is advising that the opioid addiction medications buprenorphine and methadone should not be withheld from patients taking benzodiazepines or other drugs that depress the central nervous system (CNS). The combined use of these drugs increases the risk of serious side effects; however, the harm caused by untreated opioid addiction can outweigh these risks. Careful medication management by health care professionals can reduce these risks.

With Opioid Crisis, a Surge in Hepatitis C

The opioid crisis spurs hepatitis C infection growth with overdose deaths and infections rising in tandem especially across Appalachian, Midwestern and New England states. After declining for two decades, new hepatitis C cases have increased to an estimated 34,000 in 2015, nearly triple that of 2010 according to the CDC. While highly effective, and highly expensive new drugs and better screening for the blood born disease could eradicate it, experts agree that without stopping the opioid epidemic, or getting all those addicted to use clean needles, hepatitis C will continue to spread. It already affects 3.5 million Americans.

Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates

New BJS data reveal that 58% of state prisoners and 63% sentenced to jail suffer from substance use disorders. Rates were higher for females, at 69% and 72% respectively. Whites had higher rates than black or Hispanics in prisons and jails.

When twisted justice stops prisoners from
starting over

This USA Today article catalogues the thousands of legal restrictions persons reentering from prison face that inhabit their ability to function in the free world.

An Introduction to Bipolar Disorder and Co-Occurring Substance Use Disorders

This advisory issued by SAMHSA talks about treating those with bipolar and substance use disorders. It include reference to a well-known screening tool for diagnosis, CIDI-based Screening Scale for Bipolar Spectrum Disorders, available at The Advisory concludes that there appears to be no evidence for avoiding the use of MAT medications for those with these co-occurring disorders. It describes both pharmacological therapy for bipolar disorders as well as psychosocial therapy and concludes: Integrated treatment, collaboration between professionals and the client, and attention to the various aspects of recovery can all work together to facilitate the management of these co-occurring disorders.

For Corrections Officers and Cops, a New Emphasis on Mental Health

Lest we ignore it, this article reminds us that correctional officers are significantly more likely to commit suicide than persons in the general public as a result of the stress and trauma associated with their job. Reaching out to include officers in RSAT programming can be a tremendous benefit both for the program and the officers themselves, providing them with tasks that will provide them positive feedback in these roles.

Treating patients with opioid disorders is not just about treating addiction. Here’s why.

These charts by STAT document the many serious physical and behavioral health problems commonly associated with opioid use disorder based on 3.1 million privately insured patient records between 2014 and 2016 by a healthcare company.

Prescription Opioid Overdose Data

Latest data from CDC on overdose. Most commonly overdosed medications continues to be methadone which will continue as long as doctors continue to prescribe it for pain relief. These methadone overdoses do not typically involve methadone used in opioid use disorder treatment.

A Fresh Take on Ending the Jail-to-Street-to-Jail Cycle

This Marshall Project article describes a housing program for those reentering from Riker’s jail based on a prior pilot project demonstrating that stable housing will prevent return to jail.

Alcohol and Drug Free Housing Options for
Re-entering Women

Women remain a small minority of incarcerated individuals, but they are a rapidly growing segment of the justice population. A higher proportion of justice-involved women have substance use disorders (SUDs) and co-occurring mental health disorders. This brief familiarizes RSAT program staff and participants recovery housing resources for women, lists contact information for affordable housing options in more than 40 states, and highlights recent expansion of ‘sober’ housing for women.

Screening and Assessment of Co-Occurring Disorders in the Justice System

This 259 page SAMHSA publication examines a wide range of evidence-based practices for screening and assessment of people in the justice system who have co-occurring mental and substance use disorders (CODs). Use of evidence-based approaches for screening and assessment is likely to result in more accurate matching of offenders to treatment services and more effective treatment and supervision outcomes. It is intended as a guide for clinicians, case managers, program and systems administrators, community supervision staff, jail and prison booking and healthcare staff, law enforcement, court personnel, researchers, and others interested in developing and operating effective programs for justice-involved individuals who have CODs. Key systemic and clinical challenges are discussed, as well as state-of-the art approaches for conducting screening and assessment.

