In a detailed interview with Becky Scott, director of the Hudson County Correctional Center, in American Jails magazine, Claire Wolfe, MPH, MS, CCHP, and Fred Meyer, MA, CJM, CCHP, ask Scott to discuss the significant challenges and strategies involved in implementing Medication-Assisted Treatment (MAT) for opioid use disorder in jails. Since its introduction in 2016, the center has focused on transforming its approach to health care by addressing the underlying systemic issues that drive behavior. Director Scott emphasizes the importance of rethinking the purpose of jails, not just as facilities for segregation but as centers for rehabilitation, aligning services to support incarcerated people’s clinical needs, and improve public safety.
Buy-in from correctional and county leadership is crucial for the successful implementation of MAT. When leadership supports the program, necessary resources, including trained medical staff and effective communication, are more likely to be sustained. Hudson County has seen positive outcomes, with correctional staff becoming more supportive as they witness the benefits firsthand. Scott stresses the importance of understanding the evidence base behind MAT and fostering collaboration between medical and correctional staff to address any concerns.
Preventing medication diversion is a significant challenge in MAT programs. Hudson County employs several strategies, such as training all staff on diversion risks, restricting medication access to authorized personnel, and using surveillance technology during medication administration. These measures aim to create a therapeutic environment while minimizing opportunities for diversion. The facility also emphasizes the clinical role of nurses in ensuring patient safety and avoiding punitive measures for medication diversion.
Scott advocates for a supportive approach to managing diversion incidents, combining investigative and disciplinary measures with mental health support. Understanding the reasons behind medication diversion, whether due to coercion or a desire for euphoria, helps tailor appropriate responses. Addressing underlying mental health and substance use issues is crucial for reducing diversion and ensuring effective treatment. Any adjustments to medication should be clinically justified and not driven by custody decisions.
Partnerships with external agencies are vital for the success of MAT programs. Hudson County collaborates with state-certified treatment providers and county welfare agencies to offer comprehensive behavioral health and support services. These partnerships ensure continuity of care and access to support systems, including housing and Medicaid, upon release. Such collaboration enhances re-entry services and helps mitigate the vulnerabilities faced by individuals post-incarceration.
Director Scott highlights the positive outcomes of a well-implemented MAT program, including improved behavioral and mental health stability, reduced substance use, and withdrawal symptoms, and potentially lower recidivism rates. By treating substance use as a chronic mental illness and providing evidence-based health care, correctional facilities can foster better relationships between staff and the incarcerated and enhance community safety.