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LisaRamirez,LeadProgramSpecialist,TexasDepartmentofStateHealthServices,MentalHealthandSubstanceAbuseDivisionRebeccaHogamier,Director,DivisionofBehavioralHealthServices,WashingtonCountyHealthDepartment(Maryland)

MarkStovell,ProgramAssociate,TheCouncilofStateGovernmentsJus4ceCenter(moderator)

July6,2016

Medica8onAssistedTreatment(MAT)inJailsandCommunity-BasedSeDngs

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Na4onalnonprofit,nonpar8sanmembershipassocia4onofstategovernmentofficials

Representsallthreebranchesofstategovernment

Providesprac8caladviceinformedbythebestavailableevidence

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TheNa8onalReentryResourceCenter

•  AuthorizedbythepassageoftheSecondChanceActinApril2008

•  LaunchedbytheCouncilofStateGovernmentsinOctober2009

•  AdministeredinpartnershipwiththeBureauofJus4ceAssistance,U.S.DepartmentofJus4ce

•  TheNRRChasprovidedtechnicalassistancetoover600juvenileandadultreentrygranteessinceincep4on

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Implementa8oninTexas

Overview

Implementa8oninWashingtonCounty,MD

Introduc8ontoMedica8onAssistedTreatment(MAT)

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Implementa8oninTexas

Implementa8oninWashingtonCounty,MD

Introduc8ontoMedica8onAssistedTreatment(MAT)

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Introduc8ontoMedica8onAssistedTreatment(MAT)

•  Atreatmentop+onforopioiddependence/opioidusedisorderusedincombina+onwithcounselingandsocialsupport

•  Considera4onsforindividualswithopioidusedisorderinthecriminaljus4cesystem:– Whileincarcerated:poten4alforopioidwithdrawalsyndrome

– Uponrelease:riskofrelapseandoverdose(some4mesfatal)andreturntoincarcera4on

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•  Opioidagonistthatreducescravingsforopioidsandblockseuphoriceffectsofotheropioidsiftheyareused

•  Takenorally•  AdministeredbyOpioidTreatmentPrograms(OTPs)cer4fiedbytheSubstanceAbuseandMentalHealthServicesAdministra4on(SAMHSA)

•  Evidencethatstar4ngmethadonemaintenanceduringincarcera4oncomparedtoaaerreleaseisassociatedwithhigherratesoftreatmentini4a4oninthecommunity

Methadone

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•  Par4alopioidagonistthatrequiresalowermaximumdosethanmethadoneanddoesnotproduceeuphoriaorwithdrawal– Canbecombinedwithnaloxone(opioidantagonist)topreventmisuse

– Takenorally– CanbeprescribedaspartofOTPorbyphysicianswhohavecompleted8hoursoftraining

– Ratesofrelapseandrearrestforjailinmatesonbuprenorphinearesimilartooutcomesforjailinmatesonmethadone

Buprenorphine

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•  Opioidantagonistthatbindstoopioidreceptorsinthebrainandblockstheeuphoriceffectsofopioids–  Canbeusedfortreatmentofalcoholdependence/alcoholusedisorder

– Administeredasatabletorbyintramuscularinjec4on– Nopoten4alformisuse–  Canbeprescribedbyhealthcareproviderslicensedtoprescribemedica4ons

– Apilotrandomizedcontrolledtrialfoundlowerratesofrelapseforinmateswhobegannaltrexonetreatmentpre-releasecomparedtothosewhodidnotreceivemedica4on

Naltrexone

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•  Whereisyouragencybased?–  Jail–  Community–  Both

•  Doesyouragencyusemedica4onassistedtreatment?–  Yes–  No

•  Ifyes,whichmedica4onop4ondoyouuse?–  Buprenorphine– Methadone–  Naltrexone

AudiencePoll

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Implementa8oninTexas

Implementa8oninWashingtonCounty,MD

Introduc8ontoMedica8onAssistedTreatment(MAT)

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TexasStrategiestoAddressCareforPregnant&

PostpartumOpioidDependentInmates

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JessicaDeSamito

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PartnershiptoProvideIntegratedandCollabora8veCare

NASOpioidTreatmentServices

CountyJail

PregnantandPostpartumInterven4onProgram

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•  CountyJails–  Referral–  Accesstoservices

•  NASOTS–  Methadone-currentlythegoldstandardinthetreatmentofpregnantopioid

dependentwomenestablishedbyNIHsince1998–  Counseling–  Medica4onswillbedeliveredandadministereddailytoeligibleinmatesby

qualifiedproviderstaff–  Zerocosttoeligiblepregnantandpostpartumwomenandcountyjailsystem

