Jail Management of Arrestees/Inmates Enrolled in Community Methadone Maintenance Programs

Fiscella, Kevin; Moore, Andrew; Engerman, Judith; Meldrum, Sean

doi:10.1093/jurban/jth147

Cited by 44 publications

(28 citation statements)

References 20 publications

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“…10 In the USA, about 10% of people receiving methadone maintenance treatment are incarcerated annually. 11 With more than 300 000 citizens receiving methadone treatment, 12 this estimate equates to about 30 000 individuals per year who enter prison or jail receiving methadone. On incarceration in the USA, nearly 90% of people on prescribed methadone are forced to stop or taper off this treatment.…”

Section: Introductionmentioning

confidence: 99%

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial

et al. 2015

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Summary Background Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable symptoms of withdrawal and renders prisoners susceptible to relapse and overdose on release. We aimed to study the effect of forced withdrawal from methadone upon incarceration on individuals’ risk behaviours and engagement with post-release treatment programmes. Methods In this randomised, open-label trial, we randomly assigned (1:1) inmates of the Rhode Island Department of Corrections (RI, USA) who were enrolled in a methadone maintenance-treatment programme in the community at the time of arrest and wanted to remain on methadone treatment during incarceration and on release, to either continuation of their methadone treatment or to usual care—forced tapered withdrawal from methadone. Participants could be included in the study only if their incarceration would be more than 1 week but less than 6 months. We did the random assignments with a computer-generated random permutation, and urn randomisation procedures to stratify participants by sex and race. Participants in the continued-methadone group were maintained on their methadone dose at the time of their incarceration (with dose adjustments as clinically indicated). Patients in the forced-withdrawal group followed the institution’s standard withdrawal protocol of receiving methadone for 1 week at the dose at the time of their incarceration, then a tapered withdrawal regimen (for those on a starting dose >100 mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3 mg per day to 0 mg; for those on a starting dose ≤100 mg, the dose was reduced by 3 mg per day to 0 mg). The main outcomes were engagement with a methadone maintenance-treatment clinic after release from incarceration and time to engagement with methadone maintenance treatment, by intention-to-treat and as-treated analyses, which we established in a follow-up interview with the participants at 1 month after their release from incarceration. Our study paid for 10 weeks of methadone treatment after release if participants needed financial help. This trial is registered with ClinicalTrials.gov, number NCT01874964. Findings Between June 14, 2011, and April 3, 2013, we randomly assigned 283 prisoners to our study, 142 to continued methadone treatment, and 141 to forced withdrawal from methadone. Of these, 60 were excluded because they did not fit the eligibility criteria, leaving 114 in the continued-methadone group and 109 in the forced-withdrawal group (usual care). Participants assigned to continued methadone were more than twice as likely than forced-withdrawal participants to return to a community methadone clinic within 1 month of release (106 [96%] of 110 in the continued-methadone group compared with 68 [78%] of 87 in the for...

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Section: Introductionmentioning

confidence: 99%

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial

et al. 2015

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“…Reasons for not offering opioid agonist therapy include concerns about diversion and philosophical objection to the notion of agonist therapy-viewing it as a substitution and thus not as legitimate as abstinence-based recovery [21]. In addition to not initiating treatment for those who need it, most correctional facilities forcibly withdraw stable patients from opioid agonist therapy upon entry into the criminal justice system [22]. This approach has been shown to decrease community treatment entry [23].…”

Section: Objections To Opioid Agonist Therapymentioning

confidence: 99%

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

Wakeman¹

2017

AMA Journal of Ethics

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Due to the criminalization of drug use and addiction, opioid use disorder is overrepresented in incarcerated populations. Decades of evidence supports opioid agonist therapy as a highly effective treatment that improves clinical outcomes and reduces illicit opioid use, overdose death, and cost. Opioid agonist therapy has been both studied within correctional facilities and initiated prerelease. It has been found to be beneficial, yet few incarcerated persons receive this evidence-based treatment. In addition to not offering treatment initiation for those who need it, most correctional facilities forcibly withdraw stable patients from opioid agonist therapy upon their entry into the criminal justice system. This approach limits their access to evidence-based health care and results in negative outcomes for individuals, communities, and society.

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“…Less than 10% of prisons offer referrals to OAT upon release (90). A 2004 study found that only half of US jails provide opioid detoxification services using recommended protocols-methadone or clonidine (37).…”

Section: Interventions To Improve Health Services Delivered In Jail Amentioning

confidence: 99%

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States

Freudenberg

Heller

2016

Annu. Rev. Public Health

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In the past decade, many constituencies have questioned the efficacy, cost, and unintended consequences of mass incarceration in the United States. Although substantial evidence now demonstrates that US incarceration policies have had unintended adverse health consequences, we know less about the strategies and policies that can prevent or reduce these problems for justiceinvolved individuals and how the criminal justice system (CJS) can contribute to the Healthy People 2020 national goal of eliminating inequities in health. This review examines strategies that have been used to improve the health of people at various stages of CJS involvement, including diversion from jail and prison stays into community settings, improvements to the social and physical environments within correctional facilities, provision of health and other services to inmates, assistance for people leaving correctional facilities to make the transition back to the community, and systems coordination and integration.

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Jail Management of Arrestees/Inmates Enrolled in Community Methadone Maintenance Programs

Cited by 44 publications

References 20 publications

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial

Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial

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

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States

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