By Mardet Homans, Denise M. Allen & Yesenia Mazariegos

The use of Medication Assisted Treatment (MAT), and specifically buprenorphine, to address opioid use disorder (OUD) is considered the gold standard of care in the community (Substance Abuse and Mental Health Service Administration (SAMHSA), 2023). However, while support of its use in correctional settings is expanding, and there are national promising practice guidelines, it remains underutilized within jails and prisons in the United States (U.S.) (National Commission on Correctional Healthcare (NCCHC), 2018; Friedmann et al., 2012). The efficacy of MAT to reduce opiate withdrawal, curb cravings, and support positive health, behavioral health, and criminal justice outcomes, including reductions in overdose deaths and recidivism, has gained national attention from criminal justice advocacy groups and policymakers. Jails and correctional agencies have been taken to court over the provision of MAT for incarcerated individuals with OUD. And state and federal courts have ruled denial of MAT for incarcerated individuals with OUD violates the Americans with Disabilities Act (ADA) (Legislative Analysis and Public Policy Association (LAPPA), n.d.). The California Department of Corrections and Rehabilitation (CDCR) and California Correctional Health Care Services (CCHCS) are at the forefront of providing MAT in a correctional setting under the Integrated Substance Use Disorder Treatment (ISUDT) Program. The ISUDT Program begins at intake into CDCR with a substance use disorder (SUD) screening and assessment and linkage to behavioral interventions and MAT with a targeted focus on preparing CDCR residents for release. This paper seeks to document the provision of MAT in correctional settings since it is expanding rapidly within the U.S. and there is currently not a national inventory of programs or practices. In addition, this paper aims to document best practices and lessons learned from California and other correctional systems that can be used to guide expansion of MAT to justice-involved populations. Contained in the appendix of this report is a comprehensive review of information regarding the current availability of MAT in U.S. jails and prisons.

Key Findings • According to the Bureau of Justice Statistics (BJS) less than 1% of the Federal Bureau of Prisons (BOP) population received MAT in 2021. • Based on a review of publicly available information, it does appear that five states – Alabama, Mississippi, Nebraska, South Dakota, and Wyoming offer MAT in their correctional institutions. • A number of states have or are currently piloting MAT in corrections. • Besides California, only 14 states offer comprehensive MAT services at either intake and/or release in a considerable number of its jails and prisons. • Locating details regarding MAT provision on many state and local correctional websites is difficult or is missing altogether. This may present as a barrier to SUD treatment and discourage justice-involved individuals or their families from seeking MAT. • Overall, there is significant variability among states regarding the provision of MAT to incarcerated individuals.

Irvine, CA: Center for Evidence‐Based Corrections University of California, Irvine 2023. 18p.

By Christi M. Smith

The fact that the United States incarcerates more of its population than the rest of the industrialized world—and that racial and ethnic minorities are overrepresented in inmate populations—is common knowledge. Yet why we continue to over- incarcerate in light of a myriad of other strategies that appropriately respond to crime remains a mystery. Alternatives to incarceration are more cost-effective, efficient and provide better outcomes for accused law violators and communities. Alternatives also save precious law enforcement and judicial resources for more serious and violent offenders. The COVID-19 pandemic presented a unique opportunity for local jail administrators and their counterparts in the judicial process to pursue alternatives, as they were forced to critically analyze the need for pretrial confinement; reconsider length of stay upon conviction; and evaluate the appropriateness of returning to jail for bail, probation or parole violations. In conjunction with experience gained from the past 21 months of the pandemic, existing research demonstrates that it is time to reduce our overreliance on carceral strategies and address the factors that contribute to crime and non-compliance with judicial interventions. These evidence-based strategies can substantially reduce jail populations and the racial and ethnic disparities therein. Key Points: 1. COVID-19 disproportionately challenged local jail administrators who, compared to their state and federal prison counterparts, receive less physical, financial and medical support to manage a dynamic and constantly shifting inmate population that moves in and out of the community. 2. To mitigate viral spread inside of the jail and out into the community, criminal justice professionals worked quickly to reduce inmate populations using a variety of alternatives to incarceration for accused and convicted law violators. These alternatives disproportionately benefited white adults and highlighted the need for targeted strategies to reduce racial and ethnic disparities in the judicial process. 3. Crime rates did not increase during the time that alternatives to incarceration were used, thereby substantiating the benefits of utilizing various alternatives to incarceration to reduce jail populations, as well as racial and ethnic disparities in jail populations. Research indicates that these alternatives are more cost-effective, efficient and fairer than traditional judicial processing

R STREET POLICY STUDY NO. 250 January 2022, 8p.