A newly released fact sheet on the use of medication treatments for opioid use disorders in the justice system offers strong words on the need for access to all three federally approved treatments—and the importance of keeping clinical decision-making about the medications in the hands of clinicians.
“Deciding on the appropriate medication is a matter of clinical discretion, taking into consideration the relevant medical standards and patient choice,” states the MAT Fact Sheet from the American Association for the Treatment of Opioid Dependence (AATOD). “People who are not addiction specialists—including judges, probation, and other justice personnel—do not have the expertise to make these medical decisions, just as they do not have the expertise to make other health-related decisions for individuals under their supervision.”
With some justice agencies tending to favor one medication or to deny access to one or more outright, the fact sheet cites the guiding principle of a Substance Abuse and Mental Health Services Administration (SAMHSA) expert panel on the subject: “What works for one group of clients at one stage of justice involvement does not necessarily work (and in fact may even be contraindicated) for other clients at other stages of justice involvement. This challenge is compounded when the justice sustem overrelies on a specific treatment modality to achieve its public safety goals.”
In a message to colleagues upon release of the MAT Fact Sheet, AATOD president Mark Parrino stated that the document is being released at an “extremely dynamic time,” given the deadly nature of the opioid crisis.
“It took years to get into the current opioid addiction crisis and it will take a long time for us to get out,” Parrino wrote.
The fact sheet outlines general information about methadone, buprenorphine and long-acting injectable naltrexone, and sets out to dispel a number of misconceptions that exist in the justice system about the drug treatments:
Use of methadone or buprenorphine doesn't substitute one addiction for another, as the medications act on the brain fundamentally differently from short-acting opioids such as heroin.
A lower dose of methadone or buprenorphine is not always preferable to a higher dose. “The use of substandard dosages is countertherapeutic since the patient will continue to use opioids if the maintenance dosage is too low,” the document states.
The preferred duration of medication treatment should depend on the individual's presenting issues. Premature discharge from methadone treatment contributes to increased death rates post-discharge.
Potential diversion of methadone or buprenorphine can be minimized with the controls that justice agencies have in place. Moreover, most diversion of methadone takes place in the context of methadone prescribed to treat pain, not methadone delivered in opioid treatment programs.
The document states in conclusion that evidence-based treatment considerations must take precedence over ideology in decision-making about medication treatment for justice-involved individuals. This is a view increasingly embraced by justice organizations, such as the National Association of Drug Court Professionals, according to the fact sheet.