For National Recovery Month, correctional healthcare leader Steve Tomlin addresses myths and misperceptions about cost-effective, life-saving addiction treatment
By Steve Tomlin
Having worked in and around the recovery community for many years, I’ve seen what works and what doesn’t. As September is National Recovery Month, I think it’s an important time to share why I am a passionate advocate for medication-assisted treatment (MAT) for opioid use disorders in the corrections industry.
Like many others who have worked in the industry for a long time, I was raised in the “abstinence-only” model, where a person would give up every substance all at once, and that was supposed to lead to sobriety. I remember when a “clubhouse detox” involved putting somebody in the garage to dry out and giving them Gatorade, a chocolate bar, and a hoagie. That was clearly an ineffective and ill-advised approach to getting clean and staying sober.
The benefits of MAT in corrections
MAT is a more effective and cost-efficient way to treat addiction and is the approach most supported by research. It is primarily used for addiction to narcotics such as heroin, fentanyl, and opiate-based prescription pain medications, as well as for alcohol addiction. MAT augments counseling and behavioral therapy with a drug that helps normalize the patient’s brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions—all without the negative effects of the abused drug.
In the correctional community, MAT has been shown to more safely manage detox, reduce withdrawal symptoms, improve patient engagement in rehabilitative programs, and provide a smoother transition to community-based care upon release. It also reduces the spread of infectious diseases and lowers the incidence of violence within facilities.
Yet despite the compelling and growing body of evidence that MAT is medically effective, promotes better health outcomes, and reduces the incidence of relapse, the treatment remains controversial and stigmatized, largely due to the myth that MAT simply replaces one drug with another.
Cost efficiency and long-term impact
The first steps, therefore, are education and training. Corrections work, by definition, prioritizes custody and safety. Correctional officers spend their careers keeping illegal substances out of their facilities. We must work together, educating administrators, officers, and patients that treating opioid use disorder with chronic-care medication, while also managing diversion protocols, offers a viable and safer solution.
And while MAT medications can be expensive, an effective program reduces costs in the long run by lowering relapse, recidivism, and violence toward staff and residents, which reduces sick calls, ER visits, and staff call-outs. For example, while it’s difficult to name an “average” cost of incarceration due to varying custody levels and geographical locations, let’s use an example where it costs about $85 a day to incarcerate someone, but only as little as $20 a day to keep someone on MAT. Any immediate cost increase to deliver these services can translate into significant long-term savings.
The ultimate goal is to return productive citizens to their communities. California’s Department of Corrections and Rehabilitation (CDCR) began offering MAT in 2019 for alcohol and opioid abuse. Over the next three years, CDCR’s overdose rate fell 62%, even as opioid overdose deaths were rising nationwide. Those are powerful numbers.
A 2018 study by NIH showed similar results, finding that people who received methadone treatment while incarcerated were more than eight times likelier to engage in substance-use treatment after their release than those who did not receive the treatment.
Every facility is different, of course. Every community is different, and every warden and sheriff has their own approaches. I have done this work in 18 states, and each one has its own challenges and opportunities. The key is to educate as many people as possible about what MAT really is, overcome the stigma, and implement successful programs. When you can do that, the results can be remarkable and life-changing.
About the author
Steve Tomlin is Chief Strategic Innovation Officer and Executive Vice President for MAT, Reentry and Community Partnership at YesCare, the premier provider of correctional healthcare and reentry services to incarcerated individuals.