Community‐based treatment for opioid dependent offenders: A pilot study

Abstract

Background Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. Objective To compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. This project randomly assigned 15 jail diversion participants to either: (1) primary care buprenorphine OST, (2) specialist facility buprenorphine OST, or (3) specialist facility methadone OST. Participation lasted 13.5 months (12 month active treatment plus a post-participation visit). Results All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (−0.24±0.17) compared to primary care (0.02±0.14; p=0.032). Conclusion Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. Scientific significance Further research is needed to clarify (1) the role of primary care in addicted offender management, and (2) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.

Primary care models for treating opioid use disorders: What actually works? A systematic review

“…MAT uses pharmacological treatments such as buprenorphine and methadone coupled with psychosocial care to treat patients with OUD. [ 6 ] Primary care-based models for MAT appear to have roughly equivalent efficacy and outcomes to specialty substance treatment facilities in certain populations with the added advantage of managing, and potentially improving, comorbidity outcomes[ 7 – 12 ]. A recent scoping review has only looked at U.S. models, but no systematic, rigorous international comparisons with a focus on implementation structures and processes of OUD MAT in primary care settings exist to date [ 13 ].…”

Substance misuse and community supervision: A systematic review of the literature

“…However, it is difficult to draw firm conclusions from much of this literature due to its heterogeneity in terms of the specific types of treatment and intervention being investigated, and the methodological approaches being employed. We did not use quality assessment to exclude studies from this review, and many of those included were small-scale and/or noted that further research is needed to establish the generalisability of their findings (see for example Brodie et al., 2009 ; Brown et al., 2013 ; Claus & Kindleberger, 2002 ; Cropsey et al., 2011 ; Hollway et al., 2007 ; J. F. Kelly et al., 2005 ; Martin et al., 2004 ; Martin et al., 2003 ). We grouped the studies into specific types of treatment or intervention, but even within these categories, there was a huge amount of variation.…”

“…Overall, 31 studies on substance misuse met the criteria for inclusion in the review. These studies were published between 2000 and 2014 in the USA ( Alemi et al., 2006 ; Anglin, Nosyk, Jaffe, Urada, & Evans, 2013 ; Brewster, 2001 ; Brown, Gassman, Hetzel, & Berger, 2013 ; Chun et al., 2007 ; Claus & Kindleberger, 2002 ; Cropsey et al., 2011 ; Evans, Li, Urada, & Anglin, 2014 ; Gottfredson & Exum, 2002 ; Gray, 2002 ; Gregoire & Burke, 2004 ; Gryczynski et al., 2012 ; Harrell, Cavanagh, & Roman, 2000 ; J. F. Kelly, Finney, & Moos, 2005 ; S. M. Kelly, O'Grady, Jaffe, Gandhi, & Schwartz, 2013 ; Kleinpeter, Deschenes, Blanks, Lepage, & Knox, 2006 ; Longshore et al., 2005 ; Mackin et al., 2008 ; Marchand, Waller, & Carey, 2006 ; Martin, Clapp, Alfers, & Beresford, 2004 ; Martin et al., 2003 ; Sia, Dansereau, & Czuchry, 2000 ; Stageberg, Wilson, & Moore, 2001 ), the UK ( Ashby, Horrocks, & Kelly, 2010 ; Eley, Gallop, McIvor, Morgan, & Yates, 2002 ; Hearnden, 2000 ; McSweeney, Stevens, Hunt, & Turnbull, 2007 ; Powell, Bankart, Christie, Bamber, & Arrindell, 2009 ; Turnbull & Webster, 2007 ), Ireland ( Hollway, Mawhinney, & Sheehy, 2007 ) and Mexico ( Brodie et al., 2009 ). Due to the heterogeneous nature of the papers, we have organised them into subsections below.…”

“…Findings from the first of these studies, a small-scale feasibility study, suggested that buprenorphine opioid substitution treatment in primary care, as opposed to a specialist facility, may be effective in terms of reducing illegal drug use, and potentially in terms of reducing HIV risk behaviours ( Brown et al., 2013 ).…”

Facilitators and barriers to utilization of medications for opioid use disorder in primary care in South Carolina

“…18,19 When it comes to treatment of opioid use disorder, primary care has similar retention rates compared to those in specialty care. [20][21][22] There has been a call for increasing MOUD availability in primary care to increase treatment capacity. 14,23 However, research suggests that MOUD is under-utilized by PCPs.…”