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McLeod KE, Buxton JA, Karim ME, Martin RE, Nosyk B, Kurz M, Scow M, Felicella G, Slaunwhite AK. Receipt of Opioid Agonist Treatment in provincial correctional facilities in British Columbia is associated with a reduced hazard of nonfatal overdose in the month following release. PLoS One 2024; 19:e0306075. [PMID: 38985687 PMCID: PMC11236203 DOI: 10.1371/journal.pone.0306075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during incarceration and nonfatal overdose in the 30 days following release. METHODS AND FINDINGS Using linked administrative healthcare and corrections data for a random sample of 20% of residents of British Columbia, Canada we examined releases from provincial correctional facilities between January 1, 2015 -December 1, 2018, among adults (aged 18 or older at the time of release) with Opioid Use Disorder. We fit Andersen-Gill models to examine the association between receipt of OAT in custody and the hazard of nonfatal following release. We conducted secondary analyses to examine the association among people continuing treatment initiated prior to their arrest and people who initiated a new episode of OAT in custody separately. We also conducted sex-based subgroup analyses. In this study there were 4,738 releases of 1,535 people with Opioid Use Disorder. In adjusted analysis, receipt of OAT in custody was associated with a reduced hazard of nonfatal overdose (aHR 0.55, 95% CI 0.41, 0.74). This was found for prescriptions continued from community (aHR 0.49, 95%CI 0.36, 0.67) and for episodes of OAT initiated in custody (aHR 0.58, 95%CI 0.41, 0.82). The effect was greater among women than men. CONCLUSIONS OAT receipt during incarceration is associated with a reduced hazard of nonfatal overdose after release. Policies to expand access to OAT in correctional facilities, including initiating treatment, may help reduce harms related to nonfatal overdose in the weeks following release. Differences in the effect seen among women and men indicate a need for gender-responsive policies and programming.
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Affiliation(s)
- Katherine E. McLeod
- Department of Family Medicine, McMaster University, Hamilton, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Megan Kurz
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Marnie Scow
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Guy Felicella
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Amanda K. Slaunwhite
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Russell C, George TP, Chopra N, Le Foll B, Matheson FI, Rehm J, Lange S. Feasibility and effectiveness of extended-release buprenorphine (XR-BUP) among correctional populations: a systematic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-20. [PMID: 38940929 DOI: 10.1080/00952990.2024.2360984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
Background: Medications for opioid use disorder (MOUD) reduce risks for overdose among correctional populations. Among other barriers, daily dosing requirements hinder treatment continuity post-release. Extended-release buprenorphine (XR-BUP) may therefore be beneficial. However, limited evidence exists.Objectives: To conduct a systematic review examining the feasibility and effectiveness of XR-BUP among correctional populations.Methods: Searches were carried out in Pubmed, Embase, and PsychINFO in October 2023. Ten studies reporting on feasibility or effectiveness of XR-BUP were included, representing n = 819 total individuals (81.6% male). Data were extracted and narratively reported under the following main outcomes: 1) Feasibility; 2) Effectiveness; and 3) Barriers and Facilitators.Results: Studies were heterogeneous. Correctional populations were two times readier to try XR-BUP compared to non-correctional populations. XR-BUP was feasible and safe, with no diversion, overdoses, or deaths; several negative side effects were reported. Compared to other MOUD, XR-BUP significantly reduced drug use, resulted in similar or higher treatment retention rates, fewer re-incarcerations, and was cost-beneficial, with a lower overall monthly/yearly cost. Barriers to XR-BUP, such as side effects and a fear of needles, as well as facilitators, such as a lowered risk of opioid relapse, were also identified.Conclusion: XR-BUP appears to be a feasible and potentially effective alternative treatment option for correctional populations with OUD. XR-BUP may reduce community release-related risks, such as opioid use and overdose risk, as well as barriers to treatment retention. Efforts to expand access to and uptake of XR-BUP among correctional populations are warranted.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, ON, Canada
| | - Tony P George
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Nitin Chopra
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Bernard Le Foll
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, ON, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Addictions Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Flora I Matheson
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, a site of Unity Health Toronto, Toronto, ON, Canada
- Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Toronto, ON, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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McNeely HL, Schreiber TL, Swann WL, Amura CR. Facilitators and barriers to adopting or expanding medications for opioid use disorder provision in rural Colorado jails: a qualitative analysis. HEALTH & JUSTICE 2024; 12:26. [PMID: 38842589 PMCID: PMC11155088 DOI: 10.1186/s40352-024-00280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) is common among individuals who are incarcerated. However, OUD treatment services are sparse in smaller county jails found in many rural areas, which limits a healthy and supportive jail environment. This study assesses the facilitators of and barriers to medications for opioid use disorder (MOUD) adoption or expansion in rural Colorado jails. A qualitative descriptive design was implemented during the summer of 2022 using semi-structured interviews with jail staff, sheriffs, and contracted personnel. Interview questions focused on facilitators of existing MOUD services and barriers to adopting or expanding services. To identify the facilitators and barriers, data were coded using thematic analysis. RESULTS Seven jails were included in the study. Representatives from each jail participated in the seven interviews, which often included multiple participants per interview. Three of the jails had established routine practices for MOUD administration. Two jails occasionally administered MOUD or had plans in place to be able to administer, while the remaining two did not offer any MOUD. While administrative support, collaborative partnerships, and jail nurses facilitated MOUD use, barriers were more prevalent, including physical space limitations, distance to services, lack of providers in the area, staffing and training issues, funding/budget issues, and perceived risk of diversion. CONCLUSION Making MOUD available to people who are incarcerated is an important and timely step in enhancing the jail environment, especially in rural areas that often lack access to MOUD. As states look to require MOUD availability for people who are incarcerated, facilitators to MOUD adoption/expansion can be leveraged while strategies are needed to overcome barriers.
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Affiliation(s)
- Heidi L McNeely
- The Schreiber Research Group, P.O. Box 371342, Denver, CO, 80237, USA.
| | - Terri L Schreiber
- The Schreiber Research Group, P.O. Box 371342, Denver, CO, 80237, USA
| | - William L Swann
- The Schreiber Research Group, P.O. Box 371342, Denver, CO, 80237, USA
- School of Public Administration, College of Public Affairs and Community Service, University of Nebraska at Omaha, 6001 Dodge Street, CPACS 111, Omaha, NE, USA
| | - Claudia R Amura
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 East 19th Avenue, 3rd Floor - Room 3255, Aurora, CO, 80045, USA
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Marshall AD, Schroeder SE, Lafferty L, Drysdale K, Baldry E, Stoové M, Dietze P, Higgs P, Treloar C. Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209066. [PMID: 37156422 DOI: 10.1016/j.josat.2023.209066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia. METHODS Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semi-structured interview in Victoria, Australia. Inclusion criteria were informed consent, aged ≥18 years, history of injection drug use, incarcerated for ≥3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences. RESULTS Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41), with heroin most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT). CONCLUSION Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose).
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Sophia E Schroeder
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Mark Stoové
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Barenie RE, Cernasev A, Jasmin H, Knight P, Chisholm-Burns M. A Qualitative Systematic Review of Access to Substance Use Disorder Care in the United States Criminal Justice System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12647. [PMID: 36231947 PMCID: PMC9566712 DOI: 10.3390/ijerph191912647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The majority of patients with a substance use disorder (SUD) in the United States do not receive evidence-based treatment. Research has also demonstrated challenges to accessing SUD care in the US criminal justice system. We conducted a systematic review of access to SUD care in the US criminal justice system. METHODS We searched for comprehensive qualitative studies in multiple databases through April 2021, and two researchers reviewed 6858 studies using pre-selected inclusion criteria. Once eligibility was determined, themes were extracted from the data. This review provides a thematic overview of the US qualitative studies to inform future research-based interventions. This review was conducted in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS There were 6858 unique abstract results identified for review, and seven qualitative studies met the inclusion criteria. Two themes were identified from these results: (1) managing withdrawal from medication-assisted treatment, and (2) facilitators and barriers to treatment programs in the criminal justice system. CONCLUSIONS Qualitative research evaluating access to SUD care in the US criminal justice system varied, with some interventions reported not rooted in evidence-based medicine. An opportunity may exist to develop best practices to ensure evidence-based treatment for SUDs is delivered to patients who need it in the US criminal justice system.
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Affiliation(s)
- Rachel E. Barenie
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Hilary Jasmin
- Department of Clinical Pharmacy and Translational Science, Health Sciences Library, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Phillip Knight
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN 37211, USA
| | - Marie Chisholm-Burns
- School of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
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Scott R, Aboud A, O'Gorman T. Long-acting injectable buprenorphine - 'best practice' opioid agonist therapy for Australian prisoners. Australas Psychiatry 2022; 30:498-502. [PMID: 34852654 DOI: 10.1177/10398562211059086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To consider opioid agonist therapy in prisons. CONCLUSIONS Given the substantial risks of substance misuse by prisoners, long-acting injectable buprenorphine should be adopted as 'best practice' treatment in Australian prison populations.
