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Medication Assisted Treatment (MAT)

A graphic explaining MATAs part of its ongoing mission to better equip reentrants as they return to their communities, the Department of Corrections (DOC) began providing Vivitrol (Naltrexone for extended release injectable suspension) for female reentrants at SCI Muncy (2014). Vivitrol is a non-narcotic medication indicated for the treatment of alcohol use disorder as well as opioid use disorder. Penn State University researchers evaluated this initiative and ultimately recommended the DOC consider expanding it to men's institutions.

As of April 2018, Vivitrol is available at all state correctional institutions (SCIs).

Medical Assistance/COMPASS

With many serious mental and physical health conditions, including substance use disorder (SUD), reentrants require essential health care immediately upon release from incarceration. To address this issue, the DOC and the PA Department of Human Services (DHS) have collaborated to create a process ensuring that Medical Assistance (MA) benefits are in place for reentrants on the date of their release. If the individual is eligible, MA is authorized no sooner than seven days prior to the individual's release date from the SCI, using the release date as the MA begin date. This partnership has resulted in the development of a more effective and expedited continuum of care.

MAT Challenges

Many treatment facility staff, who conquered their own addictions without medication, favor an abstinence model, and provider skepticism may contribute to low adoption of MAT. Staff in community corrections contract facilities (CCFs) have expressed that their corporate offices do not support the use of MAT and are therefore hesitant to personally participate in MAT expansion. Additionally, many individuals utilizing MAT are met with harsh criticism from the 12-step community.

Substance Use Disorders has been generally treated as if it were an acute illness, rather than a chronic disease. Research results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. The use of MAT for those suffering from addiction should be insured, treated and evaluated like other chronic illnesses.

Opioid Therapeutic Community Programs

In the recent years, information has shown that the United States is in a state of emergency in regards to substance use, particularly with opiates. Pennsylvania has seen this issue arise both in communities and in its state correctional institutions. Statistics from December 1, 2016, through November 30, 2017, show that 21% (3,025 out of 14,150) of the individuals that completed a drug and alcohol assessment, The Texas Christian University – II Assessment (TCU), reported opiates as their drug of choice. Another 5% (751) reported that opiates were their 2nd or 3rd drug of choice. 

In January 2017, the DOC made changes to the general population Therapeutic Community Curriculum and the Co-Occurring Disorders Therapeutic Community Curriculum to provide evidence based treatment.  On March 12, 2018, the department converted six therapeutic communities (TCs) to opiate specific therapeutic communities.

Institutions with Opiate Specific TCs:

  • Camp Hill
  • Laurel Highlands
  • Chester
  • Albion (Co-Occurring TC)
  • Quehanna Boot Camp (State Intermediate Punishment [SIP])
  • Cambridge Springs (SIP and Female)

While these are the first institutions to implement this program, the goal will be to continue to increase the program based on successes and need.

Oral Naltrexone Maintenance

The DOC has expanded its MAT programming to include oral naltrexone maintenance, which is now available at each of the Opiate Specific TC sites listed above. Participants are switched to Vivitrol prior to institutional release.

Expansion

A graphic explaining the history of MATIn January 2018, Governor Wolf declared the opioid crisis in Pennsylvania as a disaster emergency and directed that Medication Assisted Treatment (MAT) be provided within the DOC's prison system. These medications include methadone, naltrexone (Vivitrol and Revia), and buprenorphine (Suboxone, Subutex, and Sublocade).

MAT is not new to the DOC. It have always provided methadone maintenance to pregnant inmates to protect the fetus from withdrawal. Newer programs include Vivitrol injections for inmates being released and most recently oral naltrexone for select new intakes with short minimums who will be admitted to one of our Opioid Use Disorder Therapeutic Communities (OUDTC).

On April 1, 2019, the DOC began a Sublocade Pilot Program at SCI Muncy. Select parolees who are diverted to an SCI for a 14-day “detox only” placement will be prescribed Suboxone induction and then a long-acting Sublocade injection prior to being continued on parole in an outpatient or inpatient treatment setting. Once the Pilot Program concludes, it will be rolled out gradually throughout other institutions.

Beginning June 1, 2019, inmates received into institutions (PV or new intakes) who are enrolled in a verified MAT Program (community or county jail) will continue on MAT. Suboxone and oral naltrexone will be available immediately and will also be offered to those on methadone until it can be added at a later date. Any instances of an inmate entering our system on an MAT that is not available, or who does not meet criteria for continuing MAT, will be forwarded to the Bureau of Health Care Services (BHCS) for review on a case-by-case basis.

Medications for Opioid use Disorder

The following medications are approved by the FDA for use in opioid addiction treatment in conjunction with psychosocial therapy:

Methadone - Methadone, a synthetic opioid, is an agonist that mitigates opioid withdrawal symptoms and, at higher doses, blocks the effects of heroin and other drugs containing opiates. Maintenance of opioid addiction treatment with methadone is approved "in conjunction with appropriate social and medical services." Used successfully for more than 40 years in the treatment of opioid dependence, methadone at therapeutic doses (generally 80-120 mg) has been shown to eliminate withdrawal symptoms produced by stopping use of heroin and prescription opiate medications because it acts on the same targets in the brain as those drugs. Methadone can be dispensed only at an outpatient Opioid Treatment Program (OTP) certified by SAMHSA and registered with the Drug Enforcement Administration (DEA), to a hospitalized patient in an emergency, or as a three-day bridge until a patient can be scheduled with an OTP. SAMHSA-certified OTP facilities provide daily doses.

