1. MATRI Medication Assisted Treatment Reentry Initiative

2. LEARNING OBJECTIVES  Describe the three basic components of a correctional MAT program for re-entering inmates;  List the three FDA approved medications for opioid use disorder; and  Identify at least one risk or obstacle to using medication assisted treatment in a correctional facility.

3. Medication Assisted Treatment Reentry Initiative  Partnership between the Department of Correction and the Department of Public Health’s Bureau of Substance Abuse Services in response to the opioid epidemic;  An interdisciplinary workgroup comprised of medical, mental health, prison based substance abuse treatment provider, community based substance abuse treatment provider and correctional staff developed and implemented a MATRI protocol for full implementation in August 2014;  MATRI shifts prison based substance abuse treatment from a strict evidence based public safety model to a hybrid that incorporates the elements of a public health approach.

4. PURPOSE  The purpose of MATRI is to provide pre-release treatment and post- release referral for opioid and/or alcohol addicted offenders to reduce the likelihood of overdose and recidivism.  The goal is to facilitate transition into an community based substance abuse treatment program which employs a multi-faceted approach to treatment including the use of the medication Naltrexone, counseling, and aftercare referral to community-based providers.

5. Medicated Assisted Treatment (MAT) combines medications with counseling and behavioral therapies, monitoring, community-based services, and recovery support to treat the bio-psychosocial aspects of alcohol and opioid use disorders. MAT assists, not replaces, other treatment & recovery efforts. WHAT IS MAT?

6. Detox is quick and technically easy, but preventing relapse is extremely difficult. Short term MAT to counter withdrawal rarely results in long term abstinence. Treatment w/medication for a period of 12 months or more required if brain is to repair its ability to regulate stress, pain and mood for sustained abstinence. MAT VS. DETOX

7. WHAT IS VIVITROL?  Vivitrol is an antagonist, or blocking medication that attaches to opioid and alcohol receptors in the brain but doesn’t activate the brain’s pleasure response;  It blocks the effects of opioids and alcohol in the brain’s reward system;  Vivitrol does not contain opioid or other drugs unlike methadone or suboxone - it is non-addictive and non- narcotic;  A single shot provides one month of medication;  Vivitrol is only successful with on-going counseling.

8. TRAINING - GETTING BUY-IN  All Levels and All Stakeholders  Correctional Administration  Providers  Community Partners  Offenders  Barriers & Obstacles  Correctional Culture  Personal Bias

9. Recovery Support Navigator Model  The Recovery Support Navigators (RSNs) coordinate with the Medical Discharge Planners to facilitate referrals to the community based clinics and assist in the development of the offender’s post release substance abuse treatment plan. This may include linkages to faith based organizations, mentors, parole and probation.  The RSN plays a key role in developing a community network of providers and volunteer agencies to assist the offender once released into their community.  Strengthening existing partnerships with community-based agencies and creating new ones, improves the continuity in our continuum of care model in an effort to sustain reentry success and reduce recidivism.

10. ELIGIBILITY  Offenders who have graduated/successfully completed the Correctional Recovery Academy (intensive residential substance abuse treatment program) or are enrolled in a non-residential substance abuse treatment program;  Opioid and/or alcohol dependent;  Remain engaged in recovery/treatment. NOTE: Eligible inmates who have not completed/enrolled in the Correctional Recovery Academy or a non-residential treatment program may be referred to the Attorney General Grant Medication Assisted Treatment Program which includes referrals to Methadone, Suboxone and/or Vivitrol.

11. DOC MATRI SITES  Boston Pre-Release Center  MCI Shirley Medium  MCI Shirley Minimum  MCI Concord  MCI Norfolk  MCI Framingham  Northeastern Correctional Center  Old Colony Correctional Center Medium  Old Colony Correctional Center Minimum  South Middlesex Correctional Center NOTE: Eligible offenders at other sites may be classified to a selected site or referred to the Attorney General Grant Medication Assisted Treatment Program.

12. PROCESS Program ComponentResponsibleTimeline Initial Screening Spectrum Health Systems9-6 mo. Mental Health ScreenMPCH90 days Medical ScreeningHealth Services Unit90-60 days MA Health ApplicationHousing Search Specialist30 days Weekly GroupsSpectrum Health Systems ongoing RSNSpectrum Health Systems90 days Urine ScreenInner Perimeter Security 10 days Tolerance TrialHealth Services Unit upon –UA Naltrexone InjectionHealth Services Unit 7 days ReferralDischarge Planner7-4 days

13. MAT is severely under utilized, especially in correctional settings, for practical and philosophical reasons. Prisons/Jails are concerned with contraband and some have found buprenorphine (FDA approved medication) to be a drug of abuse, not promised cure. Many believe that inmates are detoxed and clean in prison/jail, why encourage him/her to put drugs back into his/her body?! EVIDENCE-BASED VS. BELIEF

14.  Better retention in treatment  Reduced recidivism  Increased employment  Reduced risk of HIV/AIDS  And, fewer overdose deaths WHY MAT?

15. Alcohol and drug addiction are major drivers of recidivism that affect up to 70% of inmates; 50% with substance/alcohol use disorders relapse within a month of release. Aftercare helps. Aftercare with MAT helps more. RE-ENTRY CHALLENGE

16. “ When prescribed and monitored properly, medications … are safe and cost-effective components of opioid addiction treatment. These medications can improve lives and reduce the risk of overdose, yet medication-assisted therapies are markedly underutilized.”’ NIDA Director, Nora Volkow, M.D. WHAT THE EXPERTS SAY

17. A systematic review of studies of MAT programs for prisoners finds consistent positive health outcomes, with 55 to 75% reduction in IV drug use, decreases HIV and hepatitis C infection, and increased retention in community-based treatment after release. MAT AND CORRECTIONS

18. DRUG DEATHS HIGHER THAN MOTOR VEHICLE ACCIDENT DEATHS

19. Within 2 weeks of release, ex-inmates nearly 129 times at greater risk for death by drug overdose than general population of same demographics. Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD. Release from prison-a high risk of death for former inmates. N Engl J Med. 2007;356(2):157–165. REENTRY DEATH RATE FROM DRUG OVERDOSE

20. OUTCOMES Since September 2014  1,082 inmates screened  521 declined  286 deemed ineligible  54 completed (received injection and released)  171 inmates pending