Are there differences in retention rates between individuals that initiate MAT prior to release versus individuals maintained and inducted at intake?

The Effects of MAT in correctional facilities on adult inmates

one-year post release treatment retention

 

The Effects of Medication Assisted Treatment in correctional facilities on adult inmates

one-year post release treatment retention

Problem Statement

The percentage of individuals with opioid addiction in US prisons are needing alternatives for substance abuse care. Medication Assisted Treatment (MAT) is the use of medications, along with counseling and behavioral therapies, to provide a holistic approach to the treatment of substance use disorders (SUD). MAT is new to the area of incarceration and despite the evidence of effectiveness, only a few prisons in the US utilize this evidence-based treatment approach (Ferguson et al., 2019). Providing inmates with MAT has sustained, long-term impact on many opioid related outcomes post-release (Brinkley-Rubinstein et al., 2018).

According to Degenhardt et al. (2014), individuals that are continuously retained in MAT post release have the lowest post release mortality rate. However, after release from prison, some individuals who seek treatment at medication assistant facilities are not mandated; therefore, treatment retention can be a problem. Treatment retention is the amount of days that an individual remains in treatment and is important for inmates who are recently released from jail/prison (Shaul et. al, 2020). It is important because drug overdose is one of the leading causes of death among people recently released from correctional facilities, and the first two weeks of release are the most crucial being the highest risk for relapse that leads to an overdose (Moore et al., 2018). MAT treatment in the correctional setting can increase the likelihood that the individual receiving MAT will seek treatment post-release, thus, leading to a higher chance for treatment retention (Fox et al, 2015). Published studies do not show the effects of MAT in correctional settings on adult inmate’s post release treatment retention. According to Fox et al., (2015), if MAT is not implemented while incarcerated it will be harder to implement during post release; therefore, the effectiveness of MAT on post release should be studied.

Purpose

The purpose of this quantitative study is to examine whether starting MAT pre-release improves retention rates post release in selected state adult correction facilities in the United States. Secondary data addressing the use of MAT in correctional settings pre-release and the effectiveness it has on inmates’ post release treatment retention will be examined. Additionally, the target population that will be examined are adult inmates inducted prior to release versus those who are maintained directly from intake. Also, retention rates between the inmates initiated prior to release versus those initiated post-release will be compared. Furthermore, the type of medication administered to inmate is to be assessed to examine any differences in retention rates.

Significance

There are several states in addition to North Carolina that offer MAT in the US that include, but are not limited to, Kentucky, Maryland, Massachusetts, Pennsylvania, Rhode Island, West Virginia, and New Jersey. Some of these correctional facilities require the inmate be currently enrolled in treatment prior to incarceration while others offer drug and alcohol assessments during incarceration to determine eligibility. There is little to no research on the retention rates of those individuals that continue MAT post-release. The results of this study will provide important insight into the issues of treatment retention in MAT once released from the correctional setting. Furthermore, the findings of this study will help inform policies within correctional settings, provide information regarding pre-release MAT on adult inmates’ post-release treatment retention, and provide information of practices in regard to expanding the use of MAT within the correctional setting throughout the United States. The opioid epidemic is on the rise daily and may cause correctional facilities to have an increase of inmates that have substance abuse issues. The effectiveness of pre-release MAT on post release treatment retention for adult inmates is important and will help inform policies and practices that will assist with public safety and the public health of society.

Background

According to a study conducted in 2007 to 2009, 58% of individuals in state prisons and 63% of individuals in jail have a substance use disorder (Csete, 2019). However, a study conducted by Pew Charitable Trust (2018) concluded that fewer than 1 percent of the more than 5,000 US prisons and jails, housing more than 2 million inmates, allow medication assisted treatment into the facility. Selected articles relating to medication assisted treatment and the correctional settings are described here. Articles searched were those that had any correlation between correctional facilities, medication assistant treatment, and retention rates. In addition, articles were searched that related to research that was completed over a 12-year period. The keywords searched were medication assisted treatment, correctional settings, jails/prisons/detention center, post release treatment, suboxone/methadone/buprenorphine, treatment facilities, heroin addiction, addiction therapies, substance use disorder, and opioid use disorder in the SAGE journals, PsycARTICLES, PsycINFO, ProQuest Central, Science Direct, and the criminal justice databases.

