Physician prescribing of opioid agonist treatments in provincial correctional facilities in Ontario, Canada: A survey

Kouyoumdjian, Fiona G.; Patel, Alexandra; To, Matthew J.; Kiefer, Lori; Regenstreif, Lori

doi:10.1371/journal.pone.0192431

Cited by 21 publications

(35 citation statements)

References 43 publications

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“…The barriers to continuity of care identified by providers, including disruptions to patientprovider relationships, medication access and health insurance coverage, align well with findings from previous research that explored experiences of individuals recently released from incarceration, as well as physicians who work in jail or prison settings [22][23][24][25]. Such disruptions to care may contribute to poor health outcomes and an increased risk of recidivism.…”

Section: Discussionsupporting

confidence: 67%

Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

et al. 2021

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Background In 2016, over 11 million individuals were admitted to prisons and jails in the United States. Because the majority of these individuals will return to the community, addressing their health needs requires coordination between community and correctional health care providers. However, few systems exist to facilitate this process and little is known about how physicians perceive and manage these transitions. Objective The goal of this study was to characterize physicians’ views on transitions both into and out of incarceration and describe how knowledge of a patient’s criminal justice involvement impacts patient care plans. Methods Semi-structured interviews were conducted between October 2018 and May 2019 with physicians from three community clinics in Hennepin County, Minnesota. Team members used a hybrid approach of deductive and inductive coding, in which a priori codes were defined based on the interview guide while also allowing for data-driven codes to emerge. Results Four themes emerged related to physicians’ perceptions on continuity of care for patients with criminal justice involvement. Physicians identified disruptions in patient-physician relationships, barriers to accessing prescription medications, disruptions in insurance coverage, and problems with sharing medical records, as factors contributing to discontinuity of care for patients entering and exiting incarceration. These factors impacted patients differently depending on the direction of the transition. Conclusions Our findings identified four disruptions to continuity of care that physicians viewed as key barriers to successful transitions into and out of incarceration. These disruptions are unlikely to be effectively addressed at the provider level and will require system-level changes, which Medicaid and managed care organizations could play a leading role in developing.

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Section: Discussionsupporting

confidence: 67%

Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

et al. 2021

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“…Few criminal justice facilities routinely and adequately screen their populations for OUD, and a smaller percentage provide OAT for incarcerated individuals with diagnosed OUD [12,13]. Significant barriers to adopting and routinizing OAT in correctional institutions exist, and concerns range from medication diversion and safety to constraints related to organizational resources, prohibitive legislations, and continuity of care [22,23].…”

Section: Introductionmentioning

confidence: 99%

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

et al. 2019

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BackgroundWorldwide opioid-related overdose has become a major public health crisis. People with opioid use disorder (OUD) are overrepresented in the criminal justice system and at higher risk for opioid-related mortality. However, correctional facilities frequently adopt an abstinence-only approach, seldom offering the gold standard opioid agonist treatment (OAT) to incarcerated persons with OUD. In an attempt to inform adequate management of OUD among incarcerated persons, we conducted a systematic review of opioid-related interventions delivered before, during, and after incarceration.Methods and findingsWe systematically reviewed 8 electronic databases for original, peer-reviewed literature published between January 2008 and October 2019. Our review included studies conducted among adult participants with OUD who were incarcerated or recently released into the community (≤90 days post-incarceration). The search identified 2,356 articles, 46 of which met the inclusion criteria based on assessments by 2 independent reviewers. Thirty studies were conducted in North America, 9 in Europe, and 7 in Asia/Oceania. The systematic review included 22 randomized control trials (RCTs), 3 non-randomized clinical trials, and 21 observational studies. Eight observational studies utilized administrative data and included large sample sizes (median of 10,419 [range 2273–131,472] participants), and 13 observational studies utilized primary data, with a median of 140 (range 27–960) participants. RCTs and non-randomized clinical trials included a median of 198 (range 15–1,557) and 44 (range 27–382) participants, respectively. Twelve studies included only men, 1 study included only women, and in the remaining 33 studies, the percentage of women was below 30%. The majority of study participants were middle-aged adults (36–55 years). Participants treated at a correctional facility with methadone maintenance treatment (MMT) or buprenorphine (BPN)/naloxone (NLX) had lower rates of illicit opioid use, had higher adherence to OUD treatment, were less likely to be re-incarcerated, and were more likely to be working 1 year post-incarceration. Participants who received MMT or BPN/NLX while incarcerated had fewer nonfatal overdoses and lower mortality. The main limitation of our systematic review is the high heterogeneity of studies (different designs, settings, populations, treatments, and outcomes), precluding a meta-analysis. Other study limitations include the insufficient data about incarcerated women with OUD, and the lack of information about incarcerated populations with OUD who are not included in published research.ConclusionsIn this carefully conducted systematic review, we found that correctional facilities should scale up OAT among incarcerated persons with OUD. The strategy is likely to decrease opioid-related overdose and mortality, reduce opioid use and other risky behaviors during and after incarceration, and improve retention in addiction treatment after prison release. Immediate OAT after prison release and additional prev...

