Medication-Assisted Treatment Initiative
In January 2018, Governor Wolf declared a disaster emergency regarding the opioid crisis in Pennsylvania.
He designated the issue a statewide public health emergency, highlighting 13 initiatives to aid the situation. Among them, he directed that medication-assisted treatment be provided within the Department of Correction prison system. These initiatives built on some efforts from prior years.
- In 2014, a Vivitrol pilot program was initiated at the Muncy State Correctional Institution.
- In 2016, Vivitrol administration was expanded to all 26 state correctional institutions in Pennsylvania.
- In 2018, six specific opioid therapeutic communities were created.
- In April 2019, a monthly injectable buprenorphine program was started for parolees at Muncy.
- In June 2019, medication-assisted treatment availability was expanded to new inmates.
In 2018, Governor Wolf dropped the prior authorization requirement for people who have state-funded insurance like Medicaid to get treatment for opioid use disorders. This means that these individuals will not have to wait in order to get medically assisted treatments to deal with opioid use disorders.
Substance use disorders have traditionally been addressed as if they were acute syndromes as opposed to chronic disorders. However, research has suggested that long-term strategies using medication-assisted treatment (MAT) and behavioral interventions produce lasting benefits. The state of Pennsylvania began to develop initiatives to make MAT available in the prison system.
Various medications can assist in the treatment of psychiatric disorders, particularly substance use disorders.
Part of the objection to using MAT comes from health professionals who were able to negotiate their own addictive behaviors without the use of medication. These individuals are often skeptical regarding the use of MAT, and certain organizations like 12-step groups that commonly work in the correctional facilities in Pennsylvania criticize the use of MAT as an appropriate method to deal with addictive behaviors. These groups tend to classify the use of MAT as replacing one addiction with another.
MAT for Opioid Abuse
The current medications approved for treatment of opioid use disorders include methadone and buprenorphine (Suboxone). They are most commonly used for maintenance and to control withdrawal syndromes.
Naltrexone (ReVia and Vivitrol) is used to control cravings for opioids.
The drug naloxone (Narcan) is an opioid antagonist, meaning that it reverses the effects of opioid drugs. It is used for the acute treatment of overdoses and not in the recovery and treatment of opioid use disorders.
It Started With Naltrexone
The Pennsylvania Department of Corrections began providing Vivitrol (extended-release naltrexone injections) for female reentrants at the state correctional institution in Muncie in 2014. Penn State University evaluated this initiative and eventually recommended that the Department of Corrections expand it to men’s institutions.
As of April 2018, Vivitrol was available at all state correctional institutions in Pennsylvania.
Naltrexone is an opioid antagonist that has no addictive potential but can reduce cravings for opioids and alcohol in individuals who have these substance use disorders.
Support is crucial to recovery from various mental health conditions, including addiction. Therapeutic communities are grouped-based, long-term programs to address certain types of mental illness. They are typically residential programs where patients live on site.
Therapeutic communities often include the use of group psychotherapy and MAT.
According to the Pennsylvania Department of Corrections, in March 2018, six therapeutic communities were converted into opioid-specific therapeutic communities to apply evidence-based treatments to the treatment of opioid use disorders. These opioid therapeutic communities use medications specifically designed to address opioid use disorders (methadone, buprenorphine, and naltrexone) along with group therapy.
The goal of the Department of Corrections is to increase the availability of these programs as needed.
In April 2019, the Pennsylvania Department of Corrections began a Sublocade Pilot Program at the state correctional institution in Muncy. Sublocade is an injectable longer-acting form of Suboxone (buprenorphine).
Certain parolees who qualified were diverted to a correctional facility for a 14-day detoxification placement. They were prescribed Suboxone and then the longer-acting Sublocade injections before being paroled and placed in an outpatient or inpatient treatment program.
If the pilot program is successful, it will be extended to other institutions in the state. The idea is to reduce relapse among new parolees.
New Inmates Can Continue With MAT
Starting in June 2019, inmates coming into institutions who are already enrolled in a verified MAT program will be able to continue taking their medications (Suboxone and/or naltrexone).
Incoming inmates who do not have a continuing MAT program but may be in need of one are forwarded to the Bureau of Health Care Services. They will assess if treatment is right for these inmates.
Prior Authorization Dropped
In 2018, Governor Wolf produced an initiative to drop the prior authorization clause for individuals on Medicaid who are seeking to become involved in MAT for opioid use disorders.
As a result, these individuals can get the medication they need much quicker. They do not have to wait 24 hours or more any longer.