Implementing Medication Assisted Treatment in Drug Treatment Courts: Implications for Enhancing Future Effectiveness

Background:  Drug Treatment Courts (DTCs) continue to thrive as a mechanism for diverting drug involved criminal justice system clients from incarceration. Nationally, those coming into DTC programs are increasingly presenting with addiction to heroin and other opiate drugs.  Despite a history of resistance by criminal justice administrators (Matusow et al., 2013; Friedman et al., 2012), medication assisted treatment (MAT) is slowly gaining acceptance in DTCs.  Nevertheless, little is known about its implementation or its impact on DTC program outcomes.   

Methods:  In April, 2014, drug treatment court case managers were requested to review client case files to ascertain details and history regarding medication assisted treatment with Methadone, Vivitrol and Suboxone for 124 clients who were active in a Midwestern urban adult drug treatment court program between October 2012 and the end of March, 2014.  Analyses focus on clients whose major drug problem was heroin or other opiates and who actively consented to participate in research (n=71).  The small sample data were also supplemented by observations and qualitative interviews conducted with members of the Drug Treatment Court Team.  

Results:  Forty-three of the 71 opiate involved clients (60.5%) received MAT.  Among those receiving MAT, thirty-six (84%) were prescribed Vivitrol at some point; a few of those prescribed Vivitrol also received methadone (N=2) or Suboxone (N=3).  The small number of clients not prescribed Vivitrol were prescribed either Suboxone (N=4) or Methadone (N=3).  There were important demographic, substance involvement, and program behavior differences between those prescribed MAT and other opiate involved clients.  Logistic regression suggested that opiate involved clients were more likely to receive MAT if they were white (Odds ratio: 8.0; p < .05), had a history of IV drug use (Odds ratio: 8.8; p <.01), and had a sanction for rule violations while in the program (Odds ratio: 16.4; p <. 05).  Bivariate follow-up analyses suggested that MAT prescribed clients were significantly more likely to be detained in jail while in the program (90.7% vs, 42.9%; X² =19.18 p < .001).  There were no significant differences in completion rates between MAT prescribed clients and others, although among those receiving MAT, clients who received more shots of Vivitrol (p < .001) and who received multiple types of MAT (p<.10) were more likely to successfully complete the program.

Implications:  The data, when supplemented with staff interviews, suggest that MAT was often used as a “last resort” to stabilize intractable clients.  Although this study is based on the experience of a single drug court, this approach to MAT implementation may be consistent with the historically anti-MAT attitudes held by those in the criminal justice system. This implementation strategy could also explain MAT’s lack of impact on program success. The tendency toward more success with a longer course of Vivitrol treatment (more shots) and for those with multiple MAT types suggest promising directions for enhancing MAT effectiveness.  Future success may require more client-specific, tailored strategies, as well as strategies to better educate and train judges and other DTC team members about effective MAT implementation in addiction treatment.