Dr. Allison Robertson Discusses Medication-Assisted Treatment Research Successes, Challenges

There is strong evidence to show the effectiveness of medication-assisted treatment (MAT) with justice-involved individuals but still a number of barriers in place to implementing it, according to Dr. Allison Robertson, a member of the Behavioral Health Core at the Wilson Center for Science and Justice at Duke Law.

Robertson – who is an associate professor in the Psychiatry and Behavioral Sciences Department at the Duke University School of Medicine – was invited to speak earlier this month about MAT and her ongoing research as part of an HRSA Center for Excellence Behavioral Health Technical Assistance program.

“It was a great opportunity to share with university educators from around the country our areas of work in studying medication-assisted treatment at the behavioral health – criminal justice interface,” Robertson said of the opportunity. “It got them oriented to challenges in MAT provision related to access, stigma, and the importance of productive communication between treatment providers and criminal justice personnel like probation officers.

“Many said they had not been fully aware of these issues in MAT provision and would be incorporating them into their curricula for a range of clinical training programs.”

MAT is the use of FDA-approved medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders, according to the Substance Abuse and Mental Health Services Administration.

MAT medications for treating opioid use disorder include methadone, buprenorphine (Suboxone) and naltrexone (Vivitrol).

It’s an effective treatment approach for many individuals with substance use disorders, and it’s a cost-effective alternative to incarceration. In her presentation, Robertson said a month of incarceration is about $22,000 whereas a month of methadone treatment is about $4,000.

Robertson said there is a growing evidence base about the implementation of MAT, but it remains markedly underused. Common barriers include limited access to prescribing physicians, limited knowledge and misunderstandings, and stigma along with negative attitudes about MAT.

One of the studies Robertson discussed was from a 2019 statewide survey to North Carolina community corrections personnel to assess their knowledge, attitudes and experience with MAT among the individuals they supervise. Robertson said it was clear there needed to be a continuation of training and education around MAT.

She also discussed the successes and challenges around a Vivitrol study in Wake County drug treatment court. Successes included establishing a string partnership between the court, treatment agency and study team, and successfully embedding a randomized drug trial in a complex community setting.

The challenges were working with vulnerable and often unstable population in which it was difficult to retain study participants, their fluctuating readiness to engage in treatment, and changes in federal funding and court policies affecting interest in studying medication.

Educators were very engaged with Robertson’s presentation and expressed a need for further MAT studies in their regions. They spanned the nation, including Chicago, New Jersey and Colorado.

“It’s exciting and an honor to be able to share our research with educators and clinicians, and to see what we have learned be applied in efforts to improve clinical care," Robertson said.