  1. Banta-Green, et al., (2019) investigated the linkage between medications for opioid use disorder and psychosocial supports post release.
  2. Brinkley-Rubinstein, et al., (2018) provided information about the benefits of post release treatment for inmates who continue receiving methadone while incarcerated.
  3. Csete, J. (2019) examined the statistics surrounding the percentage of individuals incarcerated in the US receiving MAT.
  4. Degenhardt, et al., (2014) researched information regarding opioid therapy treatment helping decrease the mortality rate (overdosing) once released from prison.
  5. Ferguson, et al., (2019) provided information pertaining to treatment retention and medicated assisted treatment.
  6. Fox, et al., (2015) evaluated information pertaining to the relapsing after release from prison/jail and overdose statistics.
  7. Langabeer, et al., (2020) offered information regarding overdose statistics after being released from incarceration and treatment retention.
  8. Moore, et al., (2018) provided information regarding the effects of MAT within the prisons.
  9. Pan, et al., (2015) assessed information pertaining to the relationship between CBT, medicated assisted treatment, and treatment retention.
  10. Ranapurwala, et al., (2018) provided information regarding a study conducted after release, at 2-week interval and 1-year interval; therefore, it provided information over a time period.
  11. Wiss, D. (2019) explored information regarding biopsychosocial theoretical framework.

Framework

The theoretical framework for this study will be a biopsychosocial approach (BPS). The biopsychosocial approach systematically considers biological, psychological and social factors and their interaction in understanding health and addiction. MAT offers medication and counseling which associates with the biological and psychological aspects along with being incarcerated which controls the social factor. This theory is to be a guide in this research as I examine whether receiving MAT pre-release has an effect on retention rates in MAT post-release treatment. Furthermore, biopsychosocial theory will inform this study about how individuals who participate in MAT program within the correctional setting pre-release will learn new behaviors, new attitudes, and new ways of thinking that will attribute to increased retention rates post-release.

Research Questions

RQ1: Are there differences in retention rates between individuals that initiate MAT prior to release versus individuals maintained and inducted at intake?

H01: There is no statistically significant difference in retention rates between individuals that initiate MAT prior to release versus individuals maintained and inducted at intake.

H1: There is a statistically significant difference in retention rates between individuals that initiate MAT prior to release versus individuals maintained and inducted at intake.

RQ2: Are there differences in retention rates between inmates that are administered Suboxone, Subutex (Buprenorphine), and Methadone?

H01: There is no statistically significant difference in retention rates between inmates that are administered Suboxone, Subutex (Buprenorphine), and Methadone.

H1: There is a statistically significant difference in retention rates between inmates that are administered Suboxone, Subutex (Buprenorphine), and Methadone.

 

 

 

Nature of The Study

This study will utilize quantitative methods with a causal-comparative design to provide an understanding of the effects of medication assistant treatment (independent variable) in correctional settings on adult inmates’ post release treatment retention (dependent variable), which is the primary focus of this doctoral study. To address how MAT in correctional settings effect post release treatment retention, individual’s treatment at medication assisted facilities will be examined from a two-week to one-year time frame. This will assist with assessing differences in treatment retention rates for individuals who began MAT prior to release versus those who started at intake post-release. In 2018, a study in North Carolina found that in the first two weeks post-release, an inmate is 40 times more likely to die of an opioid overdose than someone in the general public (Ranapurwala, Shanahan, Alexandridis, Proescholdbell, Naumann, Edwards Jr., and Marshall, 2018). This same study found that when restricted to heroin overdoses only, individuals are 74 times more likely to overdose in the first two-weeks post-release (Ranapurwala, Shanahan, Alexandridis, Proescholdbell, Naumann, Edwards Jr., and Marshall, 2018). Prior studies have measured treatment retention in a one-year time frame   (Brinkley-Rubinstein, et al., 2018). This quantitative analysis should help clarify the treatment retention rates for inmates’ post release treatment in medication assisted treatment facilities.

