Comment; MAT should be mandatory in all penal facilities with referral to outpatient treatment settings on release. MAT is the gold standard of care. It works!
By Bethany Bump
Published 4:56 pm EST, Wednesday, November 14, 2018
Photo: Will Waldron
Exterior wall and wire at the Greene County Jail on Tuesday, April 24, 2018, in Catskill, N.Y. (Will Waldron/Times Union)
NEW YORK — A group of New York lawmakers are seeking support for a bill that would require all jails and prisons in the state to offer medication that has been proven to reduce death among individuals with opioid use disorder.
On Wednesday, members of the Assembly held a hearing on the effectiveness of “medication assisted treatment,” or MAT, in the state’s jails or prisons, and concluded the state falls woefully short when it comes to its use of the evidence-based treatment. Currently only six of the state’s 54 state-run correctional facilities offer MAT, which relies on one of three FDA-approved medications to help curb opioid cravings and stabilize brain function.
“It’s a start, but time is fleeting,” Assemblywoman Linda Rosenthal told state officials after they testified that New York has seen great progress implementing MAT in its correctional facilities in recent years.
“This is a recurring problem,” she continued. “People come into our facilities with a substance use disorder; others develop it while incarcerated. And when they leave, many go back into the neighborhoods they came from and overdose. So I think it’s incumbent on the state to take a giant leap and go for it in all our facilities.”
Roughly 78 percent of all inmates in New York have a diagnosed substance use disorder, according to the state Department of Corrections and Community Supervision. While state officials could not provide a figure for the segment that’s addicted to opioids, it’s safe to assume the number is high, as opioids remain a leading cause of overdose death nationwide.
MAT has been a proven treatment for opioid use disorder for at least three decades, with studies showing it prevents relapse and significantly lowers overdose rates. But it remains controversial, in part because the medications used to curb cravings are themselves powerful and because abstinence-only proponents view any reliance on drugs as a negative.
Supporters, however, note that abstinence-only policies don’t work for everyone and stigmatize those who have gone on to lead normal, productive lives thanks to drugs like buprenorphine and methadone. These so-called maintenance drugs, they argue, save lives by preventing overdose.
Those in the drug reform movement characterize disdain for these drugs as yet another example of how those suffering from mental and behavioral conditions are treated differently than those with medical conditions.
“I hope and I believe that in every correctional facility in the state our inmates with diabetes and high blood pressure and multiple sclerosis have treatment available to them,” said Assemblyman Richard Gottfried, a co-sponsor of the bill. “If there were only six prisons in the state that had diabetes treatment available, nobody would find that acceptable.”
The high rate of fatal overdoses among former inmates has made the rollout of MAT in jails and prisons a key issue for recovery advocates.
A 2007 study, for example, found that former inmates of Washington State prisons were 12.7 times more likely to die in the first two weeks after their release than the average state resident, with drug overdose the leading cause. And that was in the late 1990s and early 2000s, before the emergence of highly potent fentanyl in America’s drug supplies.
Today, public health experts believe the chances are much higher, as synthetic opioids like illicitly manufactured fentanyl are among the fastest-growing category of drug responsible for overdose deaths.
Forced to detox before they’re incarcerated, inmates enter jail or prison without the physical dependence on a substance but continue to battle the underlying addiction. Illicit drugs smuggled into these facilities can further enable this addiction — or, if an inmate manages to stay clean behind bars but is exposed to drugs upon release, their lower tolerance greatly increases their chances of fatal overdose.
To help treat the underlying addiction, Sean Byrne, executive deputy commissioner of the state Office of Alcoholism and Substance Abuse Services, and Acting DOCCS Commissioner Anthony Annucci testified Wednesday that 53 of the 54 state correctional facilities offer psycho-social counseling services for inmates battling substance use disorder.
“They’re intense,” said Annucci. “They can last between six and 12 months.”
They also noted that while they’d like to expand MAT systemwide, it would be unwise to move too fast, as the programs currently in place downstate are only pilot programs. Obstacles, such as obtaining agreements with outside treatment providers who are licensed to provide the drugs, still have to be ironed out before a systemwide expansion is feasible, they said.
“I’ve been around a long time — 34 years — in this agency and the worst thing you can do is get excited about a pilot, rush it and then unfortunately have something happen where you lose buy-in from participants,” Annucci said.