Our webinar presenters answered a number of your questions after their presentation, "Planning and Implementing Medication Assisted Treatment in Jails: What Justice Professionals Need to Know." Here are a few of their responses.
Audience Question: Is the NSA working the appropriate federal agencies and jails from the needed opioid treatment program licensure so that they may provide methadone treatment for inmates who had been determined to be enrolled in a methadone maintenance treatment program already?
Carrie Hill: Yes. With methadone, as you heard, we are working with federal partners and recognizing that all three forms of MAT have their place. Each individual, whatever that clinical decision, we also understand that methadone may or may not be available to every jail. Not only that, methadone isn't necessarily available in every community drug in the US. Let it be a clinical decision and whether or not the facility may have the proper license, whatever that might be. Whether or not there might be available resources in the community or might there be alternatives or issues that we will all be looking at an trying to address together.
Audience Question: What does treatment look like for incarcerated women who are pregnant?
Carrie Hill: That is being explored and worked on right now. If you would trust me with this, we will be having a webinar in the next 3 months on this very topic and if you would like to send me an email, I can also provide some of the technical assistance and resources that are available right now in the field.
Audience Question: Is it considered best practice to include all forms of MAT when implementing in a jail?
Carrie Hill: I'm not sure if Dr. Gibson is still on, I think he had to leave. Understand that I am a lawyer and I can't give legal advice nor am I a clinician. So for me to speak to that would be outside of my boundaries. What I do know is that these are clinical decisions that need to be made on a case by case basis. If there are any of the panelists who can speak on that, but I have to defer on that. But we recognize that these are individual decisions as they are with any type of treatment that has been provided in the jail setting.
Peter Koutoujian: I believe it is best practice. I got to be honest, I was not interested in stepping into the agonist MAT early in the process. I'm a big fan of Vivitrol, I believe it works very well. But Vivitrol alone isn't the answer for the people up here. Neither is methadone nor is suboxone — nor any of the three necessarily. If you don't have all the tools available to individuals in your care custody and control, then you're not doing it right. Each person will respond differently and if you're just trying to give them one drug as opposed to another drug, then you're just not doing it right. That's why it's really important to try as much as you can if you're going to do this right to offer all forms and then you can just truly study all forms — the efficacy, the retention, behaviors inside, behaviors outside the facility, recidivism. But if you can offer all three forms, then you can more truly understand all three forms in a way that can bring greater benefit to this whole MAT discussion for the future.
Carrie Hill: We're working on trying to get the available resources that may or may not be available in some of our rural communities and there's great work being done by the USDA as well looking at how we can get of these resources there, as well as BJA together and SAMHSA. Please continue to know that as all of these are developing. But the goal with the promising practices guidelines is to recognize all three forms of MAT and actually all medication-assisted treatment approved by the FDA and there will be others going forward. So to keep all of that open and not to have a closed mind to any of it.
Peter Koutoujian: If people can't offer all three for whatever reason — licensing or for methadone clinics inside your facility; the ability to transport outside your facility; or the capacity within the community. In some of our communities, there has been an attempt to offer methadone but there is no capacity in the community to treat — that its a very different matter. If you can, I believe you should try and if you can't it shouldn't make you stop trying to begin the process where you can.
Audience Question: My jail is trying to implement a UA screening for medication compliance while continuing MAT, but our records get subpoenaed frequently. How do we legally and confidentially do drug screening without those results being used against the client in court?
Carrie Hill: Obviously, the screening tool is critical. It's very interesting how the Supreme Court talks about screening. And yet the recent decision in Taylor v. Barkes regarding screening on the mental health side of it. What I would like to do without skirting the issue is tell you this — we have to treat and protect. The screening tool is critical. If you are receiving data requests, there are certain ways that we can protect those and we have to fight very vigorously to protect those. The screening document itself though, I believe, would be public. But not necessarily the content thereof. I'm not sure if I'm missing your question but I would rather be in court trying to protect the results of that screening document than I wasn't trying to at least screen to gather the information. Remember, we want the knowledge so that we can identify and treat as needed as clinically indicated.
Peter Koutoujian: I think it is important that we try to do those tests in the way in. Case in point, we have detoxed over 2,000 folks a year for drugs or alcohol. About 76% have opioids or opioid-polysubstance. Of those that come into our facility that need to be detoxed, we check their medications. For those with a valid prescription for methadone or suboxone, self-reportedly, 2/3 of the suboxone users and 3/4 of the methadone users self reportedly have other drugs in their system. I want to then move into a system where we would check urine because I want to know because if they're saying 2/3 and 3/4 for suboxone and methadone respectively, I want to know what the real number is. As we're starting to do this, there were a number of people that were bucking at giving us a urine test I think they were wary that it will be used to discipline them internally. It's something that we didn't foresee coming into this. It is important that we do test. Also what's important is, as Carrie will tell you, there's a big question with regard to whether or not MAT is part of compliance with the Americans with Disability Act. And that if people have other drugs in their system, they might exempt you from compliance with the ADA. So I think that this is the future. We have to find a way to do it so that we can be trusted in taking it for whatever reasons and that it will not be used to either discipline or charge them criminally in any other way or to prove the case as I'm thinking about it too, because they might still be under the influence when they come in here after some case involving impaired driving or something like that. We have to be thoughtful about that as well. An interesting question and a new frontier into how we're going to address this in a medical correctional facility.
Click here to watch a recording of "Planning and Implementing Medication Assisted Treatment in Jails: What Justice Professionals Need to Know."