Agenda 06-18-19 Item 8-j - Letter of Agreement to Increase Medical Director’s Services at the Orange County Detention Center

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Overview of the MAT Process Four Tiers of the Program All individuals coming into the jail will be screened for current MAT use and opioid use disorder within 14 days of commitment. Screening for opioid use disorder will be done using a validated tool. The program will have four tiers of implementation conceptualized as 1=the easiest to implement and 4=a long-term goal of the program. They are: 1) MAT for Pregnant Women a. Pregnant women will be screened, continued, and initiated on suboxone. This will be done regardless of whether the pregnant woman is remaining in the jail or being transferred to prison. 2) Continuation of MAT a. For individuals reporting current naltrexone, methadone, or suboxone use in the community, medical staff will obtain written consent to confirm medication and dose with current prescriber and pharmacy, and suboxone or naltrexone will be continued. 3) Initiation of MAT a. If previous prescription of MAT is not confirmed, individuals who have opioid use disorder will be referred to the MAT program and will be prescribed either suboxone or naltrexone at a dose that is clinically appropriate. The decision of which MAT to offer a patient will be determined clinically, primarily by past experiences, patient preference, and logistical considerations. 4) Introduction of methadone prescribed by an opioid treatment provider a. We will partner with an opioid treatment provider in Durham (e.g. BAART) to begin offering methadone during incarceration. Importantly, if someone prefers to be linked to a methadone clinic upon release this will be done as a part of discharge planning. All individuals who are in the MAT program will have access to group counseling, individual counseling, discharge planning services, and prerelease linkage to comprehensive treatment and wrap around (e.g. housing, transportation) services in the community. 4