Introduction

Many publications over the last decade have documented the alarming increase in use and abuse of prescription opioids and heroin (Cicero, Inciardi, & Munoz, 2005; Davis, Severtson, Bucher-Bartelson, & Dart, 2014; GAO, 2009; Paulozzi, Budnitz, & Xi, 2006: Pletcher, Kertesz, Kohn, & Gonzales, 2008; Reifler, et al., 2012; Schneider, et al., 2009). This surge resulted largely from the significant increase in physician/dentist prescription of opioid medications to treat chronic pain during the 1990s, when a sizeable subset of patients became dependent on and/or addicted to the medications. A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) cited that 79.5 percent of heroin users had previously used prescription pain relievers for nonmedical reasons (Muhuri, Gfroerer, & Davies, 2013). More recent media reports have indicated that over 120 people die of an opiate related overdose each day (2017).

The National Institute on Drug Abuse (NIDA) has clearly established that Medication-Assisted Treatment (MAT) “increases patient retention and decreases drug use, infectious disease transmission, and criminal activity” (NIDA, 2012). This type of treatment combines counseling with medications that block opioids’ euphoric effects and relieve relapse-inducing cravings. “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems” (NIDA, 2009).

Many authorities have recommended the use of MAT in the justice system (including criminal, civil, family and juvenile). ONDCP encourages “the use of the FDA’s approved medications to treat opioid use disorder: methadone, naltrexone (Vivitrol—a once-monthly extended release injectable formulation), and buprenorphine” (ONDCP, 2014). The National Institutes of Health has recommended that “all opiate-dependent persons under legal supervision should have access to methadone maintenance therapy” (NIH, 1997). SAMSHA’s Einstein Expert Panel recommended: “At no point should mandates for a client to consume or terminate medications be levied without the input of the client and treating physician…. Similarly, individuals already receiving MAT should not be ineligible for a particular program or service” (SAMHSA, 2013). Several recent reports and guidance documents have also supported the use of MAT for opioid use disorder  in criminal justice settings (Legal Action Center, 2011; BJA, 2013; NADCP, 2013).

SAMHSA’s previously cited Einstein Expert Panel report provides an important principle:

What works for one group of clients at one stage of justice involvement does not necessarily work (and in fact may even be contraindicated) for other clients at other stages of justice involvement. This challenge is compounded when the justice system over relies on a specific treatment modality to achieve its public safety goals. The most obvious example is the reliance on residential treatment to best supervise and manage community corrections populations (SAMHSA, 2013).

An increasing amount of drug courts are referring individuals to Opioid Treatment Programs (OTPs) and DATA 2000 practices for Medication-Assisted Treatment. Additionally, correctional facilities are operating Opioid Treatment Programs within the jail setting and inducting former opioid dependent inmates on extended release injectable naltrexone prior to being released from jail.

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