Proposed Types of Data

Primary data for this quantitative research study will be collected via archival data. The archival data will be collected from medication assisted facilities in eastern NC and government agencies regarding information pertaining to the MAT in correctional facilities.   In addition, the information collected from these agencies will include data concerning the type of opioid addiction, the type of medication given, and background information regarding their time incarcerated.

Limitations

A potential limitation to this study is the weakness of archival data as it does not offer the fullness as would interviews. Archival data also may include disadvantages such as the overall quality of the data and completeness of documentation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Banta-Green, C. J., Floyd, A. S., Vick, K., Arthur, J., Hoeft, T. J., & Tsui, J. I. (2019). Opioid use disorder treatment decision making and care navigation upon release from prison: A feasibility study. Substance Abuse and Rehabilitation, Volume 10, 57–67. https://doi.org/10.2147/sar.s192045

Brinkley-Rubinstein, L., McKenzie, M., Macmadu, A., Larney, S., Zaller, N., Dauria, E., & Rich, J. (2018). A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug and Alcohol Dependence, 184, 57–63. https://doi-org.ezp.waldenulibrary.org/10.1016/j.drugalcdep.2017.11.023

Csete, J. (2019). Criminal justice barriers to treatment of opioid use disorders in the United States: The need for public health advocacy. American Journal of Public Health, 109(3), 419–422. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2018.304852

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D. J., Gibson, A., Mattick, R., Butler, T., & Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction, 109(8), 1306–1317. https://doi-org.ezp.waldenulibrary.org/10.1111/add.12536

Ferguson, W. J., Johnston, J., Clarke, J. G., Koutoujian, P. J., Maurer, K., Gallagher, C., White, J., Nickl, D., & Taxman, F. S., (2019). Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails. Health & Justice, (7)1. https://doi-org.ezp.waldenulibrary.org/10.1186/s40352-019-0100-2

Fox, A.D., Maradiaga, J., Weiss, L., Sanchez, J., Starrels, J.L., & Cunningham, C.O. (2015), Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: A qualitative study of the perceptions of former inmates with opioid use disorder. Addiction Science & Clinical Practice, 10(2), https://doi.org/10.1186/s13722-014-0023-0

Langabeer, J., Champagne-Langabeer, T., Luber, S. D., Prater, S. J., Stotts, A., Kirages, K., Yatsco, A., & Chambers, K. A. (2020). Outreach to people who survive opioid overdose: Linkage and retention in treatment. Journal of Substance Abuse Treatment, 111, 11–15. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2019.12.008

Moore, K. E., Roberts, W., Reid, H. H., Smith, K. M. Z., Oberleitner, L. M. S., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32-43 https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2018.12.003

Pan, S., Jiang, H., Du, J., Chen, H., Li, Z., Ling, W., & Zhao, M. (2015). Efficacy of cognitive behavioral therapy on opiate use and retention in methadone maintenance treatment in China: A randomized trial. PLOS ONE, 10(6), 1–13. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0127598com.ezp.waldenulibrary.org/login.aspx?direct=true&db=a9h&AN=103567731&site=eds-live&scope=site.

New Momentum for Addiction Treatment Behind Bars. (2018, April 4). The Pew Charitable Trusts. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/04/04/new-momentum-for-addiction-treatment-behind-bars

Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R. B., Edwards, D., & Marshall, S. W. (2018). Opioid overdose mortality among former North Carolina inmates: 2000–2015. American Journal of Public Health, 108(9), 1207–1213. https://doi.org/10.2105/ajph.2018.304514

Shaul, L., de Waal, M., Blankers, M., Koeter, M. W. J., Schippers, G. M., & Goudriaan, A. E. (2020). Effectiveness of a brief motivation enhancing intervention on treatment initiation, treatment retention and abstinence: Results from a multi-site cluster-randomized trial. Journal of Substance Abuse Treatment, 110, 28–36. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2019.12.002

Wiss D. A. (2019). A biopsychosocial overview of the opioid crisis: Considering nutrition and gastrointestinal health. Frontiers in Public Health, 7, 193. https://doi.org/10.3389/fpubh.2019.00193