One Good Decision: The Policy Argument for Extended Release Naltrexone in the Criminal Justice Setting

Abstract Criminal-justice (CJ) offenders with opioid-use disorders (OUDs) are at increased risk for recidivism and overdose (Durose et al. 2014, “Recidivism of Prisoners Released in 30 States in 2005: Patterns from 2005 to 2010.” Washington, DC: Bureau of Justice Statistics 28; Binswanger et al. 2007, “Release from Prison – A High Risk of Death for Former Inmates.” New England Journal of Medicine 356 (2):157–165). For the CJ system, this presents not just a challenge but a unique opportunity to improve public health and public safety. In particular, medication-assisted treatments (MATs) have shown the potential to reduce both recidivism and relapse. Nevertheless, access to MAT in this setting remains limited; for example, although U.S. drug courts were created chiefly to expand access to drug addiction treatment services, only about one-half make MAT available (Matusow et al. 2013, “Medication Assisted Treatment in US Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes.” Journal of Substance Abuse Treatment 44 (5):473–480). In this commentary, we explore the reasons for which access to MAT is limited in this setting, and lay out the evidence and arguments for a particular type of MAT: extended release (ER) naltrexone.