“I Kicked the Hard Way. I Got Incarcerated.” Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments

Abstract

Incarceration is a common experience for individuals with opioid use disorder, including those receiving medication assisted treatments (MAT), such as buprenorphine or methadone. In the United States, MAT is rarely available during incarceration. We were interested in whether challenges with methadone maintenance treatment during incarceration affected subsequent attitudes toward MAT following release. We conducted semi-structured interviews with 21 formerly incarcerated individuals with opioid use disorder in community substance abuse treatment settings. Interviews were audio recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team. The three main themes relating to methadone were: 1) rapid dose reduction during incarceration; 2) discontinuity of methadone during incarceration; and 3) post incarceration aversion to methadone. Participants who received methadone maintenance treatment prior to incarceration reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration. The severe withdrawal during incarceration contributed to a subsequent aversion to methadone and adversely affected future decisions regarding reengagement in MAT. Though MAT is the most efficacious treatment for opioid use disorder, current penal policy, which typically requires cessation of MAT during incarceration, may dissuade individuals with opioid use disorder from considering and engaging in MAT after release from incarceration.

High drug related mortality rates following prison release: Assessing the acceptance likelihood of a naltrexone injection and related concerns

“…Whilst the practice in the prisons participating in this study was to stabilise opiate dependent prisoners on OST before consideration of a change of treatment strategy towards abstinence, it is noted that within some jurisdictions such as the United States, OST has limited availability within prisons, and that the experience of enforced opiate withdrawal arising in this context can militate against some prisoners being willing to accept OST in the future where it is available (Maradiaga et al, 2016;Mitchell et al, 2009). Enforced withdrawal in prison would lead to a reduced opiate tolerance upon release, which is one of the conditions associated with an increased risk of death from opiate overdose in the immediate period following prison release (Binswanger et al, 2007(Binswanger et al, , 2012Merrall et al, 2010).…”

“…Whilst the United Kingdom Ministry of Justice acknowledges the role of OST in treating opiate dependence in prisons, it also advises that wherever possible, drug dependent prisoners be encouraged to pursue a recovery strategy in the form of drug abstinence (House of Commons, 2012). In considering the question of treatment for opiate misuse amongst prisoners more broadly, it is important to remember that the availability of OST will vary across national jurisdictions with, for example, limited availability in the United States (Maradiaga, Nahvi, Cunningham, Sanchez & Fox, 2016;Mitchell et al, 2009).…”

Association of Methadone Treatment With Substance-Related Hospital Admissions Among a Population in Canada With a History of Criminal Convictions

“…Reviewers have identified a substantial gap between policy 66 and evidence-based approaches 25 , 67 for people who have been involved with the justice system. 68 In attempts to bridge this gap, studies have evaluated the importance of early engagement in primary care 69 and team-based behavioral health models in the postrelease period, 70 demonstrating significant reductions in emergency department use and readmission rates, respectively. In light of the known harms of drug criminalization and the current opioid crisis, it has been argued that there is a moral imperative to improve the standard of substance use disorder care available to people under correctional supervision.…”

Why It's Inappropriate Not to Treat Incarcerated Patients with Opioid Agonist Therapy

“…This approach has been shown to decrease community treatment entry [23]. It also functions to detract people with a history of incarceration from engaging in treatment due to fear of subsequent forced withdrawal [24].…”