Preliminary Analysis of the Medication for Addiction Treatment (MAT) - - PowerPoint PPT Presentation

Preliminary Analysis of the Medication for Addiction Treatment (MAT) Program at Albany County Correctional Facility (Data from January – June 2019)

Elham Pourtaher Office of Program Evaluation and Research, AIDS Institute

elham.pourtaher@health.ny.gov

2

Opioid Use Disorder (OUD) in the Criminal Justice System

• Odds of arrest among persons who use heroin is 77% (Winkelman et al. 2018)
• 75% of re-entrants* with an OUD relapse to opioid use within 3 months of release

(Fox et al., 2015)

• 24% to 46% of individuals with a heroin use disorder (over 200,000 individuals) pass

through American correctional facilities annually (Bronson, et al. 2017)

• 40% to 50% of the re-entrants with OUD are arrested for a new crime within a year

after release (Soares III, et al. 2019)

• Re-entrants with OUD are 10-40 times more likely to have a fatal opioid overdose

compared to the general public, especially within a few weeks postrelease (SAMHSA, 2019)

*Population released from correctional facilities into the community.

3

MAT

Evidence-Based Treatment

• Methadone and buprenorphine remain the gold

standard of care for OUD

• Studies indicate people on MAT are more than twice

as likely to remain opioid-free; meta-analysis of over 300 published research articles confirmed MAT to be clinically effective

• “Scientific research has firmly established that

treatment of opiate dependence with medications (MAT) reduces addiction and related criminal activity more effectively and at far less cost than incarceration.” Legal Action Center, 2011

3 FDA Approved Medications

• Methadone

– Full Agonist

• Buprenorphine

– Partial Agonist

• Naltrexone

– Antagonist

4

NYS Program: MAT in Correctional Settings

• Objective: Create an integrated step-by-step process to provide MAT to

individuals who present at the jail with OUD

• Rationale:
• Equivalence of care – MAT is the community standard
• Prevention of HIV and HCV transmission
• Reduction in post-release relapse and re-incarceration
• Reduction in post-release mortality

5

NYS Program: MAT in Correctional Settings

Collaborating Agencies:

• Albany County Correctional Facility (ACCF)
• Catholic Charities AIDS Services (CCAS)*
• Whitney M. Young, Jr. Health Center
• Conifer Park
• Camino Nuevo
• NYS Department of Health AIDS Institute:
• Office of Drug User Health (ODUH)
• Office of Program Evaluation and Research (OPER)
• NYS Office of Alcoholism and Substance Abuse Services (OASAS)

*CCAS is a Drug User Health Hub affiliated with New York State Department of Health (NYSDOH)

6

NYS Program: MAT in Correctional Settings

• Initial intake and assessment (ACCF)
• Access to treatment at the facility (ACCF in collaboration with local MAT

providers)

• Discharge planning including in-reach services (ACCF and CCAS)
• Post-discharge into the community: continuity of care, follow up and

reporting (CCAS)

• Staff training (NYSDOH, OASAS)

7

MAT at ACCF: Phased-In Approach

Phase 1: Continuation of MAT (since 01/22/2019)

• Individuals eligible for Phase 1 have the option of continuing existing

buprenorphine, methadone and/or naltrexone treatment

• County staff and outside provider (CCAS) connect the individual to

identified provider upon release for continuation of care and medication maintenance

8

MAT at ACCF: Phased-In Approach

Phase 2: Sentenced with OUD (since 03/13/2019)

• Phase 2 includes buprenorphine inductions for individuals with OUD

that are sentenced and have an expected release date

• County staff and outside provider (CCAS) connect the individual to

identified provider upon release for continuation of care and medication maintenance

9

MAT at ACCF: Phased-In Approach

Phase 3: All with OUD (tentative starting date: 09/01/2019)

• Phase 3 includes buprenorphine inductions for all individuals with OUD
• County staff and outside provider (CCAS) connect the individual to

identified providers upon release for continuation of care and medication maintenance

10

Program Evaluation

• Evaluation incorporates various complementary data collection tools and

sites with the aim of conducting a multi-faceted assessment of MAT programs at ACCF

