Medication-Assisted Treatment: Flipping the Script on Opioid Use Disorder

Steve Tomlin has worked in and around the recovery community for a long time now. He’s seen what works, and what doesn’t. And he has become a passionate advocate for medication-assisted treatment (MAT) for opioid use disorder.

“I’ve been doing this long enough that I remember when a ‘clubhouse detox’ was putting somebody in the garage and giving them Gatorade, a chocolate bar, and a hoagie,” he says wryly. “Ten years ago we would not even be having this conversation, because I, like many others, was raised in the ‘abstinence only’ model where you give up everything, and that's how you get clean and sober. What we now know as the myth of ‘replacing one drug with another drug’ wouldn’t even have been considered.” Tomlin is now YesCare’s Chief Strategic Innovation Officer and Executive Vice President for MAT, Reentry and Community Partnership.

Drug and alcohol addiction is one of the most prevalent health issues faced by correctional healthcare providers, and untreated addiction has a high correlation with recidivism. Add to that the Department of Justice’s recognition in 2022 of opioid use disorder as a medical condition that is covered under the Americans with Disabilities Act, and the need for effective, cost-efficient treatments in correctional facilities becomes obvious and pressing.

MAT is primarily used for addiction to narcotics such as heroin, fentanyl and opiate-based prescription pain medications. It augments counseling and behavioral therapy with a drug that helps normalize the patient’s brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions, all without the negative effects of the abused drug.

“MAT is the approach to treating opioid use disorder that is the most supported by research,” says Dr. Sylvie Stacy, Addiction Medicine Specialist and Utilization Management Medical Director for YesCare. “There are a lot of benefits to using MAT during incarceration, including reduced withdrawal symptoms, improved engagement in other rehabilitative programs, and a smoother

transition to community-based care upon release. It also reduces the spread of certain infectious diseases and lowers the incidence of violence in the facility.”

Yet despite the compelling and growing body of evidence that MAT is medically effective, promotes better health outcomes and reduces recidivism, many correctional facilities have been slow to embrace the treatment.

“One of the biggest challenges is the stigma,” says Crystal Gold. As YesCare’s National Director of MAT, Gold is responsible for implementing YesCare’s rapidly growing program, which has expanded from two facilities 18 months ago to 16 today. ““Corrections work by definition is custody and safety first,” she says. “These staffers have spent their entire careers keeping illegal substances out of their facilities. By helping them understand that treating opioid use disorder with a controlled substance while also managing diversion protocols of Medications for Opioid Use Disorder (MOUD), we are offering them a viable and safer solution.”

The first thing Gold and her team do when implementing a new MAT program, therefore, is to go into the facility and offer training to the correctional staff. “We need their buy-in,” she says. “They provide protection for our staff and the patients, so they need to understand exactly what’s going on. They also need to understand the symptoms of an overdose as opposed to what might be a side effect of the medication.”

Three main drugs are used in MAT – methadone, buprenorphine and naltrexone. “A big challenge is that two of the most effective medications, methadone and buprenorphine, are themselves opioid-based controlled substances with the potential to be misused and diverted,” Stacy says. “Methadone, in particular, is highly regulated, requiring specialized clinics to administer and monitor treatment. That can limit access to care, especially in correctional settings, because it is resource-intensive to set up this type of clinic and maintain compliance.”

MAT drugs come in a variety of forms, from pills and sublingual strips that must be taken daily to monthly or weekly injections. All have advantages and challenges. Daily oral treatments cost less than injectables, but they pose a much higher risk of “diversion,” where the patient sells or gives away their medication, and administering them safely and securely requires daily movement within the facility of multiple patients. Injectables are less labor-intensive for facility administrators since they only have to be administered once a month, and there is almost no opportunity for diversion, but scarcity can be a problem, and the drugs are expensive.

When Tomlin gets pushback from a facility administrator over the cost of MAT, he counters with another financial argument. “I just had this conversation recently with a sheriff. It costs him about $85 a day to keep somebody in the jail. It costs about $20 a day to keep somebody on MAT. So, any cost increase to deliver these services can translate to a million-dollar savings to the county in the long term.”

The ultimate goal, of course, is to return productive citizens back to their communities, and for Tomlin, any cost savings from the program comes in a distant second to the profound impact MAT can have on patients’ lives and wellbeing. “Just look at California,” he says. “California’s Department of Corrections and Rehabilitation (CDCR) began offering MAT in 2019 for alcohol and opioid abuse. Over the next three years, CDCR’s overdose rate fell 62%, even though opioid overdose deaths were increasing overall throughout the country. Those are powerful numbers. And now, out of 100,000 people incarcerated in the state of California, 18,000 of them are receiving MAT.”

A 2018 study by NIH showed similar results, finding that people who received methadone treatment while incarcerated were more than eight times likelier to engage in substance-use treatment after their release than people who did not receive the treatment.

“Every facility is different, every community is different, every warden and sheriff is different,” Tomlin says. “I have done this work in 18 different states, and everybody has their own approaches. You must educate them about what MAT really is and overcome the stigma. When you can do that and get a successful program implemented, the results can be remarkable and life-changing.”

For more information on YesCare, please visit: https://www.yescarecorp.com/

About YesCare

YesCare is an industry leader providing comprehensive healthcare and reentry services to incarcerated individuals. For more than 40 years, the YesCare team has provided expert medical, dental, and behavioral health services to more than 1 million patients at 475 correctional facilities across the country. Its mission is to provide exceptional care, put patients’ health and safety first, and break the cycle of recidivism, while helping improve the communities where they live and work.

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