MAT offer in all stages of the criminal justice system
MAT OFFER IN ALL STAGES OF THE CRIMINAL JUSTICE SYSTEM
MAT may also play an important role in police detention and pre-trial detention institutions. Those addicted to heroin or other opioids and being caught and arrested by the police and brought to police detention houses may face severe withdrawal symptoms. These may influence the information given to the police and may also prolong the stay in these facilities. MAT should be offered as a form of through care, which provides stability to the health status of offenders both physical and mental. Risks of overdose by using drugs in these facilities after a short period of detoxification may also be very harmful, as the opioid addicts lose the opiate tolerance within days, which then may lead to increased risks. In how far MAT may also contribute to a decreased risk of suicide or self-harm have not been studied yet. But a positive impact on these problems mostly occurring within the first days and weeks of imprisonment is quite likely.
The same accounts for institutions of pre-trial detention and remand prisons. Therefore existing MATs should be continued in police detention and pre-trial detention centres and remand prisons. Moreover, home leave, holidays etc. are periods in which basic rehabilitation steps are being undertaken, but also the risk for relapse is increased. MAT also provides stability in terms of overdose-prevention.
SPECIAL CONSIDERATIONS FOR WOMEN
Women tend to have a different experience than men with both drug dependence and treatment. Major issues are related to the high levels of both physical and mental comorbidity of women with opioid dependence, and these need to be taken into account in providing treatment. Women with opioid dependence often face a variety of barriers to treatment, including lack of financial resources, absence of services and referral networks oriented to women and conflicting child-care responsibilities.
Effective MAT of opioid dependence can substantially improve obstetric, prenatal and neonatal outcomes. MAT maintenance therapy also has an important role in attracting and retaining pregnant women in treatment and ensuring good contact with obstetric and community-based services, including primary care. In comparison with the high risks of maternal heroin use and maternal withdrawal syndrome for the child, MAT of a pregnant opioid dependent woman has minimal negative impacts on the child. Opiate withdrawal during pregnancy increases the risk of spontaneous abortion in the first trimester and of premature labour in the second and third trimester, whereas there is good evidence that starting or continuing of MAT with methadone during pregnancy is safe. Increased methadone metabolism and increased blood volume in the second and third trimester may require increase of methadone dosage. A neonatal withdrawal syndrome of the infant in the first days after birth needs attention and/or treatment by the neonatologist and may be of shorter duration with buprenorphine than methadone-based MAT. However, due to longer experience and stronger evidence, methadone is the preferred MAT medication in pregnancy. Breast feeding is possible as methadone (and buprenorphine) levels in the milk are low and not significantly affecting the infant.