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Affiliation(s)
- Russ Scott
- Prison Mental Health Service, Brisbane, Queensland, Australia
| | - Andrew Aboud
- Prison Mental Health Service, Brisbane, Queensland, Australia
| | - Thomas O'Gorman
- Metro North Mental Health Alcohol and Drug Service, Brisbane, Queensland, Australia
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Pivovarova E, Evans EA, Stopka TJ, Santelices C, Ferguson WJ, Friedmann PD. Legislatively mandated implementation of medications for opioid use disorders in jails: A qualitative study of clinical, correctional, and jail administrator perspectives. Drug Alcohol Depend 2022; 234:109394. [PMID: 35349918 PMCID: PMC9169252 DOI: 10.1016/j.drugalcdep.2022.109394] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with legal involvement and opioid use disorders (OUD) are at an increased risk of overdose and premature death. Yet, few correctional systems provide all FDA approved medications for OUD (MOUD) to all qualifying incarcerated individuals. We report on the implementation of MOUD in seven Massachusetts' jails following a state legislative mandate to provide access to all FDA-approved MOUD and to connect with treatment upon release. METHODS/PARTICIPANTS Based on the Exploration, Preparation, Implementation, and Sustainment framework, 61 clinical, corrections, and senior jail administrators participated in semi-structured interviews and focus groups between December 2019 and January 2020. Qualitative analyses focused on external and internal contexts and bridging factors. FINDINGS Participants detailed how the outer context (i.e., legislative mandate) drove acceptance of MOUD and assisted with continuity of care. Salient inner context factors included decision-making around administration of agonist medications, staff perceptions and training, and changes to infrastructure and daily routines. Leadership was critical in flattening standard hierarchies and advocating for flexibility. System-based characteristics of incarcerated individuals, specifically those who were pre-sentenced, presented challenges with treatment initiation. Inter- and intra-agency bridging factors reduced duplication of effort and led to quick, innovative solutions. CONCLUSIONS Implementation of MOUD in jails requires collaboration with and reliance on external agencies. Preparation for implementation should involve systematic reviews of available resources and connections. Implementation requires flexibility from institutional systems that are inherently rigid. Accordingly, leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success.
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Affiliation(s)
- Ekaterina Pivovarova
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, USA
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
| | - Claudia Santelices
- Claudia Santelices, Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Boston MA, 02115, USA
| | - Warren J Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School (UMCMS) - Baystate and Baystate Health, 3601 Main Street, Springfield, MA 01107, USA
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Beaudry G, Yu R, Alaei A, Alaei K, Fazel S. Predicting Violent Reoffending in Individuals Released From Prison in a Lower-Middle-Income Country: A Validation of OxRec in Tajikistan. Front Psychiatry 2022; 13:805141. [PMID: 35546919 PMCID: PMC9082534 DOI: 10.3389/fpsyt.2022.805141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although around 70% of the world's prison population live in low- and middle-income countries (LMICs), risk assessment tools for criminal recidivism have been developed and validated in high-income countries (HICs). Validating such tools in LMIC settings is important for the risk management of people released from prison, development of evidence-based intervention programmes, and effective allocation of limited resources. Methods We aimed to externally validate a scalable risk assessment tool, the Oxford Risk of Recidivism (OxRec) tool, which was developed in Sweden, using data from a cohort of people released from prisons in Tajikistan. Data were collected from interviews (for predictors) and criminal records (for some predictors and main outcomes). Individuals were first interviewed in prison and then followed up over a 1-year period for post-release violent reoffending outcomes. We assessed the predictive performance of OxRec by testing discrimination (area under the receiver operating characteristic curve; AUC) and calibration (calibration statistics and plots). In addition, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for different predetermined risk thresholds. Results The cohort included 970 individuals released from prison. During the 12-month follow-up, 144 (15%) were reincarcerated for violent crimes. The original model performed well. The discriminative ability of OxRec Tajikistan was good (AUC = 0.70; 95% CI 0.66-0.75). The calibration plot suggested an underestimation of observed risk probabilities. However, after recalibration, model performance was improved (Brier score = 0.12; calibration in the large was 1.09). At a selected risk threshold of 15%, the tool had a sensitivity of 60%, specificity of 65%, PPV 23% and NPV 90%. In addition, OxRec was feasible to use, despite challenges to risk prediction in LMICs. Conclusion In an external validation in a LMIC, the OxRec tool demonstrated good performance in multiple measures. OxRec could be used in Tajikistan to help prioritize interventions for people who are at high-risk of violent reoffending after incarceration and screen out others who are at lower risk of violent reoffending. The use of validated risk assessment tools in LMICs could improve risk stratification and inform the development of future interventions tailored at modifiable risk factors for recidivism, such as substance use and mental health problems.
