MEDICATION ASSISTED TREATMENT

1. MEDICATION ASSISTED TREATMENT In The Criminal Justice System Melody Heaps President Emeritus—TASC, Inc. Consultant—Center for Health and Justice www.centerforhealthandjustice.org www.tasc.org

2. ADDICTION IS… • a brain disease • a medical disorder • chronic • relapsing Neurobiology controls course of addiction

3. IT’S ABOUT THE SCIENCE

4. Rx field resistance to MAT • History of field education (AA & NA) • Recovering community for Clinicians • Importance of peers • Need to surrender • Trading drugs • Information under-load

5. AA/NA do not forbid the use of medications The Big Book states, “God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.” (Chapter 9, Emphasis added)

6. Neurobiological research on the brain has increased exponentially • Science has confirmed addiction as a brain disease • Explosion of pharmacological development and research • Beyond Methadone

7. MAT offers Criminal Justice Treatment and Community Connections as an additional tool for treating and managing ADDICTED OFFENDER • Alcohol addicted • Opioid addicted

8. Example CJ client who could benefit from MAT for alcoholism • Male alcoholic, mid 30’s • Early CJ involvement • Early cigarette and alcohol use • History of DUI’s and violence • Intimate partner violence • Treatment failures • Strongly desires help

9. Example CJ client who could benefit from MAT for opiates • Pregnant and non- pregnant female heroine addict between 18–45 years old • Early CJ involvement • Early cigarette and AOD use • Shoots heroine daily • Treatment failures • Repeated arrest history mostly related to prostitution and shoplifting • Extensive involvement with child protective services • Mental health issues & trauma • Recent relapse and incarceration was after a year of being clean • Strong desire to get clean and get kids back

10. Example CJ client who could benefit from MAT for opiate • Male heroin addict, mid-30’s • Early CJ involvement • Early cigarette and AOD use • Repeated arrests and incarcerations • Treatment failures • Daily criminal activity to support his habit • Also does speedballs with heroin and cocaine when taking part in robberies

11. Medications for Alcohol Dependence • Disulfram • Acamprosate • Naltrexone • XR-Naltrexone • Topiramate

12. Primary Medications for Treatment of Opioid Dependence • Methadone • Naloxone (Vivatrol) + • Buprenorphine = SUBOXONE

13. METHADONE Full opioid agonist therapy involves the use of the drug methadone. Full agonists engage the same receptors in the brain as other opioids. Consequently, agonist therapy reduces or eliminates symptoms of opioid withdrawal. The long-acting opioids used in full agonist therapy help to avoid the intense euphoric peak and rapid withdrawal associated with heroin use. However, with sufficiently high doses, agonist therapy can produce a heightened sense of euphoria, and can also prevent some of the same dangers as illicit opioids.

14. NALOXONE (Vivatrol) Opioid antagonist therapy involves the use of the drug naloxone. pioid antagonists completely block the receptor that is engaged by opioids. As a result, antagonists block feelings of euphoria, but they do not satisfy opioid cravings.

15. BUPRENORPHINE Partial opioid agonist therapy involves the use of the drug Buprenorphine. This drug partially engages opioid receptors, reducing symptoms associated with withdrawal. Unlike agonist therapy, partial agonists exhibit a ‘ceiling effect’, meaning that opiate receptors are not fully engaged even at high doses. Partial agonists also block other opiods from attaching to receptors. To prevent buprenorphine abuse, it is often combined with the drug naloxone, which induces acute withdrawal symptoms if the drug is injected instead of taken sublingually as directed.

16. Science Pushing Boundaries • Clinical studies/trials for injectable naloxone (1 per month) • Development of medications for cocaine/methamphetamine • Development of vaccine—based on genetic research

17. Criminal Justice Clients can benefit • Reduced relapse • Stabilization • Increased healthcare

18. Criminal Justice Systemscan benefit • Reduced recidivism • Increased supervision

19. How do we make it work? • Feds SAMHSA—increase education about MAT for Criminal Justice population • Develop collaborative networks with Methadone Providers, Federally Qualified Health Centers, Private Physicians

20. MAT One tool in the toolbox • Assessment • Care Management • Group Counseling • Individual Counseling • Peer Support • Community Family Support • Cognitive Behavioral Therapy

21. Criminal Justice-Referred clients have the right to have all available therapeutic interventions necessary for their individual recovery One size does not fit all and One medication does not fit all

22. “People Get Ready, There’s a Train a Coming” Pharmacology + Healthcare Reform = Need for Primary Care Integration

23. WHAT SHOULD WE DO? • READ—NIDA SAMHSA and NIAAA CHS Web sites • DEMAND—Education and information about MAT including technical assistance (Good news—SAMSHA, CSAT promotion of learning and information)

24. WHAT SHOULD WE DO? (continued) • USE—Addiction Technology Transfer Centers (ATTC) & Great Lakes/Center for Health and Justice www.attcnetwork.org www.attcnetwork.org/regcenter/index_greatlakes.asp www.centerforhealthandjustice.org • DEVELOP—networks and partnerships • EDUCATE—Criminal Justice System (Good news)

25. MAT is the wave of the future but it is insufficient without other appropriate clinical intervention and treatment

26. CONTACT INFORMATION Melody Heaps (773) 868-0449—office & fax mmh.tasc-chj@att.net Alternate information (Latonja Tuff, Project Manager) (312) 573-8336—office ltuff@tasc-il.org