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

By Steve Tomlin

For National Recovery Month, correctional healthcare leader Steve Tomlin addresses myths and misperceptions about cost-effective, life-saving addiction treatment.

Having worked in and around the recovery community for many years now, I’ve seen what works and I’ve seen what doesn’t. As September is National Recovery Month, I think it is an important time to share why I am a passionate advocate for medication-assisted treatment (MAT) for opioid use disorders in the corrections industry. 

I, like many others who have worked in the industry a long time, was raised in the ‘abstinence only’ model where a person would give up every substance all at once, and that’s how you were supposed to get clean and sober. I remember when a “clubhouse detox” involved putting somebody in the garage to dry out and giving them Gatorade, a chocolate bar, and a hoagie. That was obviously an ineffective and ill-advised approach to getting clean and staying sober.  

MAT is a more effective and more cost-efficient way to treat addiction, and is the approach that is most supported by research. It is primarily used for addiction to narcotics such as heroin, fentanyl and opiate-based prescription pain medications, and also for alcohol addiction. 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.  

In the correctional community, MAT has been shown to more safely manage detox while reducing withdrawal symptoms, improving patient engagement in other rehabilitative programs, and providing a smoother transition to community-based care upon release. It also reduces the spread of certain infectious diseases and has been shown to lower the incidence of violence within facilities. 

Yet despite the compelling and growing body of evidence that MAT is medically effective, promotes better health outcomes and reduces the incidence of relapse, the treatment remains controversial and plagued by stigma, largely due to the myth that MAT simply replaces one drug with another one.  

The first steps, therefore, are education and training. Corrections work, by definition, is custody and safety first. Correctional staffers spend their entire careers working to keep illegal substances out of their facilities. We start by working together, educating administrators, staff and patients that treating opioid use disorder with a chronic-care medication while also managing diversion protocols offers them a viable and safer solution. 

And while MAT medications can be expensive, an effective MAT program reduces costs in the long run by reducing relapse, recidivism and the incidence of violence toward staff and residents. This reduces sick call and ER runs and staff call-outs, to name just a few benefits. While it’s difficult to name an “average” cost of incarceration, due to different custody levels, geographical locations, etc., let’s use as an example a facility where it costs about $85 a day to keep somebody in jail. By contrast, it costs as little as $20 a day to keep somebody on MAT. So, any immediate cost increase to deliver these services can translate to a million-dollar savings to a county in the long term. 

The ultimate goal is to return productive citizens back to their communities, and the effect of MAT in this regard is profound. Just look at California. 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. 

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, of course. Every community is different, and every warden and sheriff is different. I have done this work in 18 different states, and everybody has their own approaches. The challenge and opportunity is to educate as many people as possible 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. 

Steve Tomlin is Chief Strategic Innovation Officer and Executive Vice President for MAT, Reentry and Community Partnership at YesCare, a provider of correctional healthcare and reentry services to incarcerated individuals.