Should Patients With Substance Use Disorders Be Prescribed Benzodiazepines? No

Patients with substance use disorders (SUDs) should not use benzodiazepines to treat anxiety, insomnia, or anything else, for the same reasons that they should not drink any alcohol or use other drugs, regardless of their primary drug used.

Guidelines for Successful Transition of People with Mental or Substance Use Disorders from Jail and Prison: Implementation Guide

This SAMHSA resource provides behavioral health, correctional, and community stakeholders with 10 guidelines to effectively transition people with mental or substance use disorders from institutional correctional settings into the community, as well as examples of local implementation of successful strategies for managing this transition. Very basic but great examples provided.

Women InJustice: Gender and the Pathway to Jail in New York City

This NY City study looks at the increasing number of women incarcerated, how they got there, their gender related needs and how they can be met. Recommendations include that the corrections must be both gender-responsive and trauma-informed.

Office on Women’s Health White Paper: Opioid Use, Misuse, and Overdose in Women

This report examines the prevention, treatment, and recovery issues for women who misuse, have use disorders, and/or overdose on opioids. This paper explores what is currently known about the opioid epidemic and describes promising practices for addressing opioid use disorder prevention and treatment for women, as well as identifies areas that are less well understood. As we move forward to address the opioid epidemic generally and its impact on women specifically, we must evaluate the impact of multiple interventions considering the unique aspects of women across age, race, and socioeconomic spectrums.

National Addiction Technology Transfer Center (ATTC) Messenger on Choosing a Medication for MAT

The January 2017 issue of the ATTC newsletter features an article on the therapeutic benefit of introducing a collaborative approach to choosing a medication with patients seeking treatment for an opioid use disorder: Shared Decision Making and Medication-Assisted Treatment: A Supportive Approach to Initiating and Sustaining Addiction Recovery The Messenger also features other articles and resources, including a link to Taking Action to Address Opioid Misuse, a new website that brings all ATTC Network training and information related to treating opioid misuse together in one place.

Shared Decision Making online tool and printable PDF handbook

Decisions in Recovery: Medications for Opioid Addiction, is a web-based, multimedia tool that is person-centered and focuses on informed treatment choices by persons seeking recovery from an opioid use disorder including the use of medication. The handbook is a companion to the multimedia tool that mirrors the web-based content. Both resources are designed to help people with an opioid use disorder make informed decisions concerning their care. It assists in learning about MAT, compare treatment options to decide what may be best for them and their recovery and discuss their preferences with a provider.

Mortality rate among state prisoners was stable from 2013 to 2014 but increased among federal prisoners and local jail inmates

In 2014, a total of 3,483 inmates died in state prisons, 444 in federal prisons, and 1,053 in local jails. The mortality rate for state prisoners was stable from 2013 to 2014 (273 deaths per 100,000 state prisoners compared to 275 per 100,000). Among federal prisoners, the mortality rate increased from 230 to 262 deaths per 100,000, and the rate for inmates in local jails increased from 136 to 140 deaths per 100,000 jail inmates over the year. These findings are based on data from BJS's Deaths in Custody Reporting Program (DCRP), which has annually collected counts of inmate deaths in local jails since 2000 and deaths in state and federal prisons since 2001.

Recidivism Rate for Individuals Incarcerated for Drug Offenses Released From Prison in 2005 Tops All

A BJS study of 404,638 state prisoners released from 30 states in 2005 found 76.6% were rearrested for a new crime by 2010. Of the 404,638, 31.8% had been incarcerated for a drug offense. The most common post release arrest was for a public order offense (58%) followed by a drug offense (38.3%). Most previously incarcerated for drug offenses committed new public order offenses (56.1%) followed by new drug offenses (51.2%). Their overall rearrest rate was almost the same as all of the others released from prison, 76.9% compared to 76.6%, but their rearrests for violent crimes were less, 33.1% compared to 38.4%.

