EVIDENCE-BASED BEST PRACTICES

The Kentucky Recovery program upon which the Fletcher Group’s recovery model is based has been cited as a model “Evidence-Based Program” by the federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA).

The citation appears in SAMHSA’s 2019 Evidence-Based Resource Guide titled, “Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings.” Its purpose is “to disseminate information on evidence-based practices and service delivery models to prevent substance misuse and help individuals with substance use disorders (SUD), serious mental illnesses (SMI), and serious emotional disturbances (SED) get the treatment and support that they need.” It is written to support health care providers, health care system administrators, and community members meet the needs of individuals at risk for, experiencing, or recovering from substance use and mental health disorders. The guide itself was developed through input from an expert panel made up of federal, state, and non-governmental participants.

The report begins by citing the enormous economic cost of the current opioid epidemic—$504 billion—and the potential for reducing that cost by instituting Medication-Assisted Treatments (MAT). The average annual cost per person of incarceration in U.S. prisons, says the report, dwarfs the per-person cost of methadone maintenance treatment—approximately $24,000 versus $4,700 annually per person. The report goes on to strongly endorse the use of MAT in criminal justice settings.

It is in that context that Recovery Kentucky is highlighted on page 42 of the report which can be read in its entirety at the bottom of this webpage.

“For people with OUD involved with the criminal justice system, a lack of access to medication-based treatment leads to a greater risk of returning to use and overdose after they are released from incarceration.”

– Medications for Opioid Use Disorders Save Lives, The National Academies of Sciences, Engineering, and Medicine

SAMHSA’S Description of Recovery Kentucky

The SAMHSA report credits the Recovery Kentucky Program for two exemplary practices: the provision of long-term treatment (up to two years) and whole-person care, meaning that all necessary treatments are provided in one location, including cognitive behavioral therapy, general aftercare, and relapse prevention support groups.

The report explains the advantages of those “Best Practices” by pointing to the well-known fact that without long-term, centralized care, individuals with OUDs typically return after incarceration to the environment where their substance use originated, putting the individual at high risk for relapse. The report adds that the risk for overdose is actually increased in such circumstances  because of reduced tolerance for opioids while incarcerated.

The SAMHSA report describes the Recovery Kentucky Program as follows:

KYDOC’s prisons and jails begin identifying individuals with substance use disorders six months prior to release. A first injection of naltrexone is offered five weeks prior to release, and a second injection is delivered one week prior to release. Participants continue to receive monthly treatment for a minimum of six months during reentry. After release, individuals are referred to post-release services directly from corrections custody, including Recovery Kentucky. Participants in Recovery Kentucky remain in treatment and support systems for up to 180 days in accordance with best practices that indicate the necessity of long-term treatment for success. Upon intake into all KYDOC treatment programs, data is collected on behaviors prior to incarceration, and follow-up data is collected 12 months after completion of the program.

Dramatically Positive Outcomes

The Recovery Kentucky program, says the report, “has seen significant improvements in healthcare costs, relapse rates, overdoses, and recidivism rates.” It states that 12 months following release “70 percent of those who completed addiction treatment programming were employed, 57.2 percent had not been reincarcerated, and 61 percent had no evidence of illegal drug use.”

Impressive Return On Investment

There were also tremendous cost-savings. “For every $1 invested in corrections-based addiction treatment in Kentucky, there was a $4.52 return on investment,” says the report, quoting from a 2018 study using data collected from July 1, 2016 to June 30, 2017.

Other Ways We Align With SAMHSA Best Practices

The following six “Best Practices,” taken verbatim from SAMHSA’s 2019 Evidence-Based Resouce Guide, have long been key components of the Fletcher Group recovery model.

Partner with Community Providers
Correctional facilities can develop partnerships with registered opioid treatment programs and other providers of MAT. Incorporating jails and prisons into a system of care allows incarcerated individuals to continue MAT upon incarceration and/or to connect with MAT services once they reenter the community.
 
Embed MAT Within Drug Court Programs
Many drug courts do not recommend (or even allow) the use of MAT for opioid dependence. Approximately half of drug courts surveyed in one study offered any form of MAT to participants.
 
Ensure Linkages to Treatment
According to a 2009 publication, only 45 percent of criminal justice facilities provided any community linkages to methadone treatment clinics. Treatment with MAT and brief drug counseling integrated into the probation and parole system have delivered positive results in terms of opioid use and re-arrest rates.
 
Support Police Officer-led Diversion Programs
Some police departments have engaged in training their officers to identify and divert non-violent opioid dependent individuals into MAT programs. One such program is the Law Enforcement Assisted Diversion (LEAD) Program in Seattle, Washington.
 
Change Organizational Policies to Reflect the Science Based on the overwhelming evidence base for MAT, many jails, prisons, parole, probation, and diversion programs are changing policies that prohibit the use of MAT medications. A growing number of states have enacted legislation authorizing or requiring expansion of MAT in the criminal justice system.
 
Register as a MAT Provider
Some jails and prisons have registered to become an opioid treatment program or have medical staff obtain buprenorphine waivers. For example, the Key Extended Entry Program (KEEP) is a methadone treatment program initiated in 1987 for incarcerated individuals. KEEP participants receive MAT behind bars, and when returning into the community, they are discharged to outpatient KEEP programs.

SAMHSA’s View Of The Opioid Epidemic

The following historical perspective on the national opioid epidemic and its costs is taken verbatim from SAMHSA’s 2019 Evidence-Based Resource Guide.

In 2017, the opioid crisis was declared a national public health emergency. At the time, over 2.1 million people in the United States suffered from an opioid use disorder (OUD), and two out of three drug overdose deaths involved opioids. Overdose deaths from opioids, including prescription opioids, heroin, and synthetic opioids like fentanyl, increased nearly six-fold since 1999.
 
The criminal justice system has felt the impact of this epidemic. Based on the 2015-2016 National Survey on Drug Use and Health (NSDUH), the odds of being arrested and becoming involved in the criminal justice system increase greatly for persons using opioids, from approximately 16 percent for those with no past-year opioid use to 52 percent for those suffering from a prescription OUD and 77 percent for those using heroin.
 
Twenty-four to thirty-six percent of individuals with a heroin use disorder (over 200,000 individuals) pass through American correctional facilities annually, and an estimated 17 percent of state prison inmates and 19 percent of jail inmates report regularly using opioids. Roughly 30 to 45 percent of inmates report suffering from serious withdrawal symptoms or an inability to control their use, indicative of severe symptoms of drug dependence.
 
These prevalence estimates cannot be attributed merely to drug possession offenses. Nearly 15 percent of state prisoners and jail inmates convicted of violent crimes and 40 percent of those convicted of property crimes reported committing their offense to support a drug addiction. Approximately 7 percent of state prison and jail inmates were intoxicated on opioids at the time of their offense.
 
The impact of opioid use on individuals transitioning from jail or prison back to the community is overwhelmingly negative. Outcomes include higher rates of returning to the criminal justice system, harm to families, negative public health effects such as the transmission of infectious diseases, and death. Within 3 months of release from custody, 75 percent of formerly incarcerated individuals with an OUD relapse to opioid use, and approximately 40 to 50 percent are arrested for a new crime within the first year.
 
Drug overdose is a leading cause of death among formerly incarcerated individuals. Prisoners and jail inmates released to the community are between 10 and 40 times more likely to die of an opioid overdose than the general population, especially within the first few weeks after reentering society. Approximately 17 percent of persons living with HIV or AIDS (approximately 155,000 people) passed through U.S. correctional facilities in 2006 alone.

Read the Entire Report Immediately Below

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