• The NYSDOH designed reporting forms to evaluate the program at two

stages (during incarceration and postrelease) and at two levels (facility and individual)

• The evaluation is also complemented with focus group discussions/interviews

with the target population during incarceration and post-release

11

Data Collection

Two sites: ACCF (during incarceration) and Catholic Charities (post-release)

• Sociodemographic factors (Jail

Management System)

• Medical records (incl. mental

health): EMR Intake assessments

• Psychological services (CASAC)
• Drug court status (CASAC)
• Knowledge, attitudes, beliefs

around MAT (Interviews and focus groups) Individual level (ACCF)

• Facility’s readiness for

implementing the MAT program

• Successes and challenges

Facility level (ACCF)

• Linkage to care and community

support

• Housing and employment
• Social support
• History of overdose
• Recidivism
• Knowledge, attitudes, beliefs

around MAT (Interviews and focus groups) Individual level (CCAS)

• Facility’s readiness for connecting

re-entrants to community providers

• Successes and challenges

Facility level (CCAS)

12

Preliminary Data (January – June 2019)

• Demographic Characteristics
• MAT Program
• Medical Records
• Psychological Services
• Adjustments to the Program
• Post-release Status
• Recidivism

13

Data (Sample Size)

ACCF

• Medical records

(n = 126)

• Demographics and

disciplinary tickets (n = 126)

• Psychological and

mental health services (n = 34)

01

CCAS (n = 57)

02

Focus Group Discussion (n = 20)

03

14

Demographic Characteristics of MAT Participants

26% 48% 16% 9% 2% 20-29 30-39 40-49 50-59 60 and older

Age

Data source: ACCF Jail Management System (January – June 2019, n=126)

70% 29% 1%

Gender

Male Female Non-Binary Gender Identity

15

Demographic Characteristics of MAT Participants

76% 11% 11% 2%

Single Divorced/Separated Married/Domestic Partnership Other

Marital Status

Data source: ACCF Jail Management System (January – June 2019, n=126)

85% 8% 6% 1%

Race/Ethnicity

White Black or African American Hispanic or Latino Undisclosed or Uncategorized Race/Ethnicity

16

MAT Program

72% 22% 4%

Phase 1 Phase 2 Phase 3

Enrollment by Phase

80% 16% 2% 1% 1% 1%

Suboxone Methadone Vivitrol Subtex Subutex Zubslov

Type of Medication

Data source: ACCF Medical Center (January – June 2019, n=126)

Since 01/22/2019 Since 03/13/2019 Currently piloting

17

17

Data source: ACCF Medical Center (January – June 2019, n=126)

6 10 28 22 22 13 2 5 3 6 4 2 1 2 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19

Type of Medication by Starting Month of the MAT Program at ACCF

Suboxone Methadone Vivitrol Zubsolv Subutex

18

Medical Records

Categories are not mutually exclusive.

Data source: ACCF Electronic Medical Records (January – June 2019, n=126)

History of Mental Health Hospitalization Drug Injection History of Overdose History of Suicide Attempt Alcohol Use Disorder Benzo Use Disorder Pregnancy

Patients' Relevant Medical Records

48% 37% 21% 13% 13% 4% 1%

19

Medical Records

88% 9% 3%

Does the MAT Participant Have Health Insurance?

Yes No Unknown

56% 23% 21%

Among Those Who Have Health Insurance, How Many Patients Are Covered by Medicaid?

Medicaid Non-Medicaid Insurance Type Unknown

Data source: ACCF Electronic Medical Records (January – June 2019, n=126)

20

Psychological Services

Data source: MAT Participants in ACCF, data provided by CASAC (January – June 2019, n=34)

Categories are not mutually exclusive. 34 21 9 7 7 5 2 Total Other CASAC-related Individualized Services MAT Alcoholics Anonymous Narcotics Anonymous Mental Health Women's Recovery Group

82% of MAT Patients at ACCF Participated in the Following Counseling Programs:

21

Adjustments to the Program

• Various strategies evolved as the program was implemented to

ensure proper security measures were in place. Examples: detailed policies and procedures for the staff regarding mouth checks, telling patients to put their hands on their sides during the administration of medication, change of the location of medication administration