Signed Out Of Prison But Not Signed Up For Insurance, Inmates Fall Prey To Ills

The Marshall Project Survey of State Medicaid Departments and Department of Correction thru September 2016 has found that most of the state prison systems in the 31 states that expanded Medicaid have either not created large scale enrollment programs or operate spotty programs that leave large numbers of exiting inmates without insurance. This includes people who are chronically ill and are in need of medication and treatment upon release. Local jails, that process millions a year, are doing worse. There are a few bright spots, including the Cook County jail that signs up inmates upon entrance into the jail because jail exit dates are so unpredictable. Often individuals are released with a two week to 30 day supply of needed medication. However, left on their own, most cannot negotiate state bureaucracies to get enrolled in time before their medications run out. They end up in emergency rooms…if they are lucky.

Older Women Released from Prison Least Likely to Return

A new study finds older women make exceptionally fine candidates for successful re-integration from prison or jail into the community. The study tracked more than 200 women released from Delaware prisons in 1990s. The follow up conducted in 2009 to 2011 found that women who were over 45 upon release demonstrated “gendered experiences of securing employment, family reunification, and substance abuse recovery, maturity, clarity about one’s personal responsibility for linked failures, and a desire to transform one’s identity were significant factors that preceded the capacity to excel in those reentry domains.

8 States Receive $ for Vivitrol for Offenders

The federal government has approved $23 million to fund MAT providing Vivitrol to prison inmates. Each state is receiving approximately a million each year for three years.

— Vermont includes offenders on parole or probation.
— Wisconsin includes prisoners who are within four months of release.
— Wyoming includes inmates as they leave prison.
— Rhode Island includes identifying, counseling and providing services to inmates with histories of prescription drug or heroin addiction before they were incarcerated.
— Illinois includes those released from Sheridan Correctional Center southwest of Chicago.
— North Carolina includes inmates being released from prison to post-release supervision and to those who are on probation in select communities.
— In Colorado includes, at least one provider, Arapahoe House, that plans to provide Vivitrol to clients involved in the criminal-justice system.
— Arizona includes medication-assisted treatment that aims to create a bridge between incarceration and outpatient treatment.

Source: Substance Abuse and Mental Health Services Administration, FY2015 and FY2016 grants.

Important Warning from the U.S. DEA

A new synthetic opioid, carfentanil, more potent than fentanyl, is appearing according to the DEA. Attached please find some information that RSAT and correctional officers should know if the drug should spread to your area of the country.

Outreach, Assistors, and Health/Insurance Literacy: A Toolkit for Justice Professionals

The provides terrific descriptions of what tools and resources are available to you in every state that you can use to ensure RSAT participants use the health care system to their maximum benefit to continue to deal with behavior and physical health needs.

223 ER Visits in 15 months?

Interesting article describes study of over utilization of ERs by persons with behavioral health issues. Explains why health literacy should be a part of RSAT curriculums.

HUD Publication Outlines Promising Reentry Housing Models

Introduces HUD’s It Starts With Housing: Public Housing Agencies Are Making Second Chances Real, June 2016. Encourages public housing authorities (PHAs) to collaborate with partners to “make second chances real for the men and women returning” from jail and prison. Successful sample policies and program designs from the King County Housing Authority in Washington, the Burlington Housing Authority in Vermont, and the New York City Housing Authority, can help other communities build their own reentry programs. May provide ideas for how RSAT reentry staff can work with local housing authorities to find housing for those about to be released.

State Correctional Policies for Treating Hepatitis C

Summary of Wall Street Journal survey of state department of corrections’ policies rationing medication for the treatment of Hepatitis C infecting up to a third of prison and jail populations. So far lawsuits are pending against correctional departments in Pennsylvania, Tennessee and Massachusetts.

