Habit OPCO Helps Educate the Criminal Justice System about Medication-Assisted Treatment

Although it’s well known that many people wind up in the criminal justice system because they are addicted to opioids, there is still work to be done in educating the system about the value of medication-assisted treatment (MAT). Jonathon Wasp, MS, director of Pennsylvania operations for Habit OPCO opioid treatment programs (OTPs), has a background in management of addiction treatment in the correctional system, and is helping to do just that.

Mr. Wasp, formerly associated with MinSec, a private community correctional services provider focusing on behavioral health care, said that the criminal justice system—especially corrections—has made strides in recent years in recognizing the importance of addiction treatment.

“By reaching out to drug-treatment courts and probation and parole officers, and requesting an opportunity to speak with them about criminal justice and addiction, we are opening the doors,” he said. But there are still barriers. As much as criminal justice officials are aware of the fact that they have people who are addicted in probation, parole, and prisons and jails, many “don’t understand the neurobiology of addiction. The way they see it, these people could just stop. They are missing the science. If you don’t understand the basic concepts, you won’t understand how methadone is important in providing addiction treatment.”

Re-entry and Drug Courts

One focus of the Habit OPCO criminal justice initiative is re-entry—treating people who are about to be released from prison and were addicted to opioids prior to their incarceration. Under the federal guidelines, a patient who met the criteria for admission to an OTP immediately before incarceration can be admitted to a program, because incarceration is “forced remission,” he said. Forced abstinence is not the same as treatment, and federal studies have shown the value of admitting inmates into OTPs prior to their release, and continuing with treatment after release. So Habit OPCO is working with prison officials on getting inmates who were addicted to opioids into treatment before their release.

Another focus of Habit OPCO is preventing people from going to prison or jail by providing them treatment up front in collaboration with a drug court or probation. But focusing on this population also means that addiction treatment providers must educate themselves about “criminogenic” thinking and risks, he said, citing the work of Edward Latessa, PhD, who developed a correctional program checklist assessment—and this can be used in community corrections as well. (Community corrections are those that take place outside of prison or jail, such as with probation and parole.)

Addiction–Crime Overlap and Dichotomy

The overlap between addiction and criminal justice involvement is so big—as many as 80 percent of inmates are incarcerated because of a drug or alcohol problem—that the treatment and criminal justice systems should understand they are dealing with the same people, he said, adding that all addiction treatment providers should do a “risk-need-responsivity” assessment for criminal behavior. Substance abuse is one of the seven risks for criminal behavior under this model, first developed in the 1980s. Others include social isolation, poor education, and distrust of or lack of adherence to authority, he said. Interestingly, these risks are also relapse triggers.

“At the end of the day, not only are we serving the same people, but we’re supposed to be serving them in the same way—and we’re not. We never got away from the dichotomy that addiction treatment is for public health and criminal justice is for public safety.” The biggest danger of this dichotomy is that the criminal justice system “looks at treatment agencies as completely separate, and we don’t advance at all. So our purpose at Habit OPCO is to show that not only are we serving the same people, but we have the same vested interest.” Public safety is improved by people getting MAT, and that’s the message that he is taking to corrections, probation, and parole officials.

There is no reason to separate patients who are referred from drug courts or pretrial diversion—not convicted—from other patients in an OTP, he said. “They’re not incarcerated, they’re supervised by a probation officer.”

But it’s important to understand the different mindset of someone who is coming into an OTP after months of incarceration, he said. Even if they had been unfairly incarcerated, they were in the prison system, and that inevitably had an effect on them.

The ‘Substitution’ Question

Many criminal justice practitioners view methadone as a substitute for heroin, and while there is some truth in that, when we look at the neurobiology of opiate dependence, the substitution “debate” is overly simplistic. It ignores a substantial body of evidence that suggests that this treatment modality, which also provides extensive individual and group interventions, addresses the stressors and causes of addiction. At the same time, it ensures that the opiate dependent person is physiologically stabilized with a substance that does not provide the euphoric effects of heroin.

Mr. Wasp related a particularly poignant example of the need for education. A medical provider of correctional treatment services in Pennsylvania was looking for a provider for pregnant opioid-dependent women. So the prison physician toured an OTP. “I could tell he had something on his mind; I could tell from his body language,” said Mr. Wasp. “I said that methadone is a tool, part of the recovery process. But clearly my agenda and his were not in sync.

“So I asked him, ‘What did you expect to get from coming here today?’” The physician—whom Wasp declined to identify—responded, “How would you answer the question, which I will be asked by my superiors, ‘Why should we substitute these people’s heroin addiction on the taxpayer’s dollar?’” Mr. Wasp answered, “With all due respect, you’re going to pay one way or another.” He noted that treatment with MAT is much less expensive than being incarcerated.

Other ways Habit OPCO reaches out to the criminal justice system, in addition to providing tours for county correctional administrators and health care administrators, include:

1)    providing information to corrections, probation, and parole staff members by purchasing and staffing a booth at the Pennsylvania Probation Parole and Corrections annual state-wide conference;

2)    attending and presenting information to the Lackawanna County Criminal Justice Advisory Board (a board comprised of sentencing judges, county probation, county corrections, county investigators, the District Attorney’s office, and Pennsylvania state police);

3)    inviting our local state parole office to host their monthly staff meeting at our facility (encouraging parole agents to tour the facility while on site); and

4)    creating and presenting a four-hour training to county probation staff on the benefits of medication-assisted treatment with the criminal justice population.

“In many cases, we have handed out the AT Forum White Paper on medication-assisted treatment and criminal justice,” said Mr. Wasp. “In this day and age, with evidence-based practices being the buzz in criminal justice, it’s nice to be able to hand them the evidence in a well-done, prepackaged document.”

Because of his experience with the criminal justice system, Mr. Wasp sympathized with the physician who questioned the value of MAT. “There is not a single institution anywhere in this country where there’s not some level of a rub between the security professionals in a jail and the medical people,” he said. “Corrections officers believe that it’s their job to do custody and control. And there’s the treatment people, who say it’s their job to help people be more productive.”