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

Abstract

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.

Multi-level implementation factors that influence scale-up of methadone maintenance treatment in Moldovan prisons: A qualitative study

“…Another possibility is that individuals receiving MMT begin to feel more favorably toward the prison administration over time as they interact with them on a daily basis, since MMT requires daily exposure to the prison administration. A plausible explanation for this increased favorability is that the medical personnel providing MMT in Moldovan prisons may begin to relinquish stigmatizing attitudes toward methadone as they continue to provide this treatment, a pattern that other studies have observed in prison settings elsewhere (Bandara et al, 2021).…”

Jail-based treatment for opioid use disorder in the era of bail reform: a qualitative study of barriers and facilitators to implementation of a state-wide medication treatment initiative

“…Years of public health advocacy around this issue [ 10 ], along with several lawsuits against correctional facilities that refused to provide MOUD in the midst of a worsening opioid epidemic [ 11 ], have pushed jurisdictions around the country to increase access to MOUD in correctional settings. Despite initial success in some model states such as Rhode Island [ 12 ] much remains to be learned about addressing implementation challenges related to acceptance, adoption and sustainability of MOUD behind bars and upon release [ 13 ].…”

“…Local jails experience particular challenges to implementing MOUD programs [ 13 ]. Unlike prisons, jails are typically overseen by local governments and primarily house persons awaiting trial who cycle rapidly through them, often with unpredictable lengths of stay.…”

Reversal of increases in methadone distribution for opioid use disorder in the US during the COVID-19 pandemic

“…Most importantly, new patients wishing to initiate methadone treatment were faced with this barrier in 20% of clinics (19). Similarly, prior to the pandemic, both methadone and buprenorphine-based OTPs were found to be effective in US jails and prisons; however, following the pandemic, these OTPs have been discontinued (20)(21).…”

“…Most importantly, new patients wishing to initiate methadone treatment were faced with this barrier in 20% of clinics (19). Similarly, prior to the pandemic, both methadone and buprenorphine-based OTPs were found to be effective in US jails and prisons; however, following the pandemic, these OTPs have been discontinued (20-21). Together, it is very important to examine the changes in methadone distribution during the COVID-19 pandemic and determine whether there are regional disparities in access to this evidence-based pharmacotherapy.…”