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. 

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

Continuum of Care
Type of Evidence
Report with evaluation
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article

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."