Study reveals limited access to opioid treatment in US jails

A new look into addiction treatment availability in the U.S. criminal justice system reveals that fewer than half (43.8%) of 1,028 jails surveyed across the nation offered any form of medication for opioid use disorder, and only 12.8% made these available to anyone with the disorder. With two-thirds of people who are incarcerated in U.S. jails experiencing a substance use disorder – in many cases, an opioid use disorder – the failure to make these medications widely available in criminal justice settings represents a significant missed opportunity to provide life-saving treatments in an environment where people in need of care can be easily reached.

The study, published in JAMA Network Open and supported by NIH's National Institute on Drug Abuse (NIDA), also found that most jails did offer some type of substance use disorder treatment or recovery support (70.1%). The most common reason jails cited for not offering medications for opioid use disorder was lack of adequate licensed staff (indicated by 49.8% of jails). In general, larger jails, those in counties with lower "social vulnerability" (lower levels of poverty and unemployment, and greater education, housing, and transportation access), and those with greater proximity to community-based providers of medications for opioid use disorder were more likely to offer these treatments.

Offering substance use disorder treatment in justice settings helps to break the debilitating – and often fatal – cycle of addiction and incarceration. Though someone may be in jail for only a short time, connecting them to addiction treatment while they are there is critical to reduce risk of relapse and overdose, and to help them achieve long-term recovery."

Nora D. Volkow, M.D., NIDA Director 

The criminal justice system is a crucial point of intervention in the overdose crisis. Overdose is the leading cause of death among people returning to their communities after incarceration. A recent county-level study found that 21% of individuals who died of a fatal overdose had been in jail, a facility for short-term stays, where most people are awaiting trial, sentencing, or serving a short sentence.

Research shows that medications for opioid use disorder – buprenorphine, methadone, and naltrexone – reduce opioid use, prevent overdose deaths, and support long-term recovery. Among people who were formerly incarcerated, access to these medications during incarceration or at release has been shown to reduce overdose deaths, increase use of community-based treatment, and decrease rates of reincarceration. However, access to medications for opioid use disorder in jails remains limited due to various barriers, including cost, staffing, and regulatory challenges.

To update current knowledge of addiction treatment gaps in jails across the country, researchers at NORC at the University of Chicago invited a random sample of 2,791 jails to take a survey on availability of medications for opioid use disorder. These jails were selected to be representative of the over 3,500 jails in the U.S. The researchers collected data between June 2022 and April 2023 and received responses from 1,028 jails, 927 of which were included in analysis. More than half of the participating jails (55.6%) were located in non-metropolitan areas, and many jails offered contracted health care services (59.8%).

The researchers found that more than half of the surveyed jails did not offer medications for opioid use disorder, and that those with direct or hybrid health care services were more likely to provide these medications than those relying on external facilities or with no onsite health care services. For those jails that did offer these medications, buprenorphine was the most commonly provided – available in 69.9% of jails that offered these medications – followed by naltrexone (54.5%) and methadone (46.6%).

The researchers note that even within the jails that offer medications for opioid use disorder, most often these medications are only made available to people who are pregnant, or to those who were already receiving any of these medications at the time of their arrest. The research team is conducting additional analyses to better understand the barriers to universal medication availability within jails.

"Data on health care gaps for people who are incarcerated provides a necessary knowledge base to help policymakers, public health officials, researchers, and communities assess where to allocate resources to improve care for opioid use disorder for this population," said Elizabeth Flanagan Balawajder, senior research associate at NORC at the University of Chicago and the study's corresponding author. "Our findings suggest that supporting areas such as staff training, infrastructure improvements, and partnerships with community treatment providers are key areas to improve substance use disorder treatment for people in jail."

While this study provides the most comprehensive overview to date of the availability of these medications in U.S. jails, its limitations include low rates of jail responses, reliance on self-reported data, and a lack of assessment of the quality or outcomes of addiction treatment programs. Future research will include evaluating the impact of providing these medications on health outcomes for the people in jail, as well as exploring sex, gender, race and ethnicity-related disparities in access to medications for opioid use disorder within the criminal justice system.

This study was conducted by researchers in the NIDA-funded Justice Community Opioid Innovation Network (JCOIN), which is supported through the NIH Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative. The study included contributions from experts at the University of Illinois Chicago, Baystate Health, the University of Massachusetts Chan Medical School-Baystate, the University of Chicago's Crown Family School of Social Work, Policy and Practice, the Department of Medicine and Public Health Sciences at the University of Chicago, and NIDA.

Under the Biden-Harris Administration, the Department of Health and Human Services has taken several steps that expand access to medications for opioid use disorder and addiction care to people who are incarcerated. For examples, see new guidance from the Centers for Medicare & Medicaid Services, new funding opportunities through the Health Resources and Services Administration, and SAMHSA's Adult Reentry Program Grants.

Source:
Journal reference:

Balawajder, E. F., et al. (2024). Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2024.34704.

Comments

  1. Frank Sterle Frank Sterle Canada says:

    Societally/socially neglecting and therefor failing people struggling with debilitating addiction should not be an acceptable or preferable political, economic or religious/morality option. But the more callous politics and politicians (usually angry-/vengeful-God theists thus lousy Christians) that are typically involved with lacking addiction funding/services tend to reflect conservative electorate and representatives’ opposition, however irrational, against making proper treatment available to low- and no-income addicts.

    The unfortunate fact is: the greater the induced euphoria or escape one attains from the self-medicated experience, the more one wants to repeat the experience; and the more intolerable one finds their non-self-medicating reality, the more pleasurable that escape will likely be perceived.In other words: the greater one’s mental pain or trauma while not self-medicating, the greater the need for escape from one's reality, thus the more addictive the euphoric escape-form will likely be.

    Especially when the substance abuse is due to past formidable mental trauma, the lasting solitarily-suffered turmoil can readily make each day an ordeal unless the traumatized mind is medicated.

  2. Frank Sterle Frank Sterle Canada says:

    Most people, including me, self-medicate in some form or another (besides caffeine), albeit it’s more or less ‘under control’. And there are various forms of self-medicating, from the relatively mild to the dangerously extreme, that include non-intoxicant-consumption habits, like chronic shopping/buying, gambling, or over-eating.

    If they’re anything like drug-intoxication self-medicating or addiction, it should follow that: the greater the induced euphoria or escape one attains from it, the more one wants to repeat the experience; and the more intolerable one finds their non-self-medicating reality, the more pleasurable that escape will likely be perceived. In other words: the greater one’s mental pain or trauma while not self-medicating, the greater the need for escape from one's reality, thus the more addictive the euphoric escape-form will likely be.

    With food, the vast majority of obese people who considerably over-eat likely do so to mask mental pain or even PTSD symptoms. I utilized that method myself during much of my pre-teen years, and even later in life after ceasing my (ab)use of cannabis and alcohol.

    Today, my emotionally tumultuous existence is a continuous discomforting anticipation of ‘the other shoe dropping’ and being afraid of how badly I will deal with the negative or horrible event — that almost never transpires — and especially if I feel I'm at fault for the event. ... Besides morning coffee, my current form of medicating is doctor-prescription or alcohol via wine. Though I don’t take it lightly, it’s possible that someday I could instead return to over-eating.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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