Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters

Original research
by
Bandara, Sachini et al

Release Date

2021

Geography

USA

Language of Resource

English

Full Text Available

No

Open Access / OK to Reproduce

No

Peer Reviewed

Yes

Objective

To identify implementation barriers and facilitators to the adoption and implementation of programs that provide opioid agonist treatments (OAT) with methadone and buprenorphine to treat opioid use disorder in jails and prisons in the United States.

Findings/Key points

Stigma among staff, particularly medical staff, challenged program adoption, but reduced over time as staff were exposed to the program. Regulations on OAT dispensation, such as licensing requirements and prescribing limits, were key challenges to program implementation and shaped program structure. Dispensing medication required significant staff, time and space. Facilities were further challenged to overcome stigma and concerns about diversion, as OAT medication is often treated as contraband in carceral settings. Some systems deviated from evidence-based treatment by limiting OAT dosage to low levels, requiring counseling for participation and requiring detoxification before medication initiation.

Design/methods

From August 2019 to January 2020, we conducted 20 key informant interviews with 35 individuals representing 19 carceral systems that both initiate and maintain OAT

Keywords

Safer supply
About prescribers
Justice system/law enforcement
Substitution/OAT