Medication-Assisted Treatment in Drug Abuse Cases: A Path to - Episode 15
Drug-related convictions place a substantial burden on the criminal justice system and on society. The MD Magazine Peer Exchange “Medication-Assisted Treatment in Drug Abuse Cases: A Path to Success” features a panel of experts in the criminal justice field who provide insight on medication-assisted re-entry programs.
This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and an associate director of Surgical Intensive Care at New York-Presbyterian Hospital.
The panelists are:
Peter L. Salgo, MD: Hasn’t it always been a public health issue? Or are we just waking up to that nationally?
Phillip Barbour: Probably.
Jac A. Charlier, MPA: Actually, I’ll give you a very interesting intersect between your question, Peter, and TASC. TASC was founded under the Nixon Administration when veterans were coming back from Vietnam with addiction issues. And, back then, under a Republican administration, the United States looked and said, “What should we do with people who have addiction issues? Should we just let them flood our jails or should we do something else with them?” And, we, in the United States, as citizens, said, “We should do something else with them and take a public health approach.” That’s the founding of TASC. So, it’s a great, great question. But, in the interim, since then to where we are right now in 2016, we have moved through this war on drugs, which has really been an enforcement strategy on drugs. Now, again, for drug dealing and manufacturing, you can go enforcement, absolutely; that’s bad stuff, bad people involved. But, the war on drugs does not do anything for addiction; zero, zilch, it will not solve it at all.
Peter L. Salgo, MD: And MAT pilot programs seem to work. They do stuff for addiction. They actually get people straight and keep them straight.
Joshua D. Lee, MD, PhD: Yes. I’ll tell you about a little town called New York City, where we have a model program for methadone, buprenorphine, and, in some study of extended release, naltrexone. So, essentially there’s a way to get any of the 3 as you’re leaving jails in New York City. But, the methadone program has been in existence since the late 80’s, largely in response at that time to TB and HIV epidemics, which were tearing apart the city and underserved communities.
And anybody that’s arrested in New York can raise their hand and say, “I’m a heroin addict,” and they’ll get a methadone detox, which is not going to be treatment, but is a very humane way to incarcerate somebody initially. And then, if they’re out of treatment or interested in methadone, they can raise their hand again and say, “I actually want to try maintenance this time. I’ve been around the block and I think I shouldn’t just detox, I should stay on it.”
Also, if you are in a methadone program on a dose, and you get arrested and incarcerated, you’ll be continued on that, which is extremely important. For most jails in the country, the first place you’re going to go after an arrest would stop your methadone, which is a disaster in terms of chronic medications, but, otherwise, successful now. All of a sudden we’re not going to continue it.
And then, when you’re about to leave Rikers Island, you get referred back out to the City’s pretty rich network of methadone treatment programs, or opiate treatment programs, and you’re on your way. It’s not a sophisticated highly resource program in that there’s not a lot of handholding, case management, or aftercare to make sure you follow up at the program. It’s really more of like a citywide, uniform, low barrier, cheaply budgeted and run type of program. It’s not like we’re spending tons of money on it, but it’s available year after year to, essentially, the entire Rikers Island population.
Jonathan Grand: Peter, let me tell you about one of the oldest MAT reentry jail programs in the country. It’s been around for about 4 years now, and it’s a Vivitrol program. They give the shot to their inmates before they leave. But, even before that, the jail staff meets on a regular basis with the community’s service staff. And they all meet as a group. What they do is they review who’s being discharged in the next 2, 3 weeks. They figure out what the treatment plan is: behavioral health, case management, etc. Then they go out with those navigators that we talked about. They get the treatment. And, they’ve done some research. Their initial research is that 80% of the people they discharge report to the behavioral health facility and get their second shot of the Vivitrol 28 days later. And, up to 3 years later, 82% have not returned to jail. So, does it work? With medication, with case management, with behavioral health, and what the research is saying, the longer you can keep them in treatment and the longer you can have them taking the medication, the better chance you have of recovery.