Does incarceration influence patients’ goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail

Vail, William Lee; Faro, Elissa Z.; Watnick, Dana; Giftos, Jonathan; Fox, Aaron D.

doi:10.1016/j.drugalcdep.2021.108529

Cited by 15 publications

(12 citation statements)

References 27 publications

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“…These challenges rendered participants vulnerable to relapse, release revocations, and potential re-incarceration—as evidenced by the high percentage of those who returned positive urinalysis drug tests during their supervision period and consequently had their release suspended and/or returned to custody. Many of these challenges have been well documented in previous research that has highlighted critical OAT interruptions upon community release, resulting in negative health and social consequences (Jamin et al, 2021 ; Joudrey et al, 2019 ; Vail et al, 2021 ). For instance, a recent qualitative study conducted in multiple European countries found that individuals released into the community encountered similar barriers to OAT engagement, particularly in the first few days post-release.…”

Section: Discussionmentioning

confidence: 95%

“…For instance, system- and structural-level factors have been identified to uniquely impact and hinder OAT retention. These include sub-par release planning, administrative issues, challenges securing housing and employment, negative interactions with the correctional system and/or parole officers, and a lack of transportation (Bunting et al, 2018 ; Hu et al, 2020 ; Jamin et al, 2021 ; Joudrey et al, 2019 ; Vail et al, 2021 ; Velasquez et al, 2019 ). Individual-level (i.e., psychological or social/behavioural) barriers have also been identified, including motivation, mental and physical health conditions, stigma, stress, and poor social support including negative influences of substance-using peers which commonly contribute to substance use relapse (Binswanger et al, 2012 ; Jamin et al, 2021 ; Owens et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Russell

Pang

Nafeh

et al. 2022

International Journal of Qualitative Studies on Health and Well

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Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Russell

Pang

Nafeh

et al. 2022

International Journal of Qualitative Studies on Health and Well

View full text Add to dashboard Cite

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“…Many studies focused on incarcerated populations have been done outside of the U.S., where MOUD has longer been available in prisons 21 – 23 . Studies that have examined incarcerated individual's perspectives on MOUD treatment in the U.S. have primarily reported experiences of individuals released from jails rather than prisons, 24 , 25 focused primarily or exclusively on post-release MOUD experiences, 24 , 26 discussed use of MOUD in the context of a high-fentanyl drug environment, 27 or described how perspectives while incarcerated affect perceptions of MOUD use before or after release 25 . Findings across these studies highlight the challenge of returning to community life, 24 – 26 psychosocial barriers to recovery, 24 , 25 and how abstinence only as a goal (in which many considered MOUD incompatible) precluded many from initiating MOUD 25 , 26 .…”

Section: Introductionmentioning

confidence: 99%

“…25 Findings across these studies highlight the challenge of returning to community life, [24][25][26] psychosocial barriers to recovery, 24,25 and how abstinence only as a goal (in which many considered MOUD incompatible) precluded many from initiating MOUD. 25,26 While these studies highlight perspectives on MOUD of justice-involved persons, there is little research examining experiences of individuals who began MOUD while in state prison, often following prolonged periods without drug use, and how their perspectives changed following release. As MOUD programs begin to expand throughout U.S. correctional systems, it is critical to better understand incarcerated individuals' decision-making around MOUD, experiences with prison-based MOUD, and transitions to community-based treatment post-release.…”

Section: Introductionmentioning

confidence: 99%

Medications for Opioid use Disorder in State Prisons: Perspectives of Formerly Incarcerated Persons

et al. 2022

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Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants’ generally positive experiences with MOUD support the expansion of correctional MOUD programs.

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“…16,17 Additional research has begun exploring the barriers that justice-involved people face when seeking treatment in the community including stigma, limited social support, inadequate access to health care, and unstable housing. [18][19][20][21] The purpose of this study was to deepen our understanding of the factors that impact post-release treatment engagement among people who are incarcerated with access to all 3 MOUD options and discharge planning. To identify barriers, we conducted an analysis of semistructured qualitative interviews with patients in the RIDOC MOUD program and examined their prior experiences with MOUD in the community, previous discharge planning experiences, and anticipated barriers to treatment engagement in the community post-release.…”

mentioning

confidence: 99%

Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration

et al. 2022

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BackgroundAlthough the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist.MethodsWe conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12.ResultsParticipants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release.ConclusionOur findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.

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Does incarceration influence patients’ goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail

Cited by 15 publications

References 27 publications

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Medications for Opioid use Disorder in State Prisons: Perspectives of Formerly Incarcerated Persons

Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration

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