By Brady P. Horn, Aakrit Joshi and Paul Guerin

Substance use disorders (SUD) are very prevalent and costly in the United States and New Mexico. Over 20 million individuals in the US meet diagnostic criteria for SUD and over 65 thousand US residents died from drug opioid overdose in 2020. It is well known that there is a strong correlation between SUD and incarceration. National studies have found that on average two thirds of prisoners have SUD and approximately 30% of inmates report having an opioid use disorder (OUD). There is growing momentum nationally to incorporate SUD, particularly OUD treatment, into incarceration systems and numerous studies have found that providing medication for opioids use disorder (MOUD) in incarceration systems is clinically effective. Since 2005, there has been a Methadone Maintenance Treatment (MMT) continuation program within the Metropolitan Detention Center (MDC) where individuals who were already receiving community-based treatment could continue their treatment within the jail. Prior work has found that this program was associated with reduced crime. In 2017 this program was expanded and started providing treatment to individuals who had not been receiving methadone in the community prior to incarceration. In this study we evaluate the impact of this treatment program. Data was collected from numerous different sources, linked, thoroughly cleaned, and a difference-in-difference empirical strategy is used. Robust evidence is found that MMT initiation reduced reincarceration. Our main results find that MMT initiation is associated with a per-person reduction in 19 incarceration days in the one-year period after jail-based MMT was received. We also find evidence confirming prior studies that found MMT continuation reduces recidivism. We find that jail-based MMT continuation is associated with a per-person reduction in 31 incarceration days in the one-year period post release. Also, a heterogenous treatment effect is found where individuals that received jail-based MMT for longer periods of time had larger reductions in reincarceration. Individuals who received MMT initiation for 70 days or more were associated with 22 fewer reincarceration days and individuals that received MMT continuation were associated with 60 fewer reincarceration days.

Albuquerque: University of New Mexico, Institute for Social Research, 2023. 43p

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.