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Medication Assisted Treatment and Directed Opioid Recovery (MATADOR) Program

A program in a Massachusetts jail that delivers all three forms of medication treatment for opioid use disorder to eligible inmates

The Middlesex Sheriff's Office launched the Medication Assisted Treatment and Directed Opioid Recovery (MATADOR) Program in 2015, recognizing that a large portion of its inmates screened positive for opioid use disorder (OUD) upon admission to the Middlesex County Jail and House of Corrections. In addition, those recently released from incarceration are at extremely high risk for overdose. The MATADOR program began offering extended-release naltrexone injections (Vivitrol) to eligible inmates before reentry, and has recently expanded to using all three forms of medications for opioid use disorder (MOUD), including methadone and buprenorphine, in 2019 as part of a statewide pilot program. 

In addition to medication treatment, some innovative features of MATADOR include:

  • Each participant is assigned a recovery coach/navigator, who follows the individual for six months post-release and serves as an advocate and emotional support person as well as a communications link between the various entities involved in the person’s treatment and re-entry
  • Participants are enrolled in Medicaid during incarceration to ensure that continued treatment upon release is not cost-prohibitive to the individual
  • A large number of community resources are available to participants upon release
  • The program is voluntary and behavioral health services begin behind the wall and continue upon release

The program has been nationally recognized for its innovation. More information on the program can be found in the presentation here. Preliminary self-reported evaluation data is promising and an academic paper suggests that participants in MATADOR receiving Vivitrol as well as comprehensive services, including working with a recovery navigator, likely experienced reduced opioid-related mortality. 

76% of participants did not experience recidivism, and this percentage was even higher when participants actively worked with a recovery coach. 

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Report with evaluation
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article
Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails
Evaluation of an in-jail and post-release comprehensive treatment model for opioid use disorder in Massachusetts
Related Resources
Jail-based Medication-assisted Treatment: Promising Practices, Guidelines, and Resources for the Field
Partnering with Jails to Improve Reentry: A Guidebook for Community-Based Organizations
Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit
Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
Advancing the Implementation and Sustainment of Medication Assisted Treatment for Opioid Use Disorders in Prisons and Jails
Effectiveness of Medication Assisted Treatment for Opioid Use in Prison and Jail Settings: A Meta-analysis and Systematic Review
A Primer for Implementation of Overdose Education and Naloxone Distribution in Jails and Prisons
Interventions for Incarcerated Adults with Opioid Use Disorder in the United States: A Systematic Review with a Focus on Social Determinants of Health
Opioid-Related Treatment, Interventions, and Outcomes Among Incarcerated Persons: A Systematic Review
Reentry Matters: Strategies and Successes of Second Chance Act Grantees
Opioid Use Disorder Treatment in Jails and Prisons
MATADOR Evaluation.pdf

Evidence of Program Effectiveness

Providing MOUD to incarcerated individuals with OUD is an evidence-based practice. Specifically for the MATADOR program, self-reported results on recidivism during treatment with extended-release naltrexone are promising:

"536 unique individuals enrolled in the program and received at least one naltrexone injection between its launch in 2015 and September 2019. 76% of all participants, regardless of program completion status, did not recidivate—defined as a reconviction, reincarceration, and/or a violation of probation/parole that leads to additional jail time. However, among the 125 individuals who completed the six-month program of monthly injections and worked with a recovery coach, a slightly higher 82 percent did not recidivate."

Self-reported results on mortality are also promising:

"As of June 2018, 96% of MATADOR participants—regardless of their tenure in the program—had not succumbed to a fatal overdose post-release."

"There was no difference in opioid-related mortality between program participants and a propensity-matched comparison group (adjusted hazards ratio (aHR) 0.58, 95 % confidence interval (CI): 0.28-1.22). However, the sensitivity analysis found a decreased risk in the intervention group (aHR = 0.47, 95 % CI: 0.23-0.96) compared to a propensity-matched comparison group. Individuals who completed the program were less likely to experience an opioid overdose death (aHR=0.25, 95 % CI: 0.08-0.72) compared to a propensity-matched comparison group. Individuals who underwent a polysubstance detoxification upon incarceration were less likely to complete the program (adjusted odds ratio=0.32, 95 % CI: 0.17-0.59)...Extended-release naltrexone delivered within a comprehensive care model including recovery navigator support may be an effective option to reduce opioid-related mortality for incarcerated individuals who choose not to initiate opioid agonist treatment, but more research is needed." (Koutoujian et al., 2025)