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

Komalasari, Rita; Wilson, Sarah; Haw, Sally

doi:10.1016/j.drugpo.2020.102978

Cited by 23 publications

(16 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The experiences of these early adopters can provide implementation success stories and guidance on program structure to other carceral programs considering adopting OAT. Consistent with prior research, we find that OAT provision is challenged by logistic constraints, stigma and difficulty with reentry services [19–21]. Participants in our study offer ways to overcome such barriers, including partnering with community OAT providers, eliminating unnecessary eligibility criteria and utilizing peer navigators.…”

Section: Discussionsupporting

confidence: 81%

“…Lessons learned from innovators and early adopters can contribute to the continued diffusion of an innovation, as the majority of adopters seek implementation success stories, evidence of effectiveness and pressure from peers to motivate adoption. Single‐site studies of OAT implementation among innovators and programs that only provide medication maintenance identify space and staffing constraints, stigma and difficulty in arranging post‐incarceration care as key challenges to implementation [19–21].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In both of the study prisons with MMT programmes, many prisoners indicated that they had experienced stigma associated with their participation in these programmes as indicated by previous study (Komalasari et al, 2020). This was confirmed by some health-care staff in the general methadone prison and has also been recognised in studies in other locations (Woo et al, 2017;Carlin, 2005;Mitchell et al, 2009).…”

Section: Discussionsupporting

confidence: 69%

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

Komalasari

Wilson

Nasir

et al. 2020

IJPH

Self Cite

View full text Add to dashboard Cite

Purpose In spite of the effectiveness of opioid antagonist treatment (OAT) in reducing injecting drug use and needle sharing, programmes in prison continue to be largely stigmatised. This affects programme participation and the quality of programmes delivered. This study aims to explore how Indonesian prison staff and prisoners perceived and experienced stigma relating to prison OAT programmes and identify potential strategies to alleviate this stigma. Design/methodology/approach Three prisons in Indonesia were selected as part of a qualitative case study. Two of the prisons provided OAT, in the form of methadone maintenance treatment (MMT). Purposive and snowball sampling were used to recruit study participants. In total, 57 semi-structured interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Prisoners included both participants and non-participants in methadone programmes. The data were analysed thematically. Findings MMT programme participants were perceived by both prison staff and other prisoners to be engaged in illicit drug use, and as lazy, poor, dirty and unproductive people. They were also presumed to be HIV-positive. These multi-layered, intersectional sources of (inter-personal) stigma amplified the effects on prisoners affecting not only their quality of life and mental health but also their access to prison parole programmes, and therefore the possibility of early release. In addition, organisational factors – notably non-confidential programme delivery and lack of both family and institutional supports for methadone prisoners – exacerbated the stigmatisation of MMT programme participants. Practical implications Effective strategies to alleviate stigma surrounding OAT programmes such as MMT programmes are urgently needed to ensure participation in and the quality of programmes in prisons. Originality/value Many prisoners reported experiencing stigma relating to their participation in MMT programmes in both the methadone prisons studied. They often emphasised the ways that this stigmatisation was amplified by the ways that MMT programme participation was associated with drug use and HIV infection. However, these intersecting experiences and concerns were not recognised by health-care staff or other prison staff. Effective strategies to alleviate stigma surrounding OAT programmes such as MMT programmes are urgently needed to ensure participation in and the quality of programmes in prisons.

show abstract

“…In common with other studies (Sto ¨ver and Kastelic, 2016; Komalasari et al, 2020;Komalasari et al, 2021), this study found considerable misunderstandings relating to the use of methadone programmes as part of an HIV harm reduction strategy amongst both prison staff and prisoners and across all three study prisons. The idea that methadone is simply another type of illicit drug, was prevalent amongst most prison officers and some health-care staff, again across all three prisons.…”

Section: Discussionsupporting

confidence: 69%

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

Komalasari

Wilson

Haw

2021

IJPH

Self Cite

View full text Add to dashboard Cite

Purpose Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM). Design/methodology/approach The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically. Findings The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources. Research limitations/implications The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant. Practical implications Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners’ families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons. Social implications The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons. Originality/value This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.

show abstract

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

Cited by 23 publications

References 35 publications

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

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

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

Contact Info

Product

Resources

About