Assistance Programs and Patient Health Literacy Resources-Information for Justice Professionals

This short monograph will inform you about what inmates need to know in order to be able to afford medications, including those for opioid and Alcohol use disorders as well as anti-psychotic medications upon release. It is particularly relevant for inmates in the states that have not expanded Medicaid eligibility covering most inmates in other states.

Mobile addiction treatment clinic travels where it's needed

In PA, a mobile van delivers medication to released inmates and others who live far away from clinics that provide medication for opioid or alcohol use disorders. Another barrier removed in allowing clients to continue to get medication once released to the community.

Medication has become part of treatment for some fighting addiction in Pierce County Drug Court

This article from the News Tribune, Tacoma, Washington, describes how the local drug court is collaborating with the jail’s medication assisted treatment program to expand the use of MAT for justice involved populations. If the drug court defendants “slip up,” they are sent to jail, detoxed and offered MAT.

Update on Medical Marijuana

A total of 25 states and D.C., Guam and Puerto Rico now allow for medical marijuana use. This brief updates provides the current status of state laws.

At Fabled Addiction Treatment Center, A New Approach

Hazelden, a premier abstinence only SUD treatment facility for 70 years is now adopting MAT,cutting drop out rates from 25% to just 5%.

New York Prison Ban on Motorized Wheelchairs Ruled Illegal

The 2nd Circuit appeals court ruled that New York prisons can no longer ban disabled inmates’ motorized wheelchairs. As a result of the decision, the onus is on the prison that it can provide appropriate alternatives for the disabled inmates. It cannot simply enact a blanket ban of such devices. The lawyer for the inmate said the decision has “the potential to affect a number of inmates with disabilities, not only inmates with mobility impairments.”

Update – Hepatitis C Prevention and Treatment in Prisons

Hepatitis C (HCV) affects about 1% of the U.S. population as a whole, but more than 17% of the overall prison population. In some states, a much larger proportion of inmates are infected. Testing for HCV is available in many prisons, but it is not always offered routinely. Many states only test inmates at-risk for HCV infection, such as those reporting a history of injection drug use. This approach offers some short-term economic advantages, but it is also likely to miss the opportunity to identify a significant proportion of infected inmates, an opportunity that many experts say offers significant public health benefits.

HHS acts to help more ex-inmates get Medicaid

Describes efforts to enroll 600,000 inmates released each year into Medicaid around the country. U.S. prisons and jails enrolled only 112,520 from late 2013 up to January 2015. Also describes how HHS has made up to 96,000 half-way house inmates eligible for Medicaid. 31 states and DC now have expanded Medicaid.

Probuphine Implants Hit the Market

Titan Pharmaceuticals, Inc. announced that 10 patients received treatment last week with the Probuphine (buprenorphine) implant, making them the first patients in the US to receive the medication since it was approved by the FDA in May, 2016 for maintenance treatment of opioid dependence. To date, more than 1,000 health care providers in 44 states have completed required training to be certified to provide Probuphine. Several Blue Cross Blue Shield Plans, as well as United Healthcare, have been among the first insurance companies that approved reimbursement for the first patients implanted. A fear expressed by some experts is that some opioid addicts with implants might skip accompanying substance abuse treatment, relying solely on the medication to prevent relapse and advance recovery.

Medical Conditions, Mental Health Problems, Disabilities, and Mortality Among Jail Inmates

Jail inmates tend to be sicker, more likely to have a chronic medical condition or infectious disease than the general population.

Prisoners age 55 or older made up 10% of the state prison population in 2013, up from 3% in 1993

Prisoners age 55 or older sentenced to more than one year in state prison increased from 26,300 in 1993 to 131,500 in 2013. This represented a growth from 3% to 10% of the total state prison population during this period. From 1993 to 2013, the median age of state prisoners increased from 30 to 36 years.