•  PPI–  Mo4va4onalinterviewing–  Casemanagement-coordina4onwithCPSandhospitalsystems–  Educa4on-OverdosePreven4on,MommiesCurriculum–  Outreach-Homevisita4on,transport,riskreduc4on–  Freeofcharge–  Co-loca4onwithNASOTS

Services

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Implementa8oninTexas

Implementa8oninWashingtonCounty,MD

Introduc8ontoMedica8onAssistedTreatment(MAT)

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Funding

•  SecondChanceGrant–FamilyBasedPrisonerSubstanceAbuseTreatment

•  StateofMaryland,DepartmentHealthandMentalHygiene,AlcoholandDrugAbuseAdministra4on

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ProgramGoals

•  Decreaserecidivism•  Increaseengagementandreten4onincommunitybasedbehavioralhealthtreatment

•  Reduceopioidoverdoses

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ProgramPartners

•  WashingtonCountyHealthDepartment

•  WashingtonCountyDeten4onCenter

•  ConmedHealthcareManagement,Inc.

•  AlcoholandDrugAbuseAdministra4on

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Exis8ngProgramComponents

•  Establishedjailbasedtreatmentforsubstanceusedisorders

•  Establishedoutpa4enttreatmentforsubstanceusedisorders

•  Establishedoutpa4entmedica4onassistedtreatment

•  Preven4onProgramofferingParen4ngServices

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ProgramComponents

•  BehavioralHealthServices•  Telemedicine•  Medica4onAssistedTreatment•  CriminogenicAssessment•  Trauma-InformedParen4ng•  StructuredVideoFamilyVisita4on•  FamilyNeedsAssessment•  Paren4ngServices•  Par4cipa4onIncen4ves•  CareCoordina4on

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ProgramUniqueness

•  StructuredVideoFamilyVisita4on

•  Telemedicine

•  Medica4onAssistedTreatment

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Medica8onAssistedTreatment

•  Assessment•  Referral•  MedicalEvalua4on•  BloodWork•  PrescribetheMedica4on•  DrugTest•  AdministerInjec4on

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ProgramChallenges

•  ObtainingafullyexecutedQualifiedServiceOrganiza4onAgreement

•  Prescribingofthemedica4on•  Releasedatefromthedeten4oncenter•  Coordina4ngservicesoncetheindividualisreleasedfromthedeten4oncenter

•  Enrollingtheindividualforhealthbenefits

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Sustainability

•  BehavioralHealthServices•  Telemedicine•  Medica4onAssistedTreatmentusingVivitrol•  CareCoordina4on•  RecoveryServices

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ResultsAWerOneYear

•  21individualspar4cipatedinmedica4onassistedtreatment

•  92%receivingmedica4oncon4nuedintreatmentuponrelease,priortoprogramimplementa4on,50%wouldcon4nueintreatmentuponrelease

•  80%ofthoseindividualsremainedintreatment90daysorlonger

•  85%reportedareduc4oninsubstanceuse

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ResultsAWerTwoYears

•  44individualspar4cipatedinmedica4onassistedtreatment

•  75%(18individuals)receivingmedica4oncon4nuedintreatmentuponrelease

•  82%(28individuals)remainedintreatment90daysorlonger

•  8%(2individuals)testedposi4veforsubstanceswhileintreatment

•  4%(1individual)receivedlegalchargeswhileintreatment

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RecidivismOutcomes

AsofDecember2015•  92%par4cipa4nginmateshavenotreturnedtothedeten4oncenteroneyearaaerrelease.

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SciencetoServiceAward

May20,2013,TheWashingtonCountyHealthDepartmentwasawardedtheSubstanceAbuse&MentalHealthServicesAdministra4onSciencetoServiceAwardforOffice-basedOpioidTreatment

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Implementa8oninTexas

Overview

Implementa8oninWashingtonCounty,MD

Implementa8onofMedica8onAssistedTreatment(MAT)

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Addi8onalResourcesonMAT

•  “Medica4onAssistedTreatment,”SubstanceAbuseandMentalHealthServicesAdministra4on

•  “Medica4onAssistedTreatmentforOpioidAddic4on,”Na4onalIns4tuteonDrugAbuse

•  “Medica4onAssistedTreatmentforOpioidAddic4oninaCriminalJus4ceContext,”TASC-ATTC

•  “RSATTrainingTool:Medica4onAssistedTreatment(MAT)forOffenderPopula4ons,”AHP-TASC-ACJS-BJA

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ThankYou

The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the

Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site.

Joinourdistribu4onlisttoreceiveCSGJus4ceCenterprojectupdates!

www.csgjus4cecenter.org/subscribe

Formoreinforma4on,contactLisaRamirez,Lisa.Ramirez@dshs.state.tx.us

RebeccaHogamier,rebecca.hogamier@maryland.govMarkStovell,mstovell@csg.org