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Affiliation(s)
- Gabrielle Beaudry
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Arash Alaei
- Department of Health Care Administration, California State University Long Beach, Long Beach, CA, United States
- Institute for International Health and Education, Albany, NY, United States
| | - Kamiar Alaei
- Department of Health Science, California State University Long Beach, Long Beach, CA, United States
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Russell C, Nafeh F, Pang M, MacDonald SF, Derkzen D, Rehm J, Fischer B. Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study. BMC Public Health 2022; 22:436. [PMID: 35246083 PMCID: PMC8897889 DOI: 10.1186/s12889-022-12685-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Background Incarcerated populations experience an elevated prevalence of opioid use disorder (OUD). Federal correctional institutions in Canada have increasingly treated OUD among correctional populations via opioid agonist treatment (OAT) – an evidence based pharmacotherapy that works to reduce drug use and related health harms. However, there is limited evidence regarding incarcerated individuals’ experiences with institutional-based OAT, as well potential OAT-related community release prospects. This information is important for optimal treatment retention and improved health. To address this knowledge gap, we conducted a longitudinal follow-up study examining OAT-related experiences among federally incarcerated individuals before and after community release. This article focuses on the baseline (pre-release) data. Methods This mixed-methods study examined OAT-related experiences and release prospects among n = 46 individuals scheduled for community release, recruited from seven federal prisons located in Ontario, Canada. Participants underwent a comprehensive interviewer-administered on-site assessment, including quantitative and qualitative items. Assessment data was furthermore linked to administrative correctional data. Data were analyzed using thematic qualitative and descriptive quantitative approaches. Results Participants had complex histories with opioid use including related negative health outcomes. Experiences with institutional OAT were divergent and provision was not standardized; those with OAT engagement pre-admission did not experience many challenges, whereas those initiating OAT during incarceration experienced barriers such as treatment waitlists and adverse process experiences. Most participants expressed a preference for buprenorphine-naloxone over methadone, but described difficulties accessing it. Participants were keen to transition into community-based treatment, yet envisaged prospective barriers and facilitators concerning successful reintegration and treatment continuity. Conclusions Major barriers towards the current administration of OAT in federal correctional systems in Canada exist, including extensive waitlists, non-standardized practices, and challenges accessing preferred OAT formulations; this contributes to sub-optimal treatment. Eliminating waitlists, standardizing OAT provision, providing additional OAT options, and more comprehensive release planning may be essential for treatment retention and positive outcomes.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.
