Rhode Island Expanding on Groundbreaking MAT Initiative for Offenders

Rhode Island has made pioneering progress in ensuring that justice-involved individuals with an opioid use disorder (OUD) receive medication treatment both while in custody and post-release. A new initiative in the state is now targeting the one population that has been most likely to fall through the cracks and not see continuity of care when in the community.

The state's effort to provide access to all three OUD medication options within the state prison system has led to significant (and nationally lauded) declines in fatal overdose for a highly vulnerable population. The main reason why a 76% continuity of care rate for MAT in the community hasn't gone higher involves difficulty in reaching individuals who may be in state custody for only a short period—sometimes only several days. It is this group that state leaders are now targeting with additional support in the community.

Linda Hurley, president and CEO of CODAC Behavioral Healthcare, which operates an opioid treatment program (OTP) and related services in the state's corrections system, says service teams involving a counselor, a peer support specialist and a plainclothes state police officer are working to connect at-risk individuals to care and support. The state's new HOPE (Heroin-Opioid Prevention Effort) initiative is reaching individuals both with and without a criminal justice history.

“This is really exciting because it's allowing police to become part of the community in a supportive way for folks who are suffering,” Hurley tells Addiction Professional. “The police are not coming out to see if you have an outstanding warrant.”

Avenues of support

Hurley describes two distinct ways in which at-risk individuals are being reached in the community. In some cases, a first responder is identifying the individual, leading to outreach from the team. The identified individuals may have some or no criminal justice history. In other cases, individuals who have been in custody and are being released can request a ride home or to a treatment facility, with an opportunity for ongoing support from the HOPE initiative.

“We picked up two individuals this week,” Hurley says. “One went to a pain management clinic and one went home.”

A three-year, $1.5 million grant from the Substance Abuse and Mental Health Services Administration's (SAMHSA's) MAT-PDOA program is allowing the state to focus on the incarcerated subpopulation that is most difficult to engage because of the undetermined nature of their stay in custody, Hurley says. She explains that this group includes individuals who want to receive MAT while incarcerated but are released before treatment is initiated, as well as those who are held while awaiting trial and may be released after court disposition.

The groups with which the state has tended to have more success in maintaining continuity of care post-release are inmates who entered custody on MAT and are continued on the medication behind bars, and those with an OUD history who have not been on medication but are inducted prior to their release date.

The MAT-PDOA funds under SAMHSA go to states with high rates of primary treatment admissions for heroin and prescription opioids. The grant program in Rhode Island involves a partnership among CODAC, the Department of Corrections and Brown University.

Clinician characteristics

CODAC is currently staffing the clinician roles on the engagement teams, although Hurley says the ultimate goal is to involve other provider agencies in the state as well.

She says the organization tries to fill these roles with clinicians who have an understanding of MAT as well as a high level of maturity, and with peers who preferably have lived experience receiving medication treatment. Hurley says CODAC has been fortunate to have on board a clinician with significant experience in crisis work with police.

The participating police officers must seek to achieve a balance between maintaining community safety and taking a more treatment-focused approach to addressing individuals with an opioid use disorder, Hurley says.