Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System

Green, Traci C.; Clarke, Jennifer G.; Brinkley‐Rubinstein, Lauren; Marshall, Brandon D. L.; Alexander‐Scott, Nicole; Boss, Rebecca; Rich, Josiah D.

doi:10.1001/jamapsychiatry.2017.4614

Cited by 256 publications

(164 citation statements)

References 6 publications

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“…It has been well documented that expanded access to medications for OUD is associated with reduced overdose mortality, among other public health benefits . In fact, providing medications for OUD for individuals in the criminal justice system, particularly those in the high‐risk postincarceration period, shows promise in reducing overdose death rates . Yet, the lack of available medication treatment remains a serious gap in the system of care for OUD …”

Section: Public Health Responsesmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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The roots of the remarkably lethal U.S. opioid crisis are complex and inextricably entangled with healthcare, especially in its treatment of another serious health problem: pain. Failures of the healthcare system—including lack of both training in pain management and caution in using an addictive class of medications—precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host–agent–environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the “vector” to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host–agent–vector–environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical‐related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.

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Section: Public Health Responsesmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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“…86,87 Rhode Island is the first and only state to offer all FDA-approved MAT options in prisons and jails, and research shows that this program reduced postrelease deaths by 60% and all opioid-related deaths in the state by >12%. 88 In April 2019, the First District US Court of Appeals ruled a rural Maine jail must provide MAT to a woman on maintenance therapy. 89…”

Section: Barriers To Remaining In Mat Case Example Fivementioning

confidence: 99%

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Grubb

2019

Clinical Therapeutics

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Opioid use disorder (OUD) is a pediatric and adolescent problem as most young adults (aged <25 years) in treatment programs report initiating use before 25 years of age, and there are lifelong impacts from early substance use necessitating early screening for opioid use and subsequent treatment. Medicationassisted treatment (MAT) is a highly effective intervention for OUD, and there is strong evidence for its use with adolescents; however, most adolescents with OUD are unable to access MAT or remain in MAT long term to achieve substantial recovery. Using case examples drawn from a pediatric and adolescent physician's experiences proving MAT to adolescents and young adults (ages 16e24 years), this article explores the personal and socioeconomic determinants in MAT of OUD in adolescents and young adults and provides suggestions for advocacy areas and resources to improve MAT with this population. (Clin Ther. 2019;41:1669e1680)

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“…Out‐patient OUD populations may respond to unavailability or reduced dosage of therapeutic opioids by increasing use of heroin and fentanyl, leading to higher fatality. Medication‐assisted treatment (MAT), a component of Harm Reduction has demonstrated effectiveness . It substitutes agonists—methadone and buprenorphine—for more dangerous drugs (through OST), counters opioid overdose with naloxone and naltrexone antagonists, and offers behavioral treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Harm reduction through medication‐assisted‐treatment (MAT) combines medication management (including OST replacement of higher risk opioid drugs with safer agents such as methadone or buprenorphine) with behavioral health services and counseling. There was a large reduction in post‐prison opioid overdose deaths when post release MATs including medication and therapy were implemented to counteract drug overdoses . “Risk Mitigation” interventions provide opioid antagonists to hundreds of medical facilities and even to paraprofessional programs.…”

Section: Harm Reductionmentioning

confidence: 99%

Commentary: The opioid overdose epidemic: Evidence‐based interventions

Barglow

2018

American J Addict

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Background and Objectives Outcome intervention data from Medicare, veteran, prison, and United States’ public populations can identify best practices to decrease opioid misuse. Prescription policies for treating pain in the United States and other countries are relevant to preventing overdose. Methods Three strategies are considered: (1) Demand Reduction counsels and educates patients and current or potential opioid users about risks and treatment options to reduce motivation to consume opioids. (2) Supply Reduction limits access and dosage of opioids and co‐drugs such as benzodiazepines. It encourages use of safest prescribing practices for treating pain. (3) Harm Reduction reduces opioid deaths through medication‐assisted treatment (MAT) combining opioid substitution therapy (OST), provision of opioid antagonists like Naltrexone, and behavioral health services. Results Demand Reduction is often inadequate to treat severe pain or in the presence of major psychopathology like opioid abuse disorder (OUD). Among veterans, lower opioid doses for pain treatment were associated with diminished death rates. Supply Reduction interventions have disadvantages. Banning drugs has poor long‐term success with prison inmates, because abstinence is difficult to enforce after discharge. Limiting opioid supplies does not increase survival rates for Medicare patients. Discussion and Conclusions Sharp opioid dose restriction in outpatient treatment increases heroin and fentanyl use, explaining why recent years’ decrease in United States opioid prescriptions has not reduced national mortality rates. Although Harm Reduction is the safest, most effective single approach, combining three interventions while improving pain and addiction prescribing practices is optimal. Scientific Significance Scientific research needs to inform choice of opioid overuse interventions. (Am J Addict 2018;XX:1–3)

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Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System

Abstract: Drs Green and Marshall had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Green, Clarke, Boss, Rich.

Cited by 256 publications

References 6 publications

Epidemiology of the U.S. opioid crisis: the importance of the vector

Epidemiology of the U.S. opioid crisis: the importance of the vector

Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Commentary: The opioid overdose epidemic: Evidence‐based interventions

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