Prison Industry Enhancement Certificate Program Rated “Promising”

Prison Industry Enhancement Certificate Program (PIECP) is a program that engages state prison inmates in private sector jobs (which pay minimum wage or higher), in an effort to increase post-release employment and reduce recidivism. The program is rated “Promising.” Compared with inmates who worked in traditional prison industries and participated in other activities such as education and drug treatment, program participants had significantly higher post–release employment and lower recidivism rates.

RNR Simulation Tool Gives Probation, Parole Officers a Clinical Take on Reentry in Louisiana.

New tool that helps corrections develop reentry programs for inmates.

Changing face of MAT maintenance programing in prisons and jails is described.

Correctional Officer Wellness and Safety Literature Review

One of the greatest threats to correctional officer (CO) wellness involves the stress they encounter as a result of their occupation. This document reviews the body of literature on the causes and effects of stress for COs, and describes the available research on CO wellness programs and their effectiveness., including stressed that are Inmate-related (dealing with threats, mental illness, substance abuse, suicide); Occupational (inherent to the profession), Organizational/administrative (mismanagement, poor leadership, inadequate resources/ pay, understaffing) and Psycho-social (fear, work/family conflict, media scrutiny, etc).

Questions and answers for state Medicaid directors regarding coverage for inmates, probationers, parolees, those residing in residential facilities.

Question: What about residents in a halfway houses? Answer: Federal Financial Participation is available for covered services for Medicaid-eligible individuals living in state or local corrections-related supervised community residential facilities (whether operated by a governmental entity or a private entity) unless the individual does not have freedom of movement and association while residing at the facility....

Important Answers on Medicaid for Transitioning Inmates

The Center for Medicaid and CHIP Services (CMCS) has issued guidance to states on Medicaid inmate eligibility, enrollment and coverage policy. This letter with attached Questions and Answers (Qs & As) describes how states can better facilitate access to Medicaid services for individuals transitioning from incarceration to their communities. The letter is available online on at

SAMHSA’s Reentry Resource Guide for Individuals, Providers, Communities, and States

This resource guide from the Substance Abuse and Mental Health Services Administration (SAMHSA) provides reentry information for behavioral health providers, criminal justice practitioners, people returning home from incarceration, and state and local policymakers.

This article describes current jail and prison efforts to enroll inmates in Medicaid pre-release. It provides an overview of sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll individuals during detention, incarceration, and the release process. Seventy-seven percent of the programs are located in jails,and 56 percent use personnel from public health or social service agencies. It then describes four practices that have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment.

Important Answers on Medicaid for Transitioning Inmates

The Center for Medicaid and CHIP Services (CMCS) has issued guidance to states on Medicaid inmate eligibility, enrollment and coverage policy. This letter with attached Questions and Answers (Qs & As) describes how states can better facilitate access to Medicaid services for individuals transitioning from incarceration to their communities. The letter is available online on at

Injected Naltrexone for Justice Involved Opioid Addicts Compared to Treatment as Usual

New study examined 153 justice-involved opioid addicts at five sites in four major cities provided monthly injections of naltrexone (Vivitrol) and compared them to 155 who were referred to treatment as usual, counseling and community treatment programs. After six months of injections, 43% of the former group relapsed compared to 64% of those without the shots. Also the former who relapsed managed to stay drug free twice as long as the comparison group. One year after treatment ended, relapses were equivalent. There were more drug overdoses in the non-naltrexone group. The take away: The medication facilitated recovery, but addicts need more than six months of shots and treatment to make a long term difference. However, in regard to medications for opioid treatment, as one researcher concluded: "Right now, there's no debate or argument that going on medications is a better approach. If you're not using medications, you're not really practicing effective evidence-based medicine."

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomized,open-label trial

This study compared inmates who continued methadone while incarcerated and those who were detoxed and not allowed to continue. More of the former, not surprisingly, continued methadone upon release. More of the latter continued using illicit opioids. Both groups reported drug overdoses and one of the released inmates that had been maintained on methadone died of an overdose after release.

