- The criminal justice system is fast embracing another concept that health workers place under the “harm reduction” umbrella: medication assisted treatment (MAT).
While it’s unlikely your local jail is going to open a needle exchange anytime soon, the criminal justice system is fast embracing another concept that health workers place under the “harm reduction” umbrella: medication assisted treatment (MAT).
Treatment providers who support harm reduction usually embrace a variety of methods to help those with substance use disorders. And they say MAT is invaluable for people who are hoping to manage their cravings and withdrawal symptoms — whether they’re trying to stop using opioids or just limit their use. (Most people know of at least one form of MAT: methadone. But there’s more than one drug option these days.)
Those working in the criminal justice system, meanwhile, note that MAT can save lives.
“People’s tolerance level goes up and down very quickly,” says Marc Condojani, director of adult treatment and recovery for the state Office of Behavioral Health. “So a short period of abstinence in jail — 14 days, even three days — if someone were to leave the facility, use the same amount of opioids they were using before they were incarcerated, they’re at risk of overdose and death.”
But MAT has been proven to reduce fatal overdoses. Notably, in Rhode Island, post-incarceration deaths reduced by 61 percent in the first year after an MAT program was implemented in 2016 — correlating in a 12 percent reduction in overdose deaths statewide.
Colorado launched its own pilot program in 2017 to provide MAT to inmates in the last week or so before their release, using federal grant funding from the Substance Abuse and Mental Health Services Administration, or SAMHSA.
Earlier this year, the El Paso County Jail launched a program to provide a shot of Vivitrol — a long-lasting drug that prevents an opioid high — to inmates who wanted it, before they were discharged. El Paso County was also among at least 13 counties to apply for additional grant funding for MAT, Condojani says. This new federal grant, which has not been awarded yet, will allow jails to provide MAT throughout incarceration.
Condojani declined to give specifics about the county’s grant application, but he noted it potentially involved having multiple medications for opioid use disorders available to inmates, and showed the jail was “pretty darn invested in offering comprehensive care.”
Having options is valuable, because each of the three main drugs used — Vivitrol, methadone and buprenorphine — works differently, and benefits some people more than others.
“I’m not of the opinion that decisions on which medication should be made by judges or probation officers or the general public,” Condojani says. “It should be a decision between a patient and their doctor.”
Scott McFadden, a licensed addiction counselor who spent years in and out of the criminal justice system and battled addiction for decades, says MAT transformed his life.
“One day I was the most hard-core, out of control, hopeless, miserable person with an addiction,” he said at a recent conference, “and the next day I was sane; I was stable; I was motivated; and I was amazed.”
McFadden began taking Suboxone, a form of buprenorphine, around 18 years ago. Since then, he’s earned a bachelor’s degree and a master’s degree, served on five specialty drug courts and worked in behavioral health roles ranging from therapist to clinical director.
Thanks to MAT, McFadden said, “I dared to hope."