Pharmacotherapy for opioid addiction in community corrections

Abstract

Pharmacotherapy for opioid addiction with methadone, buprenorphine, and naltrexone has proven efficacy in reducing illicit opioid use. These treatments are underutilized among opioid-addicted individuals on parole, probation or in drug courts. This paper examines the peer-reviewed literature on the effectiveness of pharmacotherapy for opioid addiction of adults under community-based criminal justice supervision in the US. Compared to general populations, there are relatively few papers addressing the separate impact of pharmacotherapy on individuals under community supervision. Tentative conclusions can be drawn from the extant literature. Reasonable evidence exists that illicit opioid use and self-reported criminal behavior decline after treatment entry and that these outcomes are as favorable among individuals under criminal justice supervision as the general treatment population. Surprisingly, there is no conclusive evidence regarding the extent to which pharmacotherapy impacts the likelihood of arrest and incarceration among individuals under supervision. However, given the proven efficacy of these three medications in reducing illicit opioid use and the evidence that in the general population, methadone and buprenorphine treatment are associated with reduction in overdose mortality, the use of all three pharmacotherapies among patients under criminal justice supervision should be expanded while more data are collected on their impact on arrest and incarceration.

Determination of Common Pharmaceutical Adulterants in Herbal Medicinal Products Used in the Treatment of Opioid Addiction

“…As a high-affinity and partial mu opioid receptor agonist, buprenorphine suppresses opioid withdrawal and craving. These drugs considered the most common medicines in OAT around the world [5]. Regarding the serious side effects such as respiratory depression and cardiac dysrhythmia as the result of methadone abuse, the consumption of adulterated herbal products is considered a health threat.…”

“…These drugs are mu opioid receptor agonists with different pharmacodynamic and pharmacokinetic characteristics [4]. These treatments play an effective role in improving opioid abuse/ addiction outcomes [5]. Unfortunately, the utilization of OAT is associated with the high risk of drug overdose, misuse, undesirable side effects, and drug interactions, especially among individuals in correctional settings or the complications of HIV disease [6,7].…”

The Health and Health Needs of People under Community Supervision

“…However, several small, randomized trials examining use of methadone or buprenorphine after release from prison or jail all support their efficacy in relapse prevention upon return to the community (Cropsey et al 2011; Gordon et al 2008; Magura et al 2009). A recent research review found only one randomized clinical trial for extended-release naltrexone and none for buprenorphine or methadone among patients on community supervision (Schwartz et al 2018). The single extended-release naltrexone trial found that people on community supervision who received naltrexone injections engaged in less opioid use but had no change in reincarceration rates compared to those who received placebo (Lee et al 2016).…”

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

“…OAT is an evidence-based and safe treatment that has been associated with beneficial outcomes among correctional populations upon community release. These include lowered illicit opioid use, overdoses, mortality, recidivism and re-incarceration, as well as increased health care and addiction treatment engagement, and better social re-integration (Akinsemolu et al, 2011 ; Cropsey et al, 2005 ; Crowley & Van Hout, 2017 ; Glanville et al, 2021 ; Hedrich et al, 2012 ; Malta et al, 2019 ; Moore et al, 2019 ; Perry et al, 2015 ; Schwartz et al, 2018 ; Sharma et al, 2016 ; Stallwitz & Stover, 2007 ). Confirmatory data on these benefits for Canadian-specific correctional populations also exist (Farrell-Macdonald et al, 2014 ; MacSwain et al, 2013 ; Russolillo, Moniruzzaman, McCandless et al, 2018 ; Russolillo, Moniruzzaman, Somers et al, 2018 ).…”