A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System

Grella, Christine E.; Ostile, Erika; Scott, Christy K.; Dennis, Michael L.; Carnavale, John

doi:10.1016/j.drugpo.2020.102768

Cited by 98 publications

(62 citation statements)

References 77 publications

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“…While studies have demonstrated benefits for prisoners, their families and prison staff, significant barriers to the delivery of, and prisoner participation in these programmes have also been identified (Grella et al 2020). This review identified similar barriers including the availability of illicit drugs, low levels of understanding about the OAT programmes among both staff and prisoners, concerns about withdrawal, and the stigma associated with participating in methadone programmes.…”

Section: Barriers To the Delivery And Development Of At Programmesmentioning

confidence: 93%

“…Such contextualised knowledge is essential for effective policy-making and implementation (Guba and Lincoln, 1994) but is often lost in quantitative studies through their use of the broader concepts required for quantification. Alongside Grella et al (2020), this review is also one of the few such studies to examine barriers to and facilitators of OAT programmes in prisons from the perspective of both prison staff (policy-makers, prison officers and health care staff) and prisoners. The focus in this review on implications for prison systems in lower middle income countries (LMICs), and the involvement of researchers with experience of working in an LMIC prison system, should also be noted and reflect the initial purpose of this systematic review to support the development of a qualitative research project on the implementation of OAT programmes in Indonesia, where there are concentrated epidemics among people who inject drugs (UNAIDS DATA 2019), many of whom are incarcerated (Altice et al 2016;Morineau et al 2012).…”

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confidence: 99%

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A systematic review of qualitative evidence on barriers to and facilitators of the implementation of opioid agonist treatment (OAT) programmes in prisons

Komalasari

Wilson

Haw

2021

International Journal of Drug Policy

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Background: Opioid Agonist Treatment (OAT) programmes are regarded as a gold standard treatment for people living with Opioid Use Disorders (OUDs). However, OAT programmes are often unavailable or poorly implemented in prisons, in spite of the large numbers of people living with OUDs and the high risk of HIV transmission in prison settings. Unusually, this systematic review synthesizes qualitative evidence relating to barriers to, and facilitators of, the implementation of OAT programmes in prisons in high-and low/middle-income countries (LMICs) to provide more nuanced, contextualised understandings of how prison stakeholders perceive and/or experience OAT programmes within different prison settings. Methods: We systematically reviewed six electronic databases for studies published between January 2005 and December 2019 involving prison stakeholders: policy-makers, governors, healthcare staff, prison officers, and prisoners. The search identified 8091 studies, of which only 16 incorporated qualitative methods (including qualitative elements of mixed methods) and met our quality criteria. Four of these studies were conducted in LMICs (Kyrgyzstan, Iran (2) and Indonesia). Results: Findings were organized under three broad themes: (1) perceived benefits of OAT programmes; (2) barriers to the implementation and development of OAT programmes; and (3) treatment processes. Discussion: A lack of a clear understanding of the roles of OAT programmes and doubts regarding their effectiveness for people living with OUDs in prisons are critical barriers to prisoner participation in both high-and LMIC countries. Prison systems, particularly in LMICs, often lack the resources to mitigate problems with implementation. This review highlights an urgent need to develop further qualitative studies into prison OAT programmes, employing varied methods to explore such contexts in greater depth and minimize the impact of harms relating to OUDs in prisons.

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Section: Barriers To the Delivery And Development Of At Programmesmentioning

confidence: 93%

mentioning

confidence: 99%

A systematic review of qualitative evidence on barriers to and facilitators of the implementation of opioid agonist treatment (OAT) programmes in prisons

Komalasari

Wilson

Haw

2021

International Journal of Drug Policy

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“…A key strategy to address the opioid epidemic among correctional populations is increased access to medications to treat OUD (MOUD, i.e., buprenorphine, methadone, naltrexone) (Brinkley-Rubinstein et al, 2017;Malta et al, 2019). MOUD program implementation inside correctional institutions requires significant organizational changes (Brinkley-Rubinstein et al, 2019;Grella et al, 2020;Mace et al, 2019). The Franklin County Sheriff's Office (FCSO) in Greenfield, Massachusetts, was among the first jails nationwide to offer buprenorphine and methadone, in addition to naltrexone, to treat residents with OUD.…”

