Methadone and buprenorphine prescribing and referral practices in US prison systems: Results from a Nationwide Survey

Abstract

Background-More than 50% of incarcerated individuals have a history of substance use, and over 200,000 individuals with heroin addiction pass through American correctional facilities annually. Opiate replacement therapy (ORT) with methadone or buprenorphine is an effective treatment for opiate dependence and can reduce drug-related disease and recidivism for inmates. Provision of ORT is nevertheless a frequently neglected intervention in the correctional setting.Objective and Methods-We surveyed the 50 state; Washington, District of Columbia (DC); and Federal Department of Corrections' medical directors or their equivalents about their facilities' ORT prescribing policies and referral programs for inmates leaving prison.Results-We received responses from 51 of 52 prison systems nationwide. Twenty-eight prison systems (55%) offer methadone to inmates in some situations. Methadone use varies widely across states: over 50% of correctional facilities that offer methadone do so exclusively for pregnant women or for chronic pain management. Seven states' prison systems (14%) offer buprenorphine to some inmates. The most common reason cited for not offering ORT was that facilities "prefer drug-free detoxification over providing methadone or buprenorphine." Twenty-three states' prison systems (45%) provide referrals for some inmates to methadone maintenance programs after release, which increased from 8% in 2003; 15 states' prison systems (29%) provide some referrals to community buprenorphine providers.Conclusion-Despite demonstrated social, medical, and economic benefits of providing ORT to inmates during incarceration and linkage to ORT upon release, many prison systems nationwide still do not offer pharmacological treatment for opiate addiction or referrals for ORT upon release.

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

“…For example, although the concept of narcotic blockade has been repeatedly documented since Vincent Dole's work with methadone in the 1960s (Dole et al, 1966;Kleber, 2007;Tetrault and Fiellin, 2012), less than half of respondents agreed, and 45-56% were uncertain, that agonist medication reduces or blocks the effects of heroin. These responses are consistent with previous findings both in other criminal justice dispensations (Nunn et al, 2009;Friedmann et al, 2012) and among community treatment providers (Kang et al, 1997;Kayman et al, 2006) and serve as a disquieting reminder that the stigma and uncertainty with which the public regards MAT stubbornly prevails even among experienced drug court professionals.. Numerous reasons were cited for why agonist medication was either not available or had limited availability to opioid-dependent drug court participants.…”

“…Previous studies have found both regional and population density differences in MAT attitudes and use (e.g. Peyton and Gossweiller, 2001;Nunn et al, 2009;Huddleston and Marlowe, 2011), and in the use of heroin and illicit prescription opioids (Rosenblum, et al, 2007). In order to examine attitudinal differences both within state and within urbanicity, three drug courts were selected from each state (150 total), stratified so that for each state, one urban, one suburban, and one rural court were randomly chosen.…”

“…The survey was designed with input from drug court professionals and was based in part on previous studies on MAT prescribing and referral practices in US prison systems (Nunn et al, 2009) as well as from scales that assessed counselor attitudes toward MAT (Caplehorn et al, 1997;Kang et al, 1997). Prior to launching the survey it was piloted with 10 drug courts.…”

“…Buprenorphine is a partial opioid agonist (often coformulated with naloxone, an opioid antagonist that precipitates withdrawal if injected) that has also been used to treat opioid dependence. Both buprenorphine and methadone are examples of medication-assisted treatment (MAT) for opioid abuse, and both are effective in reducing heroin and prescription opioid abuse as well as criminal behavior, HIV risk behaviors, and overdose deaths associated with opioid abuse (Nunn et al, 2009;Rich et al, 2005;Zaller et al, 2009). …”

“…Some state and federal prisons permit MAT for opioid-dependent prisoners, but the US criminal justice system has generally been reluctant to accept MAT (Magura et al, 2009;McMillan and Lapham, 2005;Nunn et al, 2009;Rich et al, 2005;Westermeyer, 2000). In 1999, a 202-court survey found that 39% of drug courts made methadone available to participants (Peyton and Gossweiler, 2001).…”