Does MAT really impact recidivism?

Sep 18 2017

Does MAT really impact recidivism?

Can drug courts reduce recidivism rates by giving parolees who have addictions medication-assisted treatment?

A new evaluation of more than two dozen Ohio drug courts found that MAT only had a minor impact on recipients’ rates of continued drug or alcohol use, and recidivism. But state officials say they still favor the use of MAT in Ohio’s criminal justice system, which has about 90 Supreme Court-certified adult and juvenile drug and recovery courts.

The state-funded study was done to assess the impact of Ohio’s investment of more than $33 million in MAT since 2013. The state paid the Philadelphia-based Treatment Research Institute $1 million to conduct the study, which covered more than 600 drug court defendants in 13 Ohio counties.

Eighty-nine percent of those recipients took Vivitrol, an opiate-blocking shot which is administered monthly. 75 percent of individuals (263) who received medications were active or graduated. Compared to 73 percent who did not receive medications were active or graduated.

The only clear cut result identified by the study was that some addicts who received medication stayed in the court programs longer than defendants who didn’t.

According to the Cleveland Plain Dealer, in a letter to legislators and state agencies last month, Ohio Mental Health and Addiction Services Director Tracy Plouck said most of the officials overseeing the state’s approximately 90 adult and juvenile drug courts “reported that they would strongly encourage others to start using MAT, but emphasized that MAT alone is not enough and it should be combined with evidence-based psychotherapy.”

On a positive note, the study found that MAT produced some health care savings: an average of $4,384 for those in the programs, which serve about 5,000 Medicaid-eligible participants annually. Officials said the savings are largely due to less use of emergency medical services.

Thirty-one of the state’s drug courts have received grants to cover addiction treatment and related costs, like transportation and housing.

State officials plan to continue the MAT program, citing larger studies supporting its value in promoting recovery, said Jamie Carmichael, acting deputy director of public affairs for OMAS.

Since Medicaid expansion, the use of MATs to help treat addiction in Ohio grew to $110 million in 2016.

The evaluation included about 500 drug court participants who participated for at least six months; some received medications and counseling services and others weren’t able or chose not to take medicine, but received addiction counseling and other services.

The researchers had planned to determine which type of Medication Assisted Treatment (MAT) was most effective for people in the criminal justice system. However, it was not possible to make that comparison because 89 percent of the participants who received MATs, took Vivitrol, a monthly opioid-blocking shot which costs about $1,000 per dose. In many of the programs studied, Vivitrol was the only option made available.

Karen Dugosh, co-author of the report with colleague David Festinger, said the heavy reliance on the Vivitrol shot indicates that more education was needed in the criminal justice system about other addiction medications like Suboxone and buphrenorphine, to “increase acceptability” of those treatment options.

Dugosh also said that of the 13 people who died during the evaluation period, 12 were not on medication and one had received Vivitrol.

State Rep. Robert Sprague, one of the state legislature’s most active drug treatment advocates, says the program “is helping people to stay in the drug court, which is good because we know the drug courts work.”

A National Institute on Drug Abuse-funded study comparing relapse rates among addicts receiving Vivitrol and Suboxone at eight community treatment centers, including one in Ohio, is expected to be released this fall.