Medication-assisted treatment (MAT) in the jail and in the community

People who have opioid addictions receive MAT in the jail and are connected to MAT in the community upon release. MAT can help reduce the cravings people have to use opioids again and treat the brain changes that are caused by opioid addiction. There are three Food and Drug Administration-approved medication options: buprenorphine, methadone, and naltrexone. Each of these should be available, as people may respond differently to each medication.

For more information on this intervention, see this resource:

• Best Practices for Successful Reentry for People Who Have Opioid Addictions

Local Examples

Franklin County, MA Franklin County Sheriff's Office

• The Franklin County Sheriff's Office is a fully licensed Opioid Treatment Program (OTP), which offers all three forms of MAT for opioid addiction.
• After appropriate screening and assessment, incarcerated patients with opioid addictions are offered MAT at booking or shortly prior to their release, or continue existing MAT upon incarceration.
• Treatment is offered both before and after sentencing.
• The OTP is supported by trauma-informed, mindfulness-based cognitive behavioral therapy from a team of licensed behavioral health providers.
• Peer specialists offer support groups within correctional facilities.
• Case workers ensure continuity of care by arranging for enrollment in Medicaid and discharge referrals to treatment programs in the community.
• Post-release case workers support clients with medication adherence and wrap-around case management services immediately upon release into the community.
• A contingency management system incentivizes post-release client contact with case workers.

For more information on this example, see these resources:

• Medication Assisted Treatment for Opioid Use Disorder in Jails and Prisons, Toolkit
• Becoming a Methadone Clinic at a Correctional Facility
• Training Videos for Correctional Officers
• Cost Calculator by the National Council

DuPage County, IL

• The DuPage County Correctional Center (DCCC) and partnering agencies are capable of offering various forms of medication-assisted treatment to ensure continuity of care.
• People in the jail have the opportunity to initiate naltrexone during their time at DCCC through the jail’s partnership with DuPage County Health Department.
• The DuPage County Health Department also offers naltrexone and buprenorphine to community members who participate in substance use therapy/counseling.

Fairfax County, VA

• As part of the intake process, all people booked into jail are screened for opioid use using the National Institute on Drug Abuse (NIDA)-4 and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). A urinalysis is completed for individuals screening positive to help focus treatment options. A pregnancy test is conducted for all women who screen positive, with treatment protocols in place for women who are pregnant.
• The Clinical Opiate Withdrawal Scale for opioid use disorders and Clinical Institute Withdrawal Assessment Alcohol Scale Revised are embedded into the jail medical provider’s electronic health record and guide decision-making for people who need withdrawal management.
• Fairfax County’s Adult Detention Center primarily offers buprenorphine for MAT. Sublocade, Subutex, and Vivitrol are additional options. Methadone is not currently provided unless by “guest-dosing” with outside providers when clinically indicated and for pregnant women who need to continue with methadone treatment.
• To facilitate community transitions, peer support specialists conduct “in-reach” to meet with people to begin to prepare for reentry, providing education on overdose reversal, harm reduction principles, and community contacts.
• The MAT program provides “bridge dosing” to people who received MAT at the jail and are reentering the community, supplying them with medications for up to 14 days based on their individual needs. MAT participants also receive a release backpack with cell phones and basic needs supplies; prescription funds if needed (for Fairfax County residents only); and overdose reversal kits with naloxone and instructions for use.
• The program provides clinical linkages to MAT before release; enrolls people in Medicaid up to 45 days before release; and provides transportation to treatment appointments via peer support specialists and Uber. All participants receive Narcan and fentanyl test strips at release. Recovery housing scholarships are also available. Community connections and reentry supports are seen as vital to ongoing treatment and recovery.

For more information on this example, see these resources:

• Implementation Science Checklists and Evidence-Based Practices
• Jail-based Addiction Recovery Program Continues at Release through Community Partnerships