The use of medication-assisted treatment (MAT) is expanding in jails and prisons. MAT has been proven to help users of opioids recover, improve treatment retention, and reduce the risk of overdose death, infectious disease transmission, and engagement in criminal activity.Nora D. Volkow, Thomas R. Friedan, Pamela S. Hyde, and Stephen S. Cha, “Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic,” New England Journal of Medicine 370, no. 22 (2014), 2063-66; and Hilary Smith Connery, “Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions,” Harvard Review of Psychiatry 23, no. 2 (2015), 63-75. However, MAT access remains limited in corrections settings. Further, medical professionals and harm reduction advocates have questioned the effectiveness of one MAT drug, naltrexone—known commercially as Vivitrol—and criticized the manufacturer’s aggressive promotion of the product to corrections officials and the law enforcement community.Abby Goodnough and Kate Zernike, “Seizing on Opioid Crisis, a Drug Maker Lobbies Hard for Its Product,” New York Times, June 11, 2017; and Alec MacGillis, “The Last Shot,” ProPublica, June 27, 2017.
There are some signs of evolving support for the expansion of MAT in corrections, particularly for pretrial detainees who may be released in relatively short periods of time. The Rhode Island Department of Corrections has expanded its MAT program and became the first state to offer all three drugs approved to treat addiction—methadone, buprenorphine, and naltrexone—to the entire incarcerated population.Andrew Joseph, “One State Takes a Novel Approach to Opioid Addiction: Access to Treatment for All Inmates,” STAT, August 3, 2017. The Vermont Department of Corrections recently increased the length of time that someone who is incarcerated can receive MAT from 90 to 120 days, including a “medically compassionate taper.”Alicia Freese, “Vermont Prisons to Expand Opiate Treatment for Inmates,” Seven Days, November 7, 2017. And the final report of the President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended that “[t]he criminal justice system should accept that medication, when clinically appropriate, can lead to lasting recovery; abstinence-only sobriety is not the only path to recovery.”The President’s Opioid Commission, Final Report (2017), at 10.