Buprenorphine - Buprenorphine, approved by the FDA in 2002 to treat opioid dependence, is a partial opioid agonist that, when dosed appropriately, suppresses withdrawal symptoms. Although buprenorphine can produce opioid agonist effects and side effects, such as euphoria and respiratory depression, its maximal effects are generally milder than those of full agonists like heroin and methadone. Physicians are permitted to distribute buprenorphine at intensive outpatient treatment programs that are authorized to provide methadone if providers are trained in its use. Additionally, a special program has been established so that buprenorphine can be prescribed by physicians in office settings and dispensed by pharmacists.

In order to prescribe this medication, physicians must complete a training course and receive a waiver granted by the DEA. Buprenorphine was tested in clinical trials for addiction treatment in the United States both by itself and in combination with naloxone, a drug used to counter the effects of an overdose of opiates such as heroin or morphine. The buprenorphine/naloxone combination is sometimes referred to as Bup/Nx (marketed under the brand name Suboxone®). Formulations approved for drug abuse treatment are intended to be taken sublingually (placed under the tongue and allowed to dissolve). When taken this way, the naloxone has little effect. However, if a patient injects Bup/Nx, the naloxone (an antagonist) enters the bloodstream and will block the buprenorphine, causing the patient to enter opioid withdrawal. This combination formulation may deter abuse through injecting because abusers are motivated to avoid unpleasant withdrawal symptoms. 

Naltrexone - Naltrexone is a non-addictive antagonist used in the treatment of alcohol and opioid dependence. The medication blocks opioid receptors so they cannot be activated. This "blockade" action, combined with naltrexone's ability to bind to opioid receptors even in the presence of other opioids, helps keep abused drugs from exerting their effects when patients have taken or have been administered naltrexone. As an antagonist, naltrexone does not mimic the effects of opioids. Rather, it simply blocks opioid receptor sites so that other substances present in a patient's system cannot bind to them. If a patient who has been administered naltrexone attempts to continue taking opioids, he or she will be unable to feel any of the opioid's effects due to naltrexone's blocking action. Naltrexone is administered in an injectable, long-acting formulation (marketed under the brand name Vivitrol®), which is designed for once-monthly dosing.

The FDA approved this medication for use in people with opioid use disorders to prevent relapse. Naltrexone should be used only in patients who have been detoxified from opioids and have been opioid free for 7–10 days. Naltrexone is non-narcotic and non-addictive; however, as with other medications that interact with the opioid receptors, there is a risk of overdose if a patient who is being treated with naltrexone misses a dose and takes an opioid, or if the patient takes large quantities of opioids in an attempt to "break the blockade." Compliance measures that closely monitor patients during the treatment period may be beneficial.

Resources

Podcasts

How Medication Is Treating Substance Use Disorder

Game Changer: Pennsylvania’s Response to the Opioid Crisis

Providing National Assistance

PA DOC Medication-Assisted Treatment Program Takes Center Stage at National Health Conference

Handouts, Links, Documents, Articles and Videos

For Justice-Involved Individuals (pdf)

For Family and Friends of Justice-Involved Individuals (pdf)

For Staff Working with Justice-Involved Individuals (pdf)

For the General Public (pdf)

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA Fact Sheet

SAMHSA TIP

Medication-Assisted Treatment for Opioid Treatment: Facts for Families and Friends

Partnership for Drug-Free Kids

Opioid Addiction Treatment Programs

MAT for Offender Populations

Getting Started with MAT: A Toolkit

Myths vs. Facts

Know Your Rights (for Individuals on MAT)

DOC Article - Saving Lives During an Epidemic (October 2015) (pdf)

Article: Pa. prisons offering inmates addiction treatment on their way out, but is it working?

NewsWorks.org |  July 5, 2017

OP-ED: Secretary Wetzel's guest editorial in the Carlisle Sentinel 
Anti-drug approach underway in state's prisons
July 20, 2016 Carlisle Sentinel

Article: New hope for a scourge that's making a comeback

By Helen Ubinas | Philadelphia Daily News | October 19, 2015

VIDEO  Massachusetts, Missouri and Pennsylvania corrections officials and offenders discuss Medication Assisted Treatment.

VIDEO - Medication Assisted Treatment (MAT)

DOC Secretary John Wetzel explains the DOC's MAT program, who's eligible and why it is necessary.

Additional Resources

Medication-Assisted Treatment for Opioid Addiction: Factsfor Family & Friends

NIDA Info Facts: Treatment Approaches to Drug Addiction

Medication-Assisted Therapy Toolkit

SAMHSA Treatment Locator 1-800-662-HELP