Abstract
Abstract
Background
Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD).
Methods
A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance.
Results
MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications.
Conclusion
Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.
Funder
National Institute on Drug Abuse
Publisher
Springer Science and Business Media LLC
Subject
Law,Public Health, Environmental and Occupational Health
Reference69 articles.
1. Adams, Z., Taylor, B. G., Flanagan, E. Kwon, E., Johnson-Kwochka, A. V., Elkington, K. S., Becan, J.E., & Aalsma, M. C. (2021). Opioid use disorder stigma, discrimination, and policyattitudes in a U.S. national sample of young adults. Journal of Adolescent Health, https://doi.org/10.1016/j.jadohealth.2020.12.142.
2. Alderks, C. E. (2017). Trends in the use of methadone, buprenorphine, and extended-release naltrexone at substance abuse treatment facilities: 2003–2015 (Update). In The CBHSQ Report: August 22, 2017. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration..
3. Alpert, A., Powell, D., & Pacula, R. L. (2018). Supply-side drug policy in the presence of substitutes: Evidence from the introduction of abuse-deterrent opioids. American Economic Journal: Economic Policy, 10(4), 1–35. https://doi.org/10.1257/pol.20170082.
4. Altekruse, S. F., Cosgrove, C. M., Altekruse, W. C., Jenkins, R. A., & Blanco, C. (2020). Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the mortality disparities in American communities study (MDAC). PLoS One, 15(1), e0227966. https://doi.org/10.1371/journal.pone.0227966.
5. Aronowitz, S. V., & Laurent, J. (2016). Screaming behind a door: The experiences of individuals incarcerated without medication-assisted treatment. Journal of Correctional Health Care, 22(2), 98–108. https://doi.org/10.1177/1078345816634079.
Cited by
43 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献