For persons with an opioid use disorder who are in the criminal justice system, the process of transitioning from jail or prison back to the community can be overwhelming. Within three months of release from custody, 75 percent of people who were in prison or jail with an opioid use disorder experience a relapse to opioid use. It is also alarming that incarcerated persons who are released to the community are between 10 and 40 times more likely to die of an opioid overdose than the general American population—especially within a few weeks after reentering society. As we observe March as National Criminal Justice Month, I’d like to call attention to SAMHSA resources and grant programs that are tackling this issue head-on.
As a society, we face the difficult challenge of preventing people with opioid use disorder reentering the community from relapsing and overdosing on opioids. However, it is possible through the use of medication-assisted treatment within the fabric of the criminal justice system. Medication-assisted treatment (MAT) is an evidence-based treatment for opioid use disorder that uses FDA-approved pharmacotherapy in combination with counseling and behavioral therapies to treat substance use disorders. Jails and prisons have been slow to offer this form of treatment, despite the overwhelming evidence of the effectiveness of MAT. However, in reaction to the current opioid epidemic, the criminal justice system is increasingly considering the use of MAT in drug courts, incarceration, reentry, and community corrections.
For the past decade, SAMHSA has supported MAT and other forms of treatment for mental and substance use disorders, and trauma-related issues for people involved in the criminal justice system through discretionary grants, programs and resources. SAMHSA recently published two new guides, “Medication-Assisted Treatment in the Criminal Justice System: Brief Guidance to States" and "Principles of Community-based Behavioral Health Services for Justice-involved Individuals: A Research-based Guide."
The SAMHSA brief, “Medication-Assisted Treatment in the Criminal Justice System: Brief Guidance to the States” provides guidance to state governments on increasing the availability of MAT in criminal justice settings. By including the criminal justice system as a path to treatment, states may see an increase in access to and maintenance in treatment, and lower rates of overdoses, re-offending, and re-incarcerations. In this brief, states are provided an overview of the issue, the challenges to incorporating MAT, key considerations for establishing MAT in criminal justice settings, and existing standards and guidelines.
SAMHSA’s “Principles of Community-based Behavioral Health Services for Justice-involved Individuals: A Research-based Guide” aims to assist community-based providers in their clinical and case management practice with the justice-involved population. Intended for direct service providers, agency leaders and program developers, the principles articulated in this guide provide a foundation for achieving a quality, community-based behavioral health treatment system that is responsive to this population. Eight key principles – reached by consensus – are described, followed by frequently asked questions, a table of evidence-based practices for substance use treatment for justice-involved individuals, and key resource materials.
During fiscal year 2019, SAMHSA also funded 43 adult drug court grants, 12 family drug court grants and two reentry program grants and encouraged these programs to utilize MAT, as appropriate, with their program participants.
It is always encouraging to hear personal success stories from SAMHSA grantees. Such an example was provided by a Project Director of a SAMHSA-funded drug court in Arizona. She recently shared the story of Patrick, one of her program graduates, who is now successfully working as a recovery support specialist for their MAT service provider. Patrick described his early struggles with anxiety and depression, becoming addicted to prescription drugs and later, heroin. His addiction led him to several stays in jail and ultimately was sentenced to state prison. After release and new charges, Patrick was eligible for, entered and graduated from a drug court program. He offered that the source of his success was being able to participate in substance use treatment, and addressing his mental health issues through intensive counseling, job training, and receipt of MAT, which Patrick says “allowed the obsession for heroin to be lifted from the nooks-and crannies of my mind, heart, and soul.”
Treatment works and recovery from opioid use disorder is possible. If you or someone you know is looking for an opioid treatment program, visit https://dpt2.samhsa.gov/treatment.