Many treatment facility staff, who conquered their own addictions without medication, favor an abstinence model, and provider skepticism may contribute to low adoption of MAT. Staff in community corrections contract facilities (CCFs) have expressed that their corporate offices do not support the use of MAT and are therefore hesitant to personally participate in MAT expansion. Additionally, many individuals utilizing MAT are met with harsh criticism from the 12-step community.
Substance Use Disorders has been generally treated as if it were an acute illness, rather than a chronic disease. Research results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. The use of MAT for those suffering from addiction should be insured, treated, and evaluated like other chronic illnesses.
In recent years, information has shown that the United States is in a state of emergency in regards to substance use, particularly with opiates. Pennsylvania has seen this issue arise both in communities and in its state correctional institutions. Statistics from December 1, 2016, through November 30, 2017, show that 21% (3,025 out of 14,150) of the individuals that completed a drug and alcohol assessment, The Texas Christian University – II Assessment (TCU), reported opiates as their drug of choice. Another 5% (751) reported that opiates were their 2nd or 3rd drug of choice.
In January 2017, the DOC made changes to the general population Therapeutic Community Curriculum and the Co-Occurring Disorders Therapeutic Community Curriculum to provide evidence-based treatment. On March 12, 2018, the department converted six therapeutic communities (TCs) to opiate specific therapeutic communities.
Institutions with Opiate Specific TCs:
Camp Hill
Laurel Highlands
Chester
Albion (Co-Occurring TC)
Quehanna Boot Camp (State Intermediate Punishment [SIP])
Cambridge Springs (SIP and Female)
While these are the first institutions to implement this program, the goal will be to continue to increase the program based on successes and need.
Oral Naltrexone Maintenance
The DOC has expanded its MAT programming to include oral naltrexone maintenance, which is now available at each of the Opiate Specific TC sites listed above. Participants are switched to Vivitrol prior to institutional release.
Expansion
In January 2018, Governor Wolf declared the opioid crisis in Pennsylvania as a disaster emergency and directed that Medication-Assisted Treatment (MAT) be provided within the DOC’s prison system. These medications include methadone, naltrexone (Vivitrol and Revia), and buprenorphine (Suboxone, Subutex, and Sublocade).
MAT is not new to the DOC. It has always provided methadone maintenance to pregnant inmates to protect the fetus from withdrawal. Newer programs include Vivitrol injections for inmates being released and most recently oral naltrexone for select new intakes with short minimums who will be admitted to one of our Opioid Use Disorder Therapeutic Communities (OUDTC).
On April 1, 2019, the DOC began a Sublocade Pilot Program at SCI Muncy. Select parolees who are diverted to an SCI for a 14-day “detox only” placement will be prescribed Suboxone induction and then a long-acting Sublocade injection prior to being continued on parole in an outpatient or inpatient treatment setting. Once the Pilot Program concludes, it will be rolled out gradually throughout other institutions.
Beginning June 1, 2019, inmates received into institutions (PV or new intakes) who are enrolled in a verified MAT Program (community or county jail) will continue on MAT. Suboxone and oral naltrexone will be available immediately and will also be offered to those on methadone until it can be added at a later date. Any instances of an inmate entering our system on an MAT that is not available, or who does not meet the criteria for continuing MAT, will be forwarded to the Bureau of Health Care Services (BHCS) for review on a case-by-case basis.
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