Issue Brief: Treating Opioid Use Disorder in Justice-Involved Populations

Opioid use disorder (OUD) is a medical condition that is treatable. Individuals involved in the criminal justice system should be screened for OUD. Anyone with moderate to severe OUD should have access to medication treatment for OUD in all criminal justice settings and upon release.

OUD is a treatable illness, like diabetes or hypertension. Like other chronic conditions, OUD often benefits from ongoing treatment with medication. The most effective treatments are FDA-approved medications for OUD: methadone, buprenorphine, and extended-release/injectable naltrexone. Oral naltrexone is not an effective treatment for OUD.1,2

Medication treatment for OUD saves lives.

  • Methadone and buprenorphine reduce the risk of overdose death by more than half compared to no treatment, and effectively treat opioid withdrawal.3,4,5,6
  • Medications for OUD reduce cravings, block the intoxicating effects of opioids (heroin, fentanyl, etc.), and prevent relapse.7,8
  • Medications for OUD reduce the acquisition, transmission, and reinfection of HIV and hepatitis C virus, and improve viral suppression.9,10
  • Medications for OUD can improve quality of life and reduce depressive symptoms.1,11
  • Without medication, people with OUD can experience substantial distress when not using opioids due to psychological and physiological effects of chronic opioid use.

Medication treatments for OUD are feasible in justice-involved populations.

  • Medications for OUD are increasingly used in jail and prison settings. All correctional health providers can apply for a SAMHSA waiver to prescribe buprenorphine.12
  • Methadone and buprenorphine can be administered in jails or prisons through a licensed opioid treatment program.
  • Medications for OUD are associated with reductions in illicit opioid use and overdose deaths in criminal justice populations.3,6,7,8
  • Medications for OUD are part of treatment court (formerly drug court) best practices.
  • Persons taking medications for OUD are “otherwise qualified” under Title II of the Americans with Disabilities Act.13
  • For those enrolled in methadone or buprenorphine treatment at the time of arrest, stopping treatment while incarcerated will cause withdrawal and increase the risk of overdose.14
  • Starting and continuing medications for OUD while incarcerated increases treatment engagement and can reduce the risk of overdose death upon release.7,8,14
  • Counseling is required for those receiving methadone or buprenorphine from an opioid treatment program (OTP). Outside of an OTP, counseling can be beneficial but is not necessary for a person to initiate and/or maintain extended-release naltrexone or prescribed buprenorphine treatments for OUD.1,12
  • Telehealth may offer additional flexibility to increase access to medications for OUD in jails and prisons.

Continued access to medications for OUD in the community is an essential part of discharge planning from jail or prison to reduce the risk of relapse and overdose death. This process should begin on admission with continuation or early initiation of medications for OUD.

  • Identification of and linkage to community treatment providers is critical.
  • Discharge planning for individuals with OUD should address Medicaid enrollment and other needs (e.g., housing/shelter, transportation, personal identification).
  • Jail or prison medical records should be transferred to community providers free of charge.
  • Several interventions to improve treatment retention are being studied through JCOIN including peer/patient navigators, which may be helpful in linking individuals with OUD to treatment and other services, and mobile health unit interventions, which may be effective in delivering harm-reduction services.

Resources

For more information on OUD and medication for OUD:

References

[1] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder, Mancher, M., & Leshner, A. I. (Eds.). (2019). Medications for Opioid Use Disorder Save Lives. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK541393/

[2] Minozzi, S., Amato, L., Vecchi, S., Davoli, M., Kirchmayer, U., & Verster, A. (2011). Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database of Systematic Reviews, 2011(4), CD001333. https://doi.org/10.1002/14651858.CD001333.pub4

[3] Green, T. C., Clarke, J., Brinkley-Rubinstein, L., Marshall, B., Alexander-Scott, N., Boss, R., & Rich, J. D. (2018). Postincarceration Fatal overdoses after implementing medications for addiction treatment in a statewide correctional system. JAMA Psychiatry, 75(4), 405–407. https://doi.org/10.1001/jamapsychiatry.2017.4614

