Preliminary Analysis of the Medication for Addiction Treatment (MAT) - PowerPoint PPT Presentation

Preliminary Analysis of the Medication for Addiction Treatment (MAT) Program at Albany County Correctional Facility (Data from January – June 2019) Elham Pourtaher Office of Program Evaluation and Research, AIDS Institute elham.pourtaher@health.ny.gov

2 Opioid Use Disorder (OUD) in the Criminal Justice System • Odds of arrest among persons who use heroin is 77% (Winkelman et al. 2018) • 75% of re-entrants* with an OUD relapse to opioid use within 3 months of release (Fox et al., 2015) • 24% to 46% of individuals with a heroin use disorder (over 200,000 individuals) pass through American correctional facilities annually (Bronson, et al. 2017) • 40% to 50% of the re-entrants with OUD are arrested for a new crime within a year after release (Soares III, et al. 2019) • Re-entrants with OUD are 10-40 times more likely to have a fatal opioid overdose compared to the general public, especially within a few weeks postrelease (SAMHSA, 2019) *Population released from correctional facilities into the community.

3 MAT Evidence-Based Treatment 3 FDA Approved Medications • Methadone and buprenorphine remain the gold • Methadone standard of care for OUD – Full Agonist • Studies indicate people on MAT are more than twice • Buprenorphine as likely to remain opioid-free; meta-analysis of over 300 published research articles confirmed MAT to – Partial Agonist be clinically effective • Naltrexone • “Scientific research has firmly established that treatment of opiate dependence with medications – Antagonist (MAT) reduces addiction and related criminal activity more effectively and at far less cost than incarceration.” Legal Action Center, 2011

4 NYS Program: MAT in Correctional Settings • Objective: Create an integrated step-by-step process to provide MAT to individuals who present at the jail with OUD • Rationale: • Equivalence of care – MAT is the community standard • Prevention of HIV and HCV transmission • Reduction in post-release relapse and re-incarceration • Reduction in post-release mortality

5 NYS Program: MAT in Correctional Settings Collaborating Agencies: • Albany County Correctional Facility (ACCF) • Catholic Charities AIDS Services (CCAS)* • Whitney M. Young, Jr. Health Center • Conifer Park • Camino Nuevo • NYS Department of Health AIDS Institute: • Office of Drug User Health (ODUH) • Office of Program Evaluation and Research (OPER) • NYS Office of Alcoholism and Substance Abuse Services (OASAS) *CCAS is a Drug User Health Hub affiliated with New York State Department of Health (NYSDOH)

6 NYS Program: MAT in Correctional Settings • Initial intake and assessment (ACCF) • Access to treatment at the facility (ACCF in collaboration with local MAT providers) • Discharge planning including in-reach services (ACCF and CCAS) • Post-discharge into the community: continuity of care, follow up and reporting (CCAS) • Staff training (NYSDOH, OASAS)

7 MAT at ACCF: Phased-In Approach Phase 1: Continuation of MAT (since 01/22/2019) • Individuals eligible for Phase 1 have the option of continuing existing buprenorphine, methadone and/or naltrexone treatment • County staff and outside provider (CCAS) connect the individual to identified provider upon release for continuation of care and medication maintenance

8 MAT at ACCF: Phased-In Approach Phase 2: Sentenced with OUD (since 03/13/2019) • Phase 2 includes buprenorphine inductions for individuals with OUD that are sentenced and have an expected release date • County staff and outside provider (CCAS) connect the individual to identified provider upon release for continuation of care and medication maintenance

9 MAT at ACCF: Phased-In Approach Phase 3: All with OUD (tentative starting date: 09/01/2019) • Phase 3 includes buprenorphine inductions for all individuals with OUD • County staff and outside provider (CCAS) connect the individual to identified providers upon release for continuation of care and medication maintenance

10 Program Evaluation • Evaluation incorporates various complementary data collection tools and sites with the aim of conducting a multi-faceted assessment of MAT programs at ACCF • The NYSDOH designed reporting forms to evaluate the program at two stages (during incarceration and postrelease) and at two levels (facility and individual) • The evaluation is also complemented with focus group discussions/interviews with the target population during incarceration and post-release

