A Q&A WITH DR. JONATHAN GIFTOS PREVENTING OPIOID RELAPSE AND OVERDOSE What are the most important things for incarcerated people to know about MAT?
DR. JONATHAN GIFTOS Former Clinical Director of Substance Use Treatment for NYC Health + Hospitals, Division of Correctional Health Services at Rikers Island
In response to the prevalence of opioid use disorder among people with justice involvement, jails and prisons are starting to change how they address it. One treatment that has increasingly gained traction is Medication Assisted Treatment (MAT), an intervention becoming known for its affordability, effectiveness, and uniquely holistic approach. Through a combination of medications (i.e. methadone, buprenorphine, and naltrexone), counseling, and behavioral therapy, it not only reduces withdrawal symptoms, but addresses underlying issues driving substance use. Dr. Jonathan Giftos, former Clinical Director of Substance Use Treatment for NYC Health + Hospitals/ Correctional Health Services, is one expert who has seen MAT’s effectiveness in helping patients with justice involvement avoid opioid relapse and overdose. In the following Q&A, he shares key information about MAT and advice for people who are incarcerated in jails and prisons that offer it. 17
Medications such as methadone or buprenorphine (e.g, Suboxone) are effective treatments for opioid use disorder (i.e, opioid addiction: addiction to heroin or prescription pain killers). They have been shown to reduce opioid use and complications such as HIV infection. Most importantly, these medications reduce risk of death. They can be complemented by other services such as counseling or recovery groups if patients are interested. The most important thing to know is that these medications are most effective when taken every day (i.e, as maintenance medications), and not when used simply to wean one’s self from opioids (i.e, “detox”). For people in correctional settings, taking methadone or buprenorphine has been associated with an 85% reduction in risk of death from overdose during the first few weeks that one returns to the community. What advice do you have for each of the following groups of people? Incarcerated people who do have access to MAT, but are ambivalent about using it Ambivalence is normal for people with addiction. And this is especially true regarding treatments like methadone or buprenorphine. Some may think they are “trading one addiction for another.” I usually tell people that there is a difference between physical dependence — which simply means that you must take a medication daily or you will feel withdrawal symptoms — and addiction, which is the compulsive and often escalating WWW.FORTUNESOCIETY.ORG
use of a substance despite negative consequences. Untreated addiction can lead to people’s lives getting worse. Medication like methadone or buprenorphine often lead to people’s lives improving. They feel better, they can engage other needed health care services, they can save money, and more. People who are being transferred from a correctional facility with MAT access to one without MAT access Some patients may be transferred from a setting with medication access to a setting with more limited medication access. If a patient worries that this may happen to them, they can discuss that concern with health care staff. There is no one answer in these cases, but coordination and counseling can sometimes help patients feel better about the process. Incarcerated people who have used MAT and are about to be released. Additionally, are there any followup steps that those specifically being released from Rikers should take? All patients who began using medication for opioid use disorder in the jail are offered a community referral. They are also tracked through discharge. The reentry process is very challenging with lots of competing pressures. Additionally, Medicaid may still be suspended due to incarceration, complicating access to medication or services. Any recently released patient in New York City who has questions about their release plan should call our Point of Reentry & Transition (PORT) line at 646-614-1000 for assistance.
