Management of Opiate Detoxification in Jails

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

doi:10.1300/j069v24n01_06

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…Forced or abrupt opioid withdrawal can cause profound mental and physical pain (including severe abdominal cramping, nausea, diarrhea, anxiety, and convulsions), and can have serious medical consequences for pregnant women and their fetuses, immunocompromised people, and people suffering from comorbid medical disorders (Fiscella et al, 2005). The trauma of imprisonment, coupled with severe opioid withdrawal, can also increase the risk of suicide in opioid dependent individuals with co-occurring disorders (USDHHS, 2005).…”

Section: Risk Environment Created By Withholding Treatmentmentioning

confidence: 99%

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Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention

Bruce

Schleifer

2008

International Journal of Drug Policy

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Opioid dependence is a complex medical condition affecting neurocognitive and physical functioning. Forced or abrupt opioid withdrawal may cause profound physical and psychological suffering, including nausea, vomiting, diarrhoea, extreme agitation and/or anxiety. Opioid-dependent individuals are especially vulnerable at the time of arrest or initial detention, when they may, as a result of their chemical dependency, be coerced into providing incriminating testimony, or be driven to engage in risky behaviour (such as sharing needles in detention) in order to avoid painful withdrawal symptoms. Upon incarceration, many opioid-dependent prisoners are forced to undergo abrupt opioid withdrawal (both from legally prescribed agonist therapy such as methadone as well as illicit opioids). Physical and psychological symptoms attendant to withdrawal may impair capacity to make informed legal decisions, and cause prisoners to risk HIV and other blood-borne diseases by sharing injection equipment. Although prisons must provide at least the standard of care to prisoners that is available in the general population, medication-assisted treatment, endorsed by international health and drug agencies as an integral part of HIV prevention and care strategies for opioid-dependent drug users, is unavailable to most prisoners. Medication-assisted treatment is a well-studied and validated pharmacological therapy for the medical condition known as opioid dependence. The failure to ensure prisoner access to this medical therapy threatens fundamental human rights protections against cruel, inhuman or degrading treatment and rights to health and to life. It also poses serious ethical problems for health care providers, violating basic principles of beneficence and non-maleficence (i.e., do good/do no harm). Governments must take immediate action to ensure access to opioid substitution to prisoners to ensure fulfilment of ethical and human rights obligations.

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Section: Risk Environment Created By Withholding Treatmentmentioning

confidence: 99%

“…Third, medications used in medication assisted treatment (MAT) are illegal in some jurisdictions (See, e.g., Human Rights Watch, 2007). And in the limited number of facilities that would be theoretically open to MAT, they are often fearful of diversion within the prison itself (Fiscella et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention

Bruce

Schleifer

2008

International Journal of Drug Policy

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“…However, providing medical detoxification from opiates, benzodiazepines, and alcohol is not part of standard practice in correctional institutions (Mason et al, 1997). For example, Fiscella and colleagues (2005) conducted a survey on the management of opiate detoxification in 245 U.S. jails. Fifty-six percent of jails routinely screened arrestees for opiate dependency and 59% used standardized opiate detoxification protocols.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, methadone and other opiates (e.g., codeine/Darvon, etc.) were used by 1% and 2% of jails respectively to treat opiate withdrawal (Fiscella et al, 2005). The practice of denying inmates medication to alleviate withdrawal symptoms is stigmatizing, punitive, and potentially life-threatening.…”

Section: Introductionmentioning

confidence: 99%

Organizational-level correlates of the provision of detoxification services and medication-based treatments for substance abuse in correctional institutions

Oser

Knudsen

Staton‐Tindall

et al. 2009

Drug and Alcohol Dependence

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In recent years, there has been an increased examination of organizational-level innovation adoption in substance abuse treatment organizations. However, the majority of these studies have focused on community-based treatment centers. One understudied area of the substance abuse treatment system is correctional institutions. This study uses the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative's National Criminal Justice Treatment Practices survey (NCJTP) to examine the adoption of detoxification services and pharmacotherapies for the treatment of substance abuse across a nationally representative sample of correctional institutions (n=198). There were significant differences between jails and prisons in the percentage of organizations offering detoxification services and medications. Specifically, detoxification services were offered by 5% of prisons and 34% of jails; and, medications were offered by 6% of prisons and 32% of jails. Binary logistic regression models were used to examine the associations between these services and organizational characteristics, including context, resources, previously introduced practices, culture, and systems integration. Variables measuring organizational context and previously introduced practices were significant correlates of the provision of both detoxification services and medications. Multivariate results indicated that the differences between jails and prisons remained significant after controlling for other organizational factors. Although the adoption of detoxification services and pharmacotherapies may be a controversial topic for correctional institutions, these services have the potential to improve offender well-being and reduce public health risks associated with substance abuse.

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“…Nevertheless, although methadone maintenance has been available in the United States for decades, its uptake among criminal justice populations has been slow (13,14). Based on national data of treatment admissions, heroin users who are referred to substance abuse treatment by the criminal justice system are significantly less likely to have methadone planned as part of their care (15).…”

Section: Introductionmentioning

confidence: 99%

Opioid Agonist Maintenance for Probationers: Patient-Level Predictors of Treatment Retention, Drug Use, and Crime

et al. 2012

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This study examined outcomes and their predictors among 181 probationers enrolling in opioid agonist maintenance with methadone or levo-alpha-acetylmethadol (LAAM). Participants were interviewed at treatment entry and 2-, 6-, and 12-month follow-ups. Treatment retention and frequency of heroin use, cocaine use, and income-generating criminal activity were examined using survival and longitudinal analyses. Participants reported marked reductions in drug use and crime relative to treatment entry. A number of patient characteristics associated with various outcomes were identified. The findings support engaging probationers in treatment and highlight patient factors that might influence outcomes.

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Management of Opiate Detoxification in Jails

Cited by 11 publications

References 14 publications

Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention

Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention

Organizational-level correlates of the provision of detoxification services and medication-based treatments for substance abuse in correctional institutions

Opioid Agonist Maintenance for Probationers: Patient-Level Predictors of Treatment Retention, Drug Use, and Crime

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