Christy K Scott1, Michael L Dennis2, Christine E Grella3, Allison F Mischel3, John Carnevale4. 1. Chestnut Health Systems, 221 W. Walton St, Chicago, IL, 60610, USA. cscott@chestnut.org. 2. Chestnut Health Systems, 448 Wylie Dr, Normal, IL, 61761, USA. 3. Chestnut Health Systems, 221 W. Walton St, Chicago, IL, 60610, USA. 4. Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD, 20878, USA.
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.
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.
Authors: Josiah D Rich; Michelle McKenzie; David C Shield; Francis A Wolf; R Garrett Key; Michael Poshkus; Jennifer Clarke Journal: J Addict Dis Date: 2005
Authors: Shannon Gwin Mitchell; Sharon M Kelly; Barry S Brown; Heather Schacht Reisinger; James A Peterson; Adrienne Ruhf; Michael H Agar; Robert P Schwartz Journal: J Psychoactive Drugs Date: 2009-06
Authors: Roman Ivasiy; Lynn M Madden; Scott O Farnum; Natalia Shumskaya; Samy J Galvez de Leon; Daniel J Bromberg; Ainura Kurmanalieva; Aibek Duishenaliev; Ruslan Tokubaev; Frederick L Altice Journal: Drug Alcohol Depend Rep Date: 2022-07-19
Authors: Gabriel G Edwards; Ayako Miyashita-Ochoa; Enrico G Castillo; David Goodman-Meza; Ippolytos Kalofonos; Raphael J Landovitz; Arleen A Leibowitz; Craig Pulsipher; Ed El Sayed; Steven Shoptaw; Chelsea L Shover; Michelle Tabajonda; Yvonne S Yang; Nina T Harawa Journal: AIDS Behav Date: 2022-09-05
Authors: Carolyn Sufrin; Camille T Kramer; Mishka Terplan; Kevin Fiscella; Sarah Olson; Kristin Voegtline; Carl Latkin Journal: JAMA Netw Open Date: 2022-01-04