Evaluation of Routine HIV Opt-Out Screening and Continuum of Care Services Following Entry into Eight Prison Reception Centers — California, 2012

This assessment of prison HIV opt-out screening is the first known to evaluate the full HIV continuum of care outcomes, including opt-out screening during the medical assessment at entry, linkage to and retention in care, ART response during incarceration, and continuity of care and viral suppression after release to the community.

Understanding and Detecting Prescription Drug Misuse and Misuse Disorders

This drug court fact sheet describes prescription drug misuse and provides information on the most commonly misused and addictive prescription drugs; the extent and consequences of misuse; side effects and toxicity; characteristics of those who are most likely to misuse prescription drugs, signs and symptoms of misuse and ways to identify and treat those who may have developed a drug use disorder, including a section on medication-assisted treatment of opioid use disorder.

New, Screening and Assessment of Co-Occurring Disorders in the Justice System

Among broader discussion, reviews instruments for screening and assessing co-occurring disorders that can be used in jails and prisons at both intake and discharge.

Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder: Review and Update

This readable SAMHSA Advisory Paper provides the latest objective information on the use of Buprenorphine in opioid use disorder treatment, including a breakdown of the different brands of buprenorphine and naloxone medication currently on the market. Briefly compares therapies using Buprenorphine/Nalaxone with Methadone.

How Medicaid Enrollment of Inmates Facilitates Health Coverage After Release

Describes how states are saving millions by assisting inmates sign up for health insurance, both in states that have expanded Medicaid and those that have not.

Gender differences in HIV risk behaviors in individuals recently released from prison

Approximately eight million individuals are released from U.S correctional facilities each year and are at increased risk for HIV. This study examine the HIV risk behaviors of inmates post release and found women at higher risk. The take away is that RSAT programs for women should include gender specific interventions to reduce risky drug related and sex related behaviors immediately following release. The study found, for example, that women’s risk was not solely attributable to engaging in transactional sex, but rather were related to other underlying differences between men and women.

Treatment in Secure Corrections for Serious Juvenile Offenders

A practice profile of programs for serious violent and chronic juveniles offenders in secure facilities, including meta-analysis outcomes and costs.

The adverse childhood experiences (ACES) survey

This toolkit can be used to help staff interview female prisoners on adverse childhood experiences that negatively impact on rehabilitation and health. As one woman suffering from trauma explains, the toolkit transformed her from a self-perceived damaged person full of blame and shame to a trauma survivor, able to protect her children and stop the cycle that was her family legacy.

LOCKED OUT: Improving Educational and Vocational Outcomes for Incarcerated Youth

Despite spending $100,000 to $300,000 per incarcerated child in secure facilities, only 13 states provide all incarcerated youth with access to equivalent education as youth in the community. Almost half do nothing to get the youth enrolled in school upon release.

Treating Addiction Recovery As Reward, Not Deprivation

Treating Addiction Recovery As Reward, Not Deprivation discusses positive reinforcements to help prevent relapse

Be a Candidate! Submit Your Interest in NIC’s T4C Training for Trainers 2016

NIC is soliciting interest from criminal justice professionals interested in applying for Thinking for a Change Training for Trainers for Fiscal year 2016. This rigorous blended-delivery program will be offered in three regional locations yet to be determined. Although there is no cost for the training itself, agencies will be responsible for the cost of participant transportation, lodging, and meals.

Does mandating offenders to treatment improve completion rates?

Study shows that mandated treatment, despite initial resistance, results in 10 times greater likelihood of completing treatment than voluntary entry.

Prerelease Naltrexone for Prison Inmates Evaluated

Summary of study of released inmates who received a shot of Vivitrol (injected Naltrexone) before release and then six more over the next six months. Those who followed through did not test positive for opioids compared to those that did not follow through 10% vs. 62.5%, p=0.003.

Second Chance Act Adult Offender Reentry Demonstration Programs: Implementation Challenges and Lessons Learned

This initial evaluation of Second Chance grantees includes an examination of re-entry programs that RSAT programs would find of interest.