Section: Treating Opioid Use Disorder In Criminal Justice Settingsmentioning

confidence: 99%

COVID-19 and treating incarcerated populations for opioid use disorder

Donelan

Hayes

Potee

et al. 2021

Journal of Substance Abuse Treatment

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The Franklin County Sheriff's Office (FCSO), in Greenfield, Massachusetts, is among the first jails nationwide to provide correctional populations with access to all three medications to treat. opioid use disorder (MOUD, i.e., buprenorphine, methadone, naltrexone). In response to the COVID-19 pandemic, FCSO quickly implemented comprehensive mitigation policies and adapted MOUD programming. Two major challenges for implementation of the MOUD program were the mandated rapid release of nonviolent pretrial individuals, many of whom were being treated with MOUD and released too quickly to conduct continuity of care planning; and establishing how to deliver physically distanced MOUD services in jail. FCSO implemented and adapted a hub-and-spoke MOUD model, developed telehealth capacity, and experimented with take-home MOUD at release to facilitate continuity-of-care as individuals re-entered the community. Experiences underscore how COVID-19 accelerated the uptake and diffusion of technology-infused OUD treatment and other innovations in criminal justice settings. Looking forward, to address both opioid use disorder and COVID-19, jails and prisons need to develop capacity to implement mitigation strategies, including universal and rapid COVID-19 testing of staff and incarcerated individuals, and be resourced to provide evidence-based addiction treatment. FCSO quickly pivoted and adapted MOUD programming because of its history of applying public health approaches to address the opioid epidemic. Utilizing public health strategies can enable prisons and jails to mitigate the harms of the co-occurring epidemics of OUD and COVID-19, both of which disproportionately affect criminal justice populations, for persons who are incarcerated and the communities to which they return.

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“…A critical research gap is understanding the implementation of programs that both initiate and maintain OAT across multiple US carceral settings [22]. Lessons learned from these early adopters can provide key information for jurisdictions considering carceral OAT programs and guide policies around the provision of OAT in these settings.…”

Section: Introductionmentioning

confidence: 99%

Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters

et al. 2021

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Aims To identify implementation barriers and facilitators to the adoption and implementation of programs that provide opioid agonist treatments (OAT) with methadone and buprenorphine to treat opioid use disorder in jails and prisons in the United States. Design Qualitative analysis: semi‐structured interviews were conducted and thematic analyses of transcripts and notes were performed using a hybrid inductive/deductive coding approach. Setting Jails and prisons in the United States. Participants From August 2019 to January 2020, we conducted 20 key informant interviews with 35 individuals representing 19 carceral systems that both initiate and maintain OAT. Measurements Interviews covered four domains: (1) program adoption; (2) policy influence on implementation; (3) program structure; and (4) program outcomes. Findings Stigma among staff, particularly medical staff, challenged program adoption, but reduced over time as staff were exposed to the program. Regulations on OAT dispensation, such as licensing requirements and prescribing limits, were key challenges to program implementation and shaped program structure. Dispensing medication required significant staff, time and space. Facilities were further challenged to overcome stigma and concerns about diversion, as OAT medication is often treated as contraband in carceral settings. Some systems deviated from evidence‐based treatment by limiting OAT dosage to low levels, requiring counseling for participation and requiring detoxification before medication initiation. Despite these challenges, early adopters felt strongly that other jails and prisons in the United States should provide OAT and that legislation and litigation may soon force OAT expansion in these carceral settings. Conclusions Despite identifying regulatory and logistical challenges, early adopters of opioid agonist treatment (OAT) programs in US jails and prisons demonstrate that OAT programs can successfully be implemented in carceral settings with tailoring to the specific context.

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A Scoping Review of Barriers and Facilitators to Implementation of Medications for Treatment of Opioid Use Disorder within the Criminal Justice System

Cited by 98 publications

References 77 publications

A systematic review of qualitative evidence on barriers to and facilitators of the implementation of opioid agonist treatment (OAT) programmes in prisons

A systematic review of qualitative evidence on barriers to and facilitators of the implementation of opioid agonist treatment (OAT) programmes in prisons

COVID-19 and treating incarcerated populations for opioid use disorder

Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters

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