Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal

Moore, Kelly; Oberleitner, Lindsay; Smith, Kathryn M. Z.; Maurer, Kathleen; McKee, Sherry A.

doi:10.1097/adm.0000000000000381

Cited by 22 publications

(18 citation statements)

References 28 publications

(30 reference statements)

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“…Fourteen studies assessed the impact of OAT provision while incarcerated (Table 3). Seven of these studies were experimental [56–62], and 7 were observational [26,63–68]. Eight studies evaluated the impact of receiving OAT—primarily methadone—while incarcerated compared to opioid detoxification [26,60–64,67,68], and 2 studies evaluated the impact of methadone dose at the time of release [65,66].…”

Section: Resultsmentioning

confidence: 99%

“…Multiple studies have found that individuals with OUD who receive MMT during their incarceration period are more likely to access, initiate, and adhere to addiction treatment post-release, compared with individuals who do not receive MMT during their incarceration [60–62]. Findings from the RCT conducted by Brinkley-Rubinstein et al [61] also indicated that those who were assigned to tapered withdrawal from methadone after the first week of incarceration were significantly more likely to experience a nonfatal overdose during the 12-month follow-up period, compared to those who received MMT while incarcerated (OR = 2.83, 95% CI 1.05–7.61, p < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…A trial conducted by Moore et al [62] compared incarcerated persons who continued engagement in MMT ( n = 184) with a control group who underwent forced tapered withdrawal from MMT while in jail ( n = 198). The authors found that participants who were maintained on MMT during incarceration were more likely to engage in community-based MMT within 1 day (OR = 32.04, 95% CI 7.55–136.01, p < 0.001) and 30 days post-release (OR = 6.08, 95% CI 3.42–10.79, p < 0.001), compared to incarcerated persons with OUD who underwent forced tapered withdrawal from MMT.…”

Section: Resultsmentioning

confidence: 99%

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Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

et al. 2019

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BackgroundWorldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration.Methods and findingsWe systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273–131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27–960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15–1,557) and 44 (range 27–382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36–55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research.ConclusionsIn this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional prev...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

et al. 2019

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“…Importantly, as participants noted, incarceration could prevent or interrupt PrEP utilization among PWID by disconnecting individuals from regular sources of healthcare and social services. Novel intervention strategies are needed to provide PrEP during criminal justice system involvement and following release from incarceration, a period when injection-related risk behaviors for HIV acquisition are known to be high [ 64 – 66 ].…”

Section: Discussionmentioning

confidence: 99%

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

et al. 2018

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BackgroundAntiretroviral pre-exposure prophylaxis (PrEP) is clinically efficacious and recommended for HIV prevention among people who inject drugs (PWID), but uptake remains low and intervention needs are understudied. To inform the development of PrEP interventions for PWID, we conducted a qualitative study in the Northeastern USA, a region where recent clusters of new HIV infections have been attributed to injection drug use.MethodsWe conducted qualitative interviews with 33 HIV-uninfected PWID (hereafter, “participants”) and 12 clinical and social service providers (professional “key informants”) in Boston, MA, and Providence, RI, in 2017. Trained interviewers used semi-structured interviews to explore PrEP acceptability and perceived barriers to use. Thematic analysis of coded data identified multilevel barriers to PrEP use among PWID and related intervention strategies.ResultsAmong PWID participants (n = 33, 55% male), interest in PrEP was high, but both participants and professional key informants (n = 12) described barriers to PrEP utilization that occurred at one or more socioecological levels. Individual-level barriers included low PrEP knowledge and limited HIV risk perception, concerns about PrEP side effects, and competing health priorities and needs due to drug use and dependence. Interpersonal-level barriers included negative experiences with healthcare providers and HIV-related stigma within social networks. Clinical barriers included poor infrastructure and capacity for PrEP delivery to PWID, and structural barriers related to homelessness, criminal justice system involvement, and lack of money or identification to get prescriptions. Participants and key informants provided some suggestions for strategies to address these multilevel barriers and better facilitate PrEP delivery to PWID.ConclusionsIn addition to some of the facilitators of PrEP use identified by participants and key informants, we drew on our key findings and behavioral change theory to propose additional intervention targets. In particular, to help address the multilevel barriers to PrEP uptake and adherence, we discuss ways that interventions could target information, self-regulation and self-efficacy, social support, and environmental change. PrEP is clinically efficacious and has been recommended for PWID; thus, development and testing of strategies to improve PrEP delivery to this high-risk and socially marginalized population are needed.

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“…Opioid treatment programs, most notably the APT Foundation in New Haven, have expanded evidence-based treatment for OUD by adopting open access models that eliminate waiting lists and shorten intake times to 90 min [22]. Methadone treatment has been expanded to incarcerated persons in six of the state's correctional facilities, beginning with the jails in New Haven in 2013 and in Bridgeport the following spring [23]. Treatment in correctional facilities has been complemented by efforts of the Department of Corrections, which have reduced the incarcerated census by one-third between 2010 and 2019 [24].…”

Section: Introductionmentioning

confidence: 99%

A Community Responds to the COVID-19 Pandemic: a Case Study in Protecting the Health and Human Rights of People Who Use Drugs

2020

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Effective responses to a global pandemic require local action. In the face of a pandemic or similar emergencies, communities of people who use drugs face risks that result from their ongoing drug use, reduced ability to secure treatment for drug use and correlated maladies, lack of access to preventive hygiene, and the realities of homelessness, street-level policing, and criminal justice involvement. Herein, we document the efforts of a coalition of people who use drugs, advocates, service providers, and academics to implement solutions to reduce these risks at a municipal and state level focusing on New Haven and the State of Connecticut. This coalition identified the communities at risk: active users needing access to harm reduction services, persons in treatment needing access to their medications, the homeless and marginally housed needing improved hygiene, people engaged in sex work, and the incarcerated needing release from custody. The section describing each of the risks demonstrates how the coalition acted preemptively at early stages of the pandemic, ahead of official initiatives, to develop ameliorative risk reduction solutions. Outcomes discussed include instances in which obstacles were overcome or still remain.

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Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal

Abstract: Results support interventions that facilitate continuity of MMT during and after incarceration. Engagement of a community provider is feasible and can improve access to methadone in correctional facilities.

Cited by 22 publications

References 28 publications

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs

A Community Responds to the COVID-19 Pandemic: a Case Study in Protecting the Health and Human Rights of People Who Use Drugs

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