How to ensure people with opioid use disorder released from prison stay on the recovery path? A solution takes root in Buffalo

BUFFALO, N.Y. – More than half the people in jail or prison in the U.S. have been diagnosed with substance use disorder (SUD). By law, inmates in New York State with opioid use disorder must be provided with medication-assisted treatment within 24 hours of intake. So it’s often incarceration that gives many of these people their first real chance at recovery.

But once released, which can happen with little or no advance notice, these individuals are at a 10-times-greater risk of overdose than the general population. During this transition, when they no longer have the support services they received in jail and have not yet established treatment in the community, they are most vulnerable to relapse, overdose and even death.

A new partnership between the MATTERS Network based at UBMD Emergency Medicine, the University at Buffalo and the Erie County Sheriff’s Office is working to eliminate that risk. It does so by ensuring that upon release, people who need medication for addiction treatment (MAT) continue to receive it without interruption while facilitating linkage to treatment programs and support close to home.

Since its launch last December, the program has been offered to 600 individuals upon release from custody in Erie County; half have taken advantage of it so far.

“Our goal in partnering with the Correctional Health Division is to allow discharged individuals to reenter the community with all the tools they need to successfully continue their recovery journey,” says Joshua J. Lynch, DO, clinical professor of emergency and addiction medicine in the Jacobs School of Medicine and Biomedical Sciences at UB and founder of the MATTERS Network. He is also a physician with UBMD Emergency Medicine.

New York State mandates that upon release from custody, people with SUD must receive a seven-day supply of their addiction-treatment medication, such as suboxone. But access to that medication and to a treatment program, both of which should be close to their home, isn’t always that simple.

‘You could be released at midnight’

“When you’re arrested and arraigned, you don’t know for how long you are going to be incarcerated,” says Kevin McGee, DO, chief medical officer at the Erie County Sheriff’s Office and assistant clinical professor of emergency medicine in the Jacobs School. “You can go to court and suddenly find that the charges have been dropped, so you could be released at midnight and find yourself on the streets.”

In that scenario, McGee explains, even though the individual has a prescription in hand, there may be no pharmacy nearby that’s open, they have no way to get there, or they lack insurance to pay for the prescription.

“If they have no clear pathway for these things and their tolerance is down since they’ve been off opioids in jail, and they lack support, they could end up using alone, so their risk of overdosing and even dying is so much higher,” says Brigid Keane, Western New York/Finger Lakes outreach coordinator for MATTERS. “That’s a recipe for disaster.”

Amanda Martinez, senior nurse practitioner in the sheriff’s office who works with these individuals, agrees. “They can make all this progress while incarcerated and then lose all that if there’s no connecting piece,” she says.

MATTERS provides that connecting piece, and doing so swiftly is key. Studies show that when someone with substance use disorder is considering getting treated, being connected to it quickly can double their chance of engaging in treatment.

That’s critical, Martinez notes, because the specter of suffering through another bout of withdrawal is ever present.

The threat of withdrawal

“So they’ve been in jail and on their medication, but if they’re unexpectedly released and can’t get suboxone, they will start to withdraw the very next day,” she explains. That means suffering through three to five days of nausea, diarrhea, body aches, sweats and chills.

“The fear of going off their meds and back into withdrawal is very real,” says Martinez.

The process works like this:

·       Once a patient on MAT is going to be released from custody, the medical department is notified. A nurse trained in MAT discharges meets with the patient and provides them with a kit complete with Narcan (and training on its use if needed), as well as fentanyl and xylazine test strips.

• Patients are then offered the opportunity to connect with a MATTERS telehealth provider, available 24 hours/7 days, in order to arrange for follow-up treatment near their home. They can do so at the holding center or within the next day or two after they are released.
• If needed, MATTERS will provide transportation vouchers so the patient can attend their first outpatient treatment appointment; it can also provide vouchers for prescriptions.
• MATTERS staff follow up with the patient within 72 hours of their release and again at 30 days. If the patient is no longer in treatment, MATTERS attempts to reengage them to continue treatment.

Once they are established with outpatient treatment, patients can access peer support from the MATTERS Community Advisory Committee, whose members have gone through treatment themselves.

Working with MATTERS can also help alleviate some of the financial constraints that corrections facilities incur because it is MATTERS staff, not corrections staff, who connect individuals to treatment.

Other states have worked with MATTERS to develop similar programs to establish robust networks for linking people to MAT through telemedicine.

“Our goal with the MATTERS Network is to link the individual with long-term care, to get them the prescription they need and the voucher for the treatment they need, and if necessary, the transportation to get them to that treatment,” says Lynch. “We look at individual barriers and figure out how to resolve each of them. We are a multilayered, wrap-around network, a real safety net.”

The MATTERS Network was founded on the premise that people with substance use disorder who are seeking treatment must be promptly linked to resources and they must see that they have plenty of choices. MATTERS successfully links patients to their first clinic appointment within 24-48 hours anywhere in New York State.