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

Wakeman, Sarah E.

doi:10.1001/journalofethics.2017.19.9.stas1-1709

Cited by 31 publications

(13 citation statements)

References 41 publications

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“…These prevalence rates are much higher than those observed for the French general population (cannabis 11%, cocaine 1.1% and heroin 0.2%) [29]. This illustrates the phenomenon of the concentration of illicit substance users in prison, which could be related in particular to the high frequency of incarcerations for drug legislation infractions (15% of incarcerations in 2012) [30, 31]. Other factors may also be involved, such as a lower socio-economic status or more frequent psychiatric disorders in the population of people that are likely to be incarcerated [4, 32].…”

Section: Discussionmentioning

confidence: 88%

Consumption of psychoactive substances in prison: Between initiation and improvement, what trajectories occur after incarceration? COSMOS study data

Rousselet

Guerlais²,

Caillet

et al. 2019

PLoS ONE

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BackgroundFew studies have examined the consumption trajectories of inmates after entry to prison. The aim of this study was to assess the changes in the consumption of psychoactive substance between the period before detention and during incarceration and to characterize the profiles of prisoners with similar consumption trajectories during incarceration.Methods and findingsA multicenter, cross-sectional study was performed in all of the prisons from one region of France. All prisoners incarcerated during their 3rd months, over 18 years old, and with a sufficient level of French fluency to participate in the study were recruited over a period of 12 months. A total of 800 prisoners were recruited. All prisoners were interviewed face-to-face by a trained interviewer. A majority of prisoners had used at least one psychoactive substance in the weeks prior to incarceration. During incarceration, a substantial reduction in alcohol and illicit drug consumption was observed. The initiation of consumption and an increase in consumption were primarily related to medications. Five different profiles of consumption before incarceration were identified. These profiles all had a high probability of migrating to a similar profile during detention, characterized by less severe consumption of psychoactive substances.ConclusionsBased on their consumption profile prior to incarceration, most prisoners would benefit from a specific medical evaluation as soon as possible following entry into detention. Prison could be an opportunity for reduced consumption and/or the initiation of treatment for the majority of prisoners, despite the pejorative development observed for a minority of prisoners during incarceration.

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Section: Discussionmentioning

confidence: 88%

Consumption of psychoactive substances in prison: Between initiation and improvement, what trajectories occur after incarceration? COSMOS study data

Rousselet

Guerlais²,

Caillet

et al. 2019

PLoS ONE

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“…Like people with diabetes or other chronic diseases, people receiving opioid agonist therapy depend on a daily medication to keep their disease in remission [59]. A refusal of OST in prisons leads to negative outcomes not only for the individuals but also for the institution, the communities, and society [1]. Opioid use disorder is a recognized chronic disease that requires treatment [60–62], and OST is a medical treatment—not a reward.…”

Section: Resultsmentioning

confidence: 99%

“…There is still a gap between the number of people living in prison in need of substitution therapy and those receiving it, although benefits such as reduced risk of death in the post-release period, reduced risk of transmission of infectious diseases, and reduced reoffending have been shown. Physicians working within correctional facilities are caught in a “dual loyalty conflict” wherein the punitive aspect of the correctional facilities’ mission and the best interest of their patients often oppose each other [1]. It is important to free the physicians from this conflict and to accept that it will not be possible to solve a health problem by criminal law resources.…”

Section: Resultsmentioning

confidence: 99%

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Opioid substitution therapy for people living in German prisons—inequality compared with civic sector

et al. 2019

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BackgroundThe above-average proportion of people with opioid use disorder living in prisons is a worldwide reality, and the need to treat these people was recognized internationally more than 20 years ago. Studies have shown that substitution therapies are best suited to treat opioid use disorder and reduce the risk of HIV and hepatitis C transmission and overdose. However, huge health inequalities exist in and outside of prison due to the different implementation of opioid substitution therapy (OST). People living in prisons are entitled to the best possible health care. This is established by the Universal Declaration of Human Rights and by the International Convention on Economic, Social and Cultural Rights. Solely the imprisonment, and not the loss of fundamental human rights, constitutes the punishment.MethodsA qualitative literature search using PubMed and Google Scholar was performed in order to identify relevant publications.ResultsThis review shows the inequality in availability of opioid substitution therapy for people living in prison compared with people outside of prison in Germany. It also gives possible reasons and evidence for this inequality, showing that continuing or initiating OST in prison is more beneficial for the health of people living in prison than abstinence-oriented treatment only.ConclusionIt is important that drug use disorder is treated as a serious illness also in prison. Joint efforts are needed to provide people living in prison with the best possible treatment and to minimize the adverse effects of drug use. Therefore, with laws, policies, and programs that conform to international human rights standards, each state must ensure that people living in prison receive the same health care as people outside of prison.

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“…In light of the known harms of drug criminalization and the current opioid crisis, it has been argued that there is a moral imperative to improve the standard of substance use disorder care available to people under correctional supervision. 71 …”

Section: Discussionmentioning

confidence: 99%

Association of Methadone Treatment With Substance-Related Hospital Admissions Among a Population in Canada With a History of Criminal Convictions

2019

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Key Points Question Is adherence to methadone associated with a lower risk of hospital admission among individuals with criminal convictions? Findings In this cohort study including 11 401 Canadian individuals, periods during which methadone was dispensed were associated with lower rates of any acute hospital admission. Meaning Adherence to methadone among individuals with criminal convictions may contribute to lower rates of acute hospitalization.

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

Cited by 31 publications

References 41 publications

Consumption of psychoactive substances in prison: Between initiation and improvement, what trajectories occur after incarceration? COSMOS study data

Consumption of psychoactive substances in prison: Between initiation and improvement, what trajectories occur after incarceration? COSMOS study data

Opioid substitution therapy for people living in German prisons—inequality compared with civic sector

Association of Methadone Treatment With Substance-Related Hospital Admissions Among a Population in Canada With a History of Criminal Convictions

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