• Beginning 05/24/2019 there has been a transition from

buprenorphine pills to films

22

Postrelease Status

39% 18% 15% 15% 3… 3% 3% 3%

Greene Schoharie Rensselaer Schenectady Clinton Columbia Saratoga Suffolk

Counties Re-entrants Moved to Outside Albany

70% 14% 14% 2%

Stays with family/friends Rents Homeless Owns

Housing Status Post-Release

Data source: MAT Participants Linked to CCAS (January – June 2019, n=57)

Bridge script was provided for 32 individuals enrolled in the MAT Program (mean=11.9 days)

61% 39%

Post-release Location

Outside Albany County Albany County

23

Post-release Status

21% 79%

Does the Re-entrant Receive Mental Health Care?

Yes No 87% 13%

Does the Re-entrant Continue the MAT Program?

Yes No 16% 84%

Is the Re-entrant Currently Employed?

Yes No

Data source: MAT Participants Linked to CCAS (January – June 2019, n=57)

24

Recidivism

3% 97%

Has the Re-entrant Returned to ACCF since Program Inception?

Yes No

Data source: MAT Participants in ACCF (n=126)

25

Focus Group Discussion: Emerging Themes

• N=20, ACCF SHARP Unit, 5 enrolled in

MAT program

• Overall positive feedback on MAT

program to date, and suggestions to improve

• Fears and hesitations:
• Relapse and overdose after release
• Withdrawal from MAT in other

facilities

• Losing hope for “becoming clean”

and believing that MAT is only “substituting one drug for another”

• Not being recognized by non-MAT

peers as “courageous enough” to “face the reality”

26

Next Steps

• Continued collection/analysis of data from ACCF and CCAS

(including interviews with participants and staff)

• Post-six-month evaluation after release (interviews with randomly

sampled re-entrants who consent)

• MAT continuation
• Recidivism
• Quality of life measures (housing, employment, access to

mental and physical care)

27

Thank you all for this amazing collaboration! Special thanks to: Albany County Correctional Facility:

• Management: Major Ralph Peltier III , 1st Sgt. John Crudo
• Medical Team: Jill Harrington, RN, HSA and Daniel Carson, RN, DON
• CASAC’s: Joan Wennstrom, Ke’Sherise Mills, and Jason Oliver

Catholic Charities AIDS Services: Ed Fox, Michael Langone Conifer Park: Joe LaCoppola Camino Nuevo: Jasmine Guerrero-Wiggs Whitney M. Young, Jr. Health Center: Maia Betts Harm Reduction Coalition: Dr. Kim Sue AIDS Institute: Matt Fallico, Narelle Ellendon, Kirsten Rowe, Shu-Yin Leung elham.pourtaher@health.ny.gov

28

References

• Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail

inmates, 2007-2009. (Rep. No. NCJ #250546). Washington, DC: United States Department of Justice, Bureau of Justice Statistics. Available from https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf.

• Fox, A. D., Maradiaga, J., Weiss, L., Sanchez, J., Starrels, J. L., & Cunningham, C. O. (2015). Release from incarceration, relapse to
• pioid use and the potential for buprenorphine maintenance treatment: A qualitative study of the perceptions of former inmates with
• pioid use disorder. Addiction Science & Clinical Practice, 10, 2. doi: 10.1186/s13722-014-0023-011
• Winkelman, T. N., Chang, V. W., & Binswanger, I. A. (2018). Health, polysubstance use, and criminal justice involvement among

adults with varying levels of opioid use. JAMA Network Open, 1, e180558. doi: 10.1001/jamanetworkopen.2018.05587

• Soares III, W. E., Wilson, D., Gordon, M. S., Lee, J. D., Nunes, E. V., O’Brien, C. P. et al. (2019). Incidence of future arrests in adults

involved in the criminal justice system with opioid use disorder receiving extended release naltrexone compared to treatment as usual. Drug and Alcohol Dependence, 194, 482-486

• Friedmann, P. D., Hoskinson Jr, R., Gordon, M., Schwartz, R., Kinlock, T., Knight, K., ... & O’Connell, D. J. (2012). Medication-assisted

treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): availability, barriers, and intentions. Substance Abuse, 33(1), 9-18.