| | - Frishta Nafeh
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Shanna Farrell MacDonald
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Dena Derkzen
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russia, 119146
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada.,School of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, 1023, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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10
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Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Subst Abuse Rehabil 2022; 13:1-12. [PMID: 35115860 PMCID: PMC8800858 DOI: 10.2147/sar.s304566] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/11/2022] [Indexed: 12/25/2022] Open
Abstract
Illicit drug use disorders are the most stigmatised health conditions worldwide, and stigma acts as a meaningful barrier to treatment entry and treatment provision. In the context of dramatically rising opioid-related harms, it is critical that we understand the drivers of stigma and how it affects opioid use disorder treatment and policy. The aim of this narrative review is to discuss how opioid-related stigma impacts treatment provision and harm reduction, and provide potential strategies to reduce stigma at a social and structural level. We used the Framework for Integrating Normative Influences on Stigma (FINIS) to identify sources of opioid-related stigma at the macro (structural stigma), meso (public stigma) and micro (internalised stigma) levels. Reducing stigma requires strategies that target multiple levels, however addressing inequity in the laws, regulations, and rules that segregate people with opioid and other substance use disorders from mainstream society is essential.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, 3199, Australia
- Turning Point, Eastern Health, Richmond, Victoria, 3121, Australia
- Correspondence: Suzanne Nielsen, Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria, 3199, Australia, Tel +61 3 9904 4641, Email
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11
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Treitler PC, Enich M, Reeves D, Crystal S. Medications for opioid use disorder in state prisons: Perspectives of formerly incarcerated persons. Subst Abuse 2022; 43:964-971. [PMID: 35420973 PMCID: PMC9869935 DOI: 10.1080/08897077.2022.2060448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: Opioid use disorder (OUD) is common among incarcerated persons and risk of overdose and other adverse drug-related consequences is high after release. Recognizing their potential to reduce these risks, some correctional systems are expanding access to medication for opioid use disorder (MOUD). This study explored the experiences and perspectives of formerly incarcerated individuals on MOUD use while incarcerated and after release. Methods: We interviewed 53 individuals with self-reported OUD who were released from New Jersey state prisons. Interviews explored motivations to use MOUD while incarcerated and after release, and experiences with prison-based MOUD and transition to community-based care. We performed cross-case analysis to examine common and divergent perspectives across participants. Results: A common reason for accepting prerelease MOUD was recognition of its effectiveness in preventing drug use, overdose, and other drug-related consequences. Participants who chose not to use MOUD often were focused on being completely medication-free or saw themselves as having relatively low-risk of substance use after a prolonged period without opioid use. A few participants reported challenges related to prison-based MOUD, including logistical barriers, stigma, and once-daily buprenorphine dosing. Most participants effectively transitioned to community-based care, but challenges included insurance lapses and difficulty locating providers. Conclusions: Many formerly incarcerated persons with OUD recognize the value of MOUD in supporting recovery, but some hold negative views of MOUD or underestimate the likelihood that they will return to drug use. Patient education on risks of post-release overdose, the role of MOUD in mitigating risk, and MOUD options available to them could increase engagement. Participants' generally positive experiences with MOUD support the expansion of correctional MOUD programs.
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Affiliation(s)
- Peter C. Treitler
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA
| | - Michael Enich
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA
| | - Donald Reeves
- Rutgers University Correctional Health Care, Bates Building, 2nd Floor, PO Box 863, Whittlesey Road & Stuyvesant Avenue, Trenton, NJ 08625, USA,Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, 671 Hoes Lane West, D325, Piscataway, NJ 08854, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA,School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901, USA,School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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12
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Bandara S, Kennedy-Hendricks A, Merritt S, Barry CL, Saloner B. Methadone and buprenorphine treatment in United States jails and prisons: lessons from early adopters. Addiction 2021; 116:3473-3481. [PMID: 33999458 DOI: 10.1111/add.15565] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/19/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
AIMS 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. DESIGN Qualitative analysis: semi-structured interviews were conducted and thematic analyses of transcripts and notes were performed using a hybrid inductive/deductive coding approach. SETTING Jails and prisons in the United States. PARTICIPANTS 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. MEASUREMENTS Interviews covered four domains: (1) program adoption; (2) policy influence on implementation; (3) program structure; and (4) program outcomes. FINDINGS 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. Despite these challenges, early adopters felt strongly that other jails and prisons in the United States should provide OAT and that legislation and litigation may soon force OAT expansion in these carceral settings. CONCLUSIONS Despite identifying regulatory and logistical challenges, early adopters of opioid agonist treatment (OAT) programs in US jails and prisons demonstrate that OAT programs can successfully be implemented in carceral settings with tailoring to the specific context.
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Affiliation(s)
- Sachini Bandara
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney Merritt
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen L Barry
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Mental Health and Addiction Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Komalasari R, Wilson S, Haw S. A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons. Int J Prison Health 2021; 17:477-496. [PMID: 38902897 DOI: 10.1108/ijph-04-2020-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM). DESIGN/METHODOLOGY/APPROACH The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically. FINDINGS The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources. RESEARCH LIMITATIONS/IMPLICATIONS The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant. PRACTICAL IMPLICATIONS Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners' families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons. SOCIAL IMPLICATIONS The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons. ORIGINALITY/VALUE This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.
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Affiliation(s)
- Rita Komalasari
- Faculty of Health Science, University of Stirling, Stirling, UK, and Faculty of Medicine, Yarsi University, Jakarta Pusat, Indonesia
| | - Sarah Wilson
- Sociology in the School of Applied Social Science at the University of Stirling, UK
| | - Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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