Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails

Abstract

BackgroundOpioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release.ResultsAll four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release.ConclusionsAdoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs.

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

“…Consistent with prior research, we find that the availability of community‐based OAT treatment and the ability to link individuals to providers following release was a significant challenge [30,31]. In 2014, fewer than 5% of individuals referred to treatment upon release from the criminal legal system received OAT or naltrexone [32].…”

The impact of the opioid crisis on U.S. state prison systems

“…Overall, lack of funds was the most frequently cited barrier to implementing all types of MOUD, either with regard to funding for medical staff or to cover cost of the medication, consistent with other studies of implementation of MOUD within correctional settings (Ferguson et al, 2019 ). However, unique issues were cited as barriers for each of the three types of medication.…”

“…Although this study identified the lack of funding as a significant barrier to the successful implementation of MOUD within state prison systems, recent federal funding initiatives provide potential resources. Yet, funding for additional resources, training, and education is not sufficient; critical to implementing MOUD within state prisons is a commitment to addressing the effects of the opioid crisis across leaders in criminal justice systems, health care, government, and community partners (Ferguson et al, 2019 ). Leaders across these systems can utilize the findings from the current study to advance policies to support the expansion of MOUD capacity to address the needs of individuals with OUD in state prisons.…”

The relationship between police contacts for drug use-related crime and future arrests, incarceration, and overdoses: a retrospective observational study highlighting the need to break the vicious cycle

“…In addition, Group 1 likely had a lower access to addiction treatment, especially MOUD, while incarcerated, because the vast majority of prisons and jails did not offer access to MOUD at that time. Although improvements have been made more recently, there are still significant gaps in addiction care, including MOUD, during and after incarceration [ 33 , 34 ]. Regardless of the surrounding circumstances, an opioid-related overdose, which requires an emergency response by the police, represents a significant event within an individual’s life and could be seen as an opportunity for intervention and referral to treatment, thereby altering the untreated addiction trajectory.…”