The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration.
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References
1.
R.Rudd, P.Seth, F.David, and L.Scholl, “Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015,”Morbidity and Mortality Weekly Report65 (2016):1445-1452.
2.
NIDA, “Overdose Death Rates: National Institute on Drug Abuse,”January6, 2017.
I.A.Binswanger, M.F.Stern, R.A.Deyoet al., “Release from Prison -- a High Risk of Death for Former Inmates,”New England Journal of Medicine356, no. 2 (2007):157-165.
5.
D.Fiellin, R.Heimer, W.Becker, and G.D’Onofrio, DMHAS, “The Connecticut Opioid REsponse Initiative,”October5, 2016.
6.
I.A.Binswanger, P.J.Blatchford, S.R.Mueller, and M.F.Stern, “Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009,”Annals of Internal Medicine159, no. 9 (2013):592-600.
7.
Id.
8.
Bureau of Justice Statistics, “Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002”, NCJ 209588, July2005; and “Drug Use and Dependence, State and Federal Prisoners, 2004,” NCJ 213530, October 2006.
9.
S.Galea and D.Vlahov, “Social Determinants and the Health of Drug Users: Socioeconomic Status, Homelessness, and Incarceration,”Public Health Reports17, Supplement 1 (2002): S135-S145.
H.D.Kleber, “Pharmacologic Treatments for Opioid Dependence: Detoxification and Maintenance Options,”Dialogues in Clinical Neuroscience9, no. 4 (2007):455-470.
13.
J.I.Tsui, J.L.Evans, P.J.Lum, J.A.Hahn, and K.Page, Opioid Agonist Therapy is Associated with Lower Incidence of Hepatitis C Virus Infection in Young Adult Persons who Inject Drugs,”JAMA Internernal Medicine174, no. 12 (2014):1974-1981.
14.
R.D.Bruce, “Methadone as HIV Prevention: High Volume Methadone Sites to Decrease HIV Incidence Rates in Resource Limited Settings,”International Journal of Drug Policy21, no. 2 (2010):122-124.
15.
A.Nunn, N.Zaller, C.Trimbur, A.Nijhawan, and J.D.Rich, “Methadone and Buprenorphine Prescribing and Referral Practices in US Prison Systems: Results from a Nationwide Survey,”Drug and Alcohol Dependence105, no. 1-2 (2009): 83-88.
16.
K.A.Dolan, J.Shearer, B.White, J.Zhou, J.Kaldor, A.D.Wodak, “Four-Year Follow-up of Imprisoned Male Heroin Users and Methadone Treatment: Mortality, Re-incarceration and Hepatitis C infection,”Addiction100, no. 6 (2005):820-828.
17.
R.Boucher, “The Case for Methadone Maintenance Treatment in Prisons,”Vermont Law Review27, no. 2 (2003):453-82.
18.
See Tsui, supra note 13.
19.
P.D.Friedmann, R.Hoskinson, M.Gordon, et al., “Medication-Assisted Treatment in Criminal Justice Agencies Affiliated with the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS): Availability, Barriers & Intentions,”Substance Abuse and Rehabilitation33, no. 1 (2012):9-18.
20.
See Tsui, supra note 13.
21.
A.S.Ludwig and R.H.Peters, “Medication-Assisted Treatment for Opioid use Disorders in Correctional Settings: an Ethics Review,”International Journal of Drug Policy25, no. 6 (2014): 1041-1046.
22.
Id.
23.
NIDA, “Principles of Drug Abuse Treatment for Criminal Justice Populations - A Research-Based Guide,”National Institute on Drug Abuse (2014).
24.
M.M.Denniston MM, R.B.Jiles, J.Drobeniuc, et al., «Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010,”Annal of Internal Medicine160, no. 5 (2014):293-300.
25.
B.Rabuy and D.Kopf, “Prisons of Poverty: Uncovering the pre-incarceration incomes of the imprisoned,” (2015), available at <https://www.prisonpolicy.org/reports/income.html> (last visited April 10, 2018).
26.
D.C.Daley, “Family and social aspects of substance use disorders and treatment,”Journal of Food and Drug Analysis21, no. 4 (2013):S73-S76; S. Calhoun, E. Conner, M. Miller, and N. Messina, “Improving the outcomes of children affected by parental substance abuse: a review of randomized controlled trials,” Substance Abuse and Rehabilition (2015): 15-24; L. Lander, J. Howsare, and M. Byrne, “The Impact of Substance Use Disorders on Families and Children: From Theory to Practice,” Social Work in Public Health 28, no. 0 (2013):194-205; M. Barnard and N. McKeganey, “The Impact of Parental Problem Drug use on Children: What is the Problem and What can be Done to Help?,” Addiction 99, no. 5 (2004): 552-559.
A.D.Fox, J.Maradiaga, L.Weiss, J.Sanchez, J.L.Starrels, C.O.Cunningham, “Release from Incarceration, Relapse to Opioid use and the Potential for Buprenorphine Maintenance Treatment: a Qualitative Study of the Perceptions of Former Inmates with Opioid use Disorder,”Addiction Science & Clinical Practice10, no. 1 (2015); W.A. Zule and D.P. Desmond, “Attitudes Toward Methadone Maintenance: Implications for HIV Prevention,” Journal of Psychoactive Drugs 30, no. 1 (1998):89-97.