Obama Tells Outdated Opioid Treatment Industry It's Time To Change

President Obama orders all agencies that provide health care services, contract to provide them, are reimbursed for such services, or facilitate access to health benefits shall review all health benefit requirements, drug formularies, program guidelines, medical management strategies in order to identify any barriers to MAT.

Random Drug Testing With Immediate Results and Sanctions Rated “Promising”

The DOC tested three different models of drug testing: 1) random drug testing with immediate results and immediate sanctions, 2) random drug testing with delayed results and delayed sanctions, and 3) routine (non-random) drug-testing procedures with delayed results and delayed sanctions. The first was found to be a promising practice. It had the lowest rate of positive drug tests (11 percent) during the 6-month treatment period, compared with 20 percent for the first control group and 24 percent for the second control group. The differences among the groups were statistically significant. However, outcomes were not sustained over time.

MAT Overview

Want to Know about Medication Assisted Treatment? SAMHSA offers a bunch of links to various websites that cover a variety of MAT related topics.

ONDCP July Newsletter: President Obama pardons nonviolent drug offenders, visits prison residential drug treatment facility

President Obama is the first American president to visit a prison. Specifically he toured a residential substance abuse treatment program in El Reno Federal Correctional Institution. His visit testifies to the importance of your work in RSAT programs.

City councilors hold hearing behind bars

The Suffolk County. Massachusetts Sheriff found a great forum to educate Boston City Councilors on the needs of inmates re-entering the community. With the help of a city councilor, he organized a City Council meeting in his jail where inmates could speak.

Prison Without Punishment

Germany allows inmates to wear their own clothes, cook their own meals, and have romantic visits. Could that work in the United States?
Wow, now for something completely different! The only thing that is remotely similar is that one of the model RSAT programs allows inmates who successfully complete the first phase of its program to change out of prison jumpsuits and wear button down work shirts and blue jeans. One of the inmates described when he got issued his new clothes he spent three days when locked in his cell just staring at his blue jeans. Said it made him feel human again.

New York City Reentry Court Found to be Effective

The Harlem Parole Reentry Court is found effective in increasing employment or education, reducing drug use and parole violations as well as reconvictions within 18 months compared to regular parole. The Harlem Parole Reentry Court engages parolees for 6-9 months and has several core elements: (1) pre-release engagement, assessment and reentry planning; (2) active judicial oversight; (3) coordination of support services; (4) graduated and parsimonious sanctions; (5) cognitive behavioral therapy for medium and high risk parolees; and (6) positive incentives for success.

Adult Drug Court Best Practice Standards

This is the second volume amplifying drug court best practice standards VI through X. The appendix includes “Complementary Needs Assessments” used to assess needs of substance involved justice populations that may also be of great use in RSAT programs. The instruments are designed for multidimensional clinical needs assessments, criminogenic needs assessments, mental health screens, trauma and PTSD scales, Health-Risk Behavior Scales, and criminal thinking scales.

Study: PTSD Increases Risk of Criminal Recidivism

Researchers looked at 771 adult jail inmates with mental disorders and find that PTSD was associated with a greater likelihood of recidivism during the year after their arrest. PTSD was found to be the same as substance use disorders in increasing risk for recidivism. The take away from this research is that PTSD as well as substance abuse should be assessed and then addressed in RSAT programs

CVS To Sell Overdose Reversal Drug Without A Prescription In 12 More States

Given that re-entering opioid addicted inmates are extremely high risk for dying from drug overdose within two weeks of release, the decision of CVS to make Naloxone available without a prescription is good news for the following states: Arkansas, California, Minnesota, Mississippi, Montana, New Jersey, North Dakota, Pennsylvania, South Carolina, Tennessee, Utah, and Wisconsin. RSAT programs should reach out to family members of re-entering high risk inmates as well as the inmates themselves to alert them to the availability of Naloxone.

Seeking Safety

Seeking Safety is a manualized program for individuals with co-occurring PTSD and substance use disorders. The National Institute of Justice has added it as “Promising” on