[4] Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D. J., Gibson, A., Mattick, R., Butler, T., & Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: Retrospective data linkage study. Addiction, 109(8), 1306–1317. https://doi.org/10.1111/add.12536

[5] Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, j1550. https://doi.org/10.1136/bmj.j1550

[6] Russolillo, A., Moniruzzaman, A., & Somers, J. M. (2018). Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. PLoS Medicine, 15(7), e1002625. https://doi.org/10.1371/journal.pmed.1002625

[7] Moore, K. E., Roberts, W., Reid, H. H., Smith, K., Oberleitner, L., & McKee, S. A. (2019). Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review. Journal of Substance Abuse Treatment, 99, 32–43. https://doi.org/10.1016/j.jsat.2018.12.003

[8] Magura, S., Lee, J. D., Hershberger, J., Joseph, H., Marsch, L., Shropshire, C., & Rosenblum, A. (2009). Buprenorphine and methadone maintenance in jail and post-release: a randomized clinical trial. Drug and Alcohol Dependence, 99(1-3), 222–230. https://doi.org/10.1016/j.drugalcdep.2008.08.006

[9] Seval, N., Wurcel, A., Gunderson, C. G., Grimshaw, A., & Springer, S. A. (2020). The impact of medications for opioid use disorder on hepatitis C incidence among incarcerated persons: A systematic review. Infectious Disease Clinics of North America, 34(3), 559–584. https://doi.org/10.1016/j.idc.2020.06.011

[10] Cunningham, W. E., Nance, R. M., Golin, C. E., Flynn, P., Knight, K., Beckwith, C. G., Kuo, I., Spaulding, A., Taxman, F. S., Altice, F., Delaney, J. A., Crane, H. M., & Springer, S. A. (2019). Self-reported antiretroviral therapy adherence and viral load in criminal justice-involved populations. BMC Infectious Diseases, 19(1), 913. https://doi.org/10.1186/s12879-019-4443-z

[11] Delaney, J. A., Nance, R. M., Whitney, B. M., Altice, F. L., Dong, X., Trejo, M., Matsuzaki, M., Taxman, F. S., Chander, G., Kuo, I., Fredericksen, R., Strand, L. N., Eron, J. J., Geng, E., Kitahata, M. M., Mathews, W. C., Mayer, K., Moore, R. D., Saag, M. S., Springer, S., … Crane, H. M. (2018). Brief report: Reduced use of illicit substances, even without abstinence, is associated with improved depressive symptoms among people living with HIV. Journal of Acquired Immune Deficiency Syndromes (1999), 79(3), 283–287. https://doi.org/10.1097/QAI.0000000000001803

[12] Substance Abuse and Mental Health Services Administration. (2019). Use of medication-assisted treatment for opioid use disorder in criminal justice settings (HHS Publication No. PEP19-MATUSECJS). National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/product/Use-of-Medication-Assisted-Treatment-for-Opioid-Use-Disorder-in-Criminal-Justice-Settings/PEP19-MATUSECJS

[13] Mace, S., Siegler, A. Wu, K., Latimore, A., & Flynn, H. The National Council for Behavioral Health & Vital Strategies. (2020). Medication-assisted treatment for opioid use disorder in jails and prisons: A planning and implementation toolkit. https://www.thenationalcouncil.org/medication-assisted-treatment-for-opioid-use-disorder-in-jails-and-prisons/

[14] Rich, J. D., McKenzie, M., Larney, S., Wong, J. B., Tran, L., Clarke, J. (2015). Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: A randomized, open-label trial. The Lancet, 386(9991). https://doi.org/10.1016/S0140-6736(14)62338-2

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This issue brief was developed by the Justice Community Opioid Innovation Network's (JCOIN) Medications for Opioid Use Disorder Workgroup. JCOIN is funded by the National Institute on Drug Abuse (NIDA) as part of the NIH HEAL Initiative. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, the NIH HEAL Initiative, or the participating sites.

Suggested citation: Justice Community Opioid Innovation Network. (2021). Treating Opioid Use Disorder in Justice-Involved Populations [JCOIN Issue Brief #3]. https://www.jcoinctc.org/issue-brief-treating-oud-in-justice-involved-populations/