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Medication Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings

Chapter 1: Use of Medication-Assisted Treatment in Criminal Justice Settings

1. Within _____ of release from custody, 75% of formerly incarcerated individuals with an OUD relapse to opioid use.

A. 48 hours

B. 7 days

C. 30 days

D. 3 months


2. Currently, medications are available to treat all of the following, except:

A. Tobacco

B. Methamphetamine

C. Alcohol

D. OUD


3. In the early stages of treatment, when persons are clinically unstable and experiencing withdrawal symptoms or drug cravings, evidence suggests medication alone may be adequate to enhance treatment retention and initiate abstinence from illicit opioids.

A. True

B. False


4. According to the U.S. Surgeon General, successful maintenance regimens typically last for 6 to 12 months.

A. True

B. False


5. All of the following describe methadone, except for:

A. It reduces withdrawal symptoms and cravings for opioids.

B. Delivered in the proper dosage to a person who is physiologically tolerant to opioids, there is no experiences of intoxication, euphoria, or sedation.

C. It does not cause physiological dependence or intoxication.

D. Most serious side effects will occur, if at all, within the first 2 weeks of treatment.


6. Which of the following medications binds preferentially to opioid receptors in the brain but does not stimulate those receptors?

A. Methadone

B. Buprenorphine

C. Naltrexone

D. Naloxone


7. Naltrexone will help to alleviate withdrawal symptoms.

A. True

B. False


8. Naltrexone does not require special licensure or certification to administer and may be prescribed or dispensed by any licensed medical practitioner or pharmacist.

A. True

B. False


9. Why is it so difficult to incorporate medication-assisted treatment into the criminal justice system?

A. Some officials and practitioners view these medications as replacing one addictive drug for another.

B. Some jails and prisons have policies that prohibit the use of controlled substances, including the medications used in MAT.

C. Some drug courts may require detoxification from methadone or buprenorphine treatment as a condition of participation.

D. Misunderstandings or lack of information on MAT along with current policies that do not support MAT all make the incorporation of MAT into the criminal justice system difficult.


Effectiveness of Medication-Assisted Treatment in Criminal Justice Settings

10. Which of the following alleviate withdrawal symptoms and cravings for opioids?

A. Methadone and buprenorphine

B. Naltrexone and Naloxone

C. Buprenorphine and Naltrexone

D. Methadone and Naloxone


11. All of the following have been reliably demonstrated to reduce illicit opioid use in studies involving jail, prison, probation, and parole populations, except for:

A. Extended-release naltrexone

B. Oral naltrexone

C. Methadone

D. Buprenorphine


12. Significant reductions in mortality have only been observed when participants receive methadone or buprenorphine beginning in custody and continuing for at least _____ consecutive weeks after release to the community.

A. 2

B. 4

C. 6

D. 8


13. Non-medically trained criminal justice professionals should never make medication decisions related to MAT.

A. True

B. False


14. Requiring inmates to discontinue or change a medication regimen that was previously successful is associated with poor outcomes and a lower likelihood of resuming MAT after release from custody.

A. True

B. False


15. Access to MAT should be denied if psychosocial services are unavailable or individuals are unwilling to avail themselves of those services.

A. True

B. False


16. Several studies in community-based OTPs and physician practices found no incremental benefits from adding evidence-based counseling to MAT on treatment retention or illicit opioid use during the first _____ months of treatment.

A. 3 to 12

B. 3 to 8

C. 2 to 6

D. 2 to 4


17. Significant improvements have typically only been reported when methadone doses exceed _____ over several months to more than a year.

A. 30 mg

B. 60 mg

C. 90 mg

D. 120 mg


18. Administering MAT for _____ days or less, which is common practice in many jails and prisons, offers no beneficial effects.

A. 30

B. 60

C. 90

D. 120


19. Substance use and mental health disorders are reciprocally aggravating conditions, meaning that continued symptoms of one disorder are likely to precipitate relapse in the other.

A. True

B. False


20. Co-occurring mental health and substance use disorders should be treated consecutively.

A. True

B. False


21. Significant reductions in criminal recidivism and improvements in employment are typically observed for post-release reentry programs where participants receive at least a _____-week supply or prescription of needed medication.

A. Four

B. Six

C. Ten

D. Twelve


22. One of the most effective ways to prevent misuse or diversion of prescription medications is to:

A. Monitor the presence of prescribed medications or their metabolites through urine or other appropriate testing methods on a random basis.

B. Call MAT participants back on a random basis for pill counts.

C. Use a medication event monitoring system.

D. Require the medication to be ingested under the direct observation of treatment or criminal justice staff.


Examples of Medication-Assisted Treatment Programs in Criminal Justice Settings

23. Which of the following is considered the highest level of care under the four-tier model that Rhode Island bases its treatment on?

A. Day treatment

B. Counseling groups

C. Modified residential therapeutic community

D. Recovery services / peer support


Addressing Challenges to Implementing Evidence-Based Practices and Programs in Criminal Justice Settings

24. The dominant approach to opioid use disorders in jails and prisons involves short-term detoxification and requires inmates to be tapered off proven medications within certain time limits.

A. True

B. False


25. All of the following is considered stigmatizing language and should be avoided, except for:

A. Recovery

B. Substance abuse

C. Addict

D. Relapse


26. Both injectable buprenorphine and naltrexone require refrigeration and, once allowed to warm to room temperature, must be used within:

A. 24 hours

B. 3 days

C. 7 days

D. 2 weeks


27. Medicaid coverage is available for all of the following, except:

A. Persons on probation or parole

B. Persons under home confinement

C. Persons in community-based correctional residential programs so long as they are free to leave the facility during work or other specified hours

D. Persons in jails or prisons


28. Medical practice guidelines require strict procedures for introducing buprenorphine at specified increments before tapering the methadone dose to avoid inducing withdrawal.

A. True

B. False


29. The factor that best distinguishes effective from ineffective prison and jail-based MAT programs is whether participants experience _____ after release to the community.

A. A smooth transition to follow-up care

B. Opioid overdose or death

C. Relapse to opioid use

D. Reincarceration


Resources to Support Effective Use of Medication-Assisted Treatment in Criminal Justice Settings

30. Forced withdrawal from opioids, including prescribed opioid medications:

A. Can be medically hazardous.

B. Reduces the likelihood that individuals will participate in substance use disorder treatment or MAT in the future.

C. Poses a serious risk of overdose or death after release from custody if the individual returns to pre-incarceration levels of opioid use.

D. Forced withdrawal from opioids, including prescribed opioid medications can be medically hazardous, reduces the likelihood that individuals will participate in substance use disorder treatment or MAT in the future, and poses a serious risk of overdose or death after release from custody if the individual returns to pre-incarceration levels of opioid use.


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