11 Data Collection Two sites: ACCF (during incarceration) and Catholic Charities (post-release) Individual level (ACCF) Individual level (CCAS) • Linkage to care and community • Sociodemographic factors (Jail support Management System) • Housing and employment • Medical records (incl. mental health): EMR Intake assessments • Social support • Psychological services (CASAC) • History of overdose • Drug court status (CASAC) • Recidivism • Knowledge, attitudes, beliefs • Knowledge, attitudes, beliefs around MAT (Interviews and focus around MAT (Interviews and focus groups) groups) Facility level (ACCF) Facility level (CCAS) • Facility’s readiness for connecting • Facility’s readiness for re-entrants to community providers implementing the MAT program • Successes and challenges • Successes and challenges

12 Preliminary Data (January – June 2019) • Demographic Characteristics • MAT Program • Medical Records • Psychological Services • Adjustments to the Program • Post-release Status • Recidivism

13 Data (Sample Size) 01 02 03 ACCF Focus Group CCAS Discussion (n = 57) • Medical records (n = 126) (n = 20) • Demographics and disciplinary tickets (n = 126) • Psychological and mental health services (n = 34)

14 Demographic Characteristics of MAT Participants Age Gender 48% 1% 29% 26% 70% 16% 9% 2% Male Female Non-Binary Gender Identity 20-29 30-39 40-49 50-59 60 and older Data source: ACCF Jail Management System (January – June 2019, n=126)

15 Demographic Characteristics of MAT Participants Race/Ethnicity Marital Status 1% 6% 76% 8% 85% 11% 11% 2% Single Divorced/Separated Married/Domestic Other White Partnership Black or African American Hispanic or Latino Undisclosed or Uncategorized Race/Ethnicity Data source: ACCF Jail Management System (January – June 2019, n=126)

16 MAT Program Enrollment by Phase Type of Medication 72% 80% 22% 4% 16% Phase 1 Phase 2 Phase 3 2% 1% 1% 1% Suboxone Methadone Vivitrol Subtex Subutex Zubslov Currently piloting Since 03/13/2019 Since 01/22/2019 Data source: ACCF Medical Center (January – June 2019, n=126)

17 17 Type of Medication by Starting Month of the MAT Program at ACCF 28 22 22 13 10 6 6 5 4 3 2 2 2 1 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Suboxone Methadone Vivitrol Zubsolv Subutex Data source: ACCF Medical Center (January – June 2019, n=126)

18 Medical Records Patients' Relevant Medical Records 48% 37% 21% 13% 13% 4% 1% History of Mental Drug Injection History of History of Suicide Alcohol Use Benzo Use Pregnancy Health Overdose Attempt Disorder Disorder Hospitalization Categories are not mutually exclusive. Data source: ACCF Electronic Medical Records (January – June 2019, n=126)

19 Medical Records Does the MAT Participant Have Among Those Who Have Health Health Insurance? Insurance, How Many Patients Are Covered by Medicaid? 3% 9% 21% 56% 23% 88% Yes No Unknown Medicaid Non-Medicaid Insurance Type Unknown Data source: ACCF Electronic Medical Records (January – June 2019, n=126)

20 Psychological Services 82% of MAT Patients at ACCF Participated in the Following Counseling Programs: Women's Recovery Group 2 Mental Health 5 Narcotics Anonymous 7 Alcoholics Anonymous 7 MAT 9 Other CASAC-related Individualized Services 21 34 Total Categories are not mutually exclusive. Data source: MAT Participants in ACCF, data provided by CASAC (January – June 2019, n=34)

21 Adjustments to the Program • Various strategies evolved as the program was implemented to ensure proper security measures were in place. Examples: detailed policies and procedures for the staff regarding mouth checks, telling patients to put their hands on their sides during the administration of medication, change of the location of medication administration • Beginning 05/24/2019 there has been a transition from buprenorphine pills to films

22 Postrelease Status Post-release Location 39% Bridge script was provided for 32 individuals enrolled in 61% the MAT Program (mean=11.9 days) Outside Albany County Albany County Counties Re-entrants Moved to Outside Albany Housing Status Post-Release 39% 70% 18% 15% 14% 14% 15% 2% 3… 3% 3% 3% Stays with Rents Homeless Owns family/friends Greene Schoharie Rensselaer Schenectady Clinton Columbia Saratoga Suffolk Data source: MAT Participants Linked to CCAS (January – June 2019, n=57)

23 Post-release Status Does the Re-entrant Is the Re-entrant Does the Re-entrant Receive Mental Health Currently Employed? Continue the MAT Care? Program? 13% 16% 21% 87% 84% 79% Yes No Yes No Yes No Data source: MAT Participants Linked to CCAS (January – June 2019, n=57)