As we work to expand access to medications for opioid use disorder (MOUD), a variety of community partnerships are crucial to supporting our patients. Many clinics offering MOUD partner with regional hospitals, emergency departments, mental health and substance use disorder treatment providers, and social service agencies in their efforts to ensure care coordination. Another key partner in a holistic community response to the opioid overdose crisis is the local jail, the subject of this month’s Best Practice.
Because non-prescribed opioid use is illegal, many people with OUD have interactions with the criminal legal system, and approximately 15 percent of all people who are incarcerated have OUD.[i] Critically, the risk of overdose increases significantly in the first two weeks after release from incarceration,[ii] making a person’s time of release an important point for creating linkages to treatment, supports, and other interventions.
[i] 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).
[ii] Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison—a high risk of death for former inmates. The New England journal of medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115
Reducing Overdose Risk
Overdose is more common at the time of release because many people undergo opioid withdrawal due to force abstinence while incarcerated, leading to reduced opioid tolerance and thus increased risk of overdose if they resume use. Two essential steps in reducing overdose risk are: 1) ensuring that people who are incarcerated have access to MOUD, and 2) supporting transition to continuity-based treatment at the time of release.
Unfortunately, most jails do not offer MOUD, which is the standard of care for OUD. A study from the JAMA Network estimated that only 3.6 percent of all people with OUD who are incarcerated in the United States received buprenorphine while incarcerated. Many jails even prevent people who were on MOUD prior to incarceration from continuing their MOUD treatment during while incarcerated.1 The Department of Justice Civil Rights Division recently published guidance indicating that not allowing an person to continue MOUD prescribed to them prior to incarceration is a violation of the Americans with Disabilities Act.
Providing MOUD to people with OUD while incarcerated results in many positive outcomes, including increased linkage to care at the time of release, reduced return to non-prescribed opioid use, reduced recidivism, and reduced risk of overdose death.1,[i]
[i] 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
Starting a Partnership
Community clinics can partner with area jails to ensure that patients who are already in care are able to continue MOUD while incarcerated and to serve as a community linkage site at the time of jail release.
Key steps to starting a partnership with area jails include:
- Reaching out to the local Sheriff to ask:
- Are people screened for OUD at point of intake?
- Are there processes in place to support people experiencing opioid withdrawal?
- Are people who are already prescribed MOUD prior to incarceration allowed to continue these medications while incarcerated?
- Are individuals who have OUD able to initiate MOUD while incarcerated?
- Offering to share resources (such as those listed below) with the local Sheriff and medical staff in the jail.
- Offering to answer questions about how your clinic’s MOUD program works and the evidence behind the medications.
- Offering to serve as a referral source for individuals who are leaving incarceration.
Resources
Resources that can be shared with the Jail:
National Sheriff’s Association, Jail-Based MAT: Promising Practices, Guidelines, and Resources
National Counsel for Mental Wellbeing, Medication-Assisted Treatment for Opioid Use Disorder in Jails and Prisons: A planning and implementation toolkit and associated webinar via Zoom
ASAM Public Policy Statement, Treatment of Opioid Use Disorder in Correctional Settings PDF
US Department of Justice Civil Rights Division, The Americans with Disabilities Act and the Opioid Crisis: Combating Discrimination Against People in Treatment or Recovery (PDF)
Bureau of Justice Assistance, Managing Substance Withdrawal in Jails: A Legal Brief