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“…Despite evidence that prevention and treatment options (e.g., methadone) may reduce the risk of death among opioid-dependent individuals [ 15 , 16 ], there remain significant barriers [ 17 , 18 ] and underutilisation [ 19 ] of substitution treatment options for offenders. Factors such as stigma, insufficient pharmacotherapy knowledge, concerns related to medication diversion, and poor links between corrections and community-based care providers can restrict access to methadone maintenance treatment (MMT) and continuity of care for offenders with opioid dependence [ 20 , 21 ] whether they are sentenced to custody or community settings, as well as following the completion of sentencing.…”

Section: Introductionmentioning

confidence: 99%

Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada

2018

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BackgroundIndividuals with criminal histories have high rates of opioid dependence and mortality. Excess mortality is largely attributable to overdose deaths. Methadone maintenance treatment (MMT) is one of the best evidence-based opioid substitution treatments (OSTs), but there is uncertainty about whether methadone treatment reduces the risk of mortality among convicted offenders over extended follow-up periods. The objective of this study was to investigate the association between adherence to MMT and overdose fatality as well as other causes of mortality.Methods and findingsWe conducted a retrospective cohort study involving linked population-level administrative data among individuals in British Columbia (BC), Canada with a history of conviction and who filled a methadone prescription between January 1, 1998 and March 31, 2015. Participants were followed from the date of first-dispensed methadone prescription until censoring (date of death or March 31, 2015). Methadone was divided into medicated (methadone was dispensed) and nonmedicated (methadone was not dispensed) periods and analysed as a time-varying exposure. Hazard ratios (HRs) with 95% CIs were estimated using multivariable Cox regression to examine mortality during the study period. All-cause and cause-specific mortality rates were compared during medicated and nonmedicated methadone periods. Participants (n = 14,530) had a mean age of 34.5 years, were 71.4% male, and had a median follow-up of 6.9 years. A total of 1,275 participants died during the observation period. The overall all-cause mortality rate was 11.2 per 1,000 person-years (PYs). Participants were significantly less likely to die from both nonexternal (adjusted HR [AHR] 0.27 [95% CI 0.23–0.33]) and external (AHR 0.41 [95% CI 0.33–0.51]) causes during medicated periods, independent of sociodemographic, criminological, and health-related factors. Death due to infectious diseases was 5 times lower (AHR 0.20 [95% CI 0.13–0.30]), and accidental poisoning (overdose) deaths were nearly 3 times lower (AHR 0.39 [95% CI 0.30–0.50]) during medicated periods. A competing risk regression demonstrated a similar pattern of results. The use of a Canadian offender population may limit generalizability of results. Furthermore, our observation period represents community-based methadone prescribing and may omit prescriptions administered during hospital separations. Therefore, the magnitude of the protective effects of methadone from nonexternal causes of death should be interpreted with caution.ConclusionsAdherence to methadone was associated with significantly lower rates of death in a population-level cohort of Canadian convicted offenders. Achieving higher rates of adherence may reduce overdose deaths and other causes of mortality among offenders and similarly marginalized populations. Our findings warrant examination in other study centres in response to the crisis of opiate-involved deaths.

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Physician prescribing of opioid agonist treatments in provincial correctional facilities in Ontario, Canada: A survey

Cited by 21 publications

References 43 publications

Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

Physicians’ perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada

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