Treatment of OUD in correctional facilities underutilized while training, resources scarce

Key takeaways:

• A systematic literature review examined current practices and the efficacy of medication-assisted therapy.
• The study showed current practices, implementation and training for OUD in correctional facilities needs to be improved.

MIAMI BEACH, Fla. — A literature review of opioid use disorder treatment in correctional facilities found medication-assisted treatments effective but underutilized due to scarce training and resources. “This review points out the situation and deficiencies in medication-assisted treatments for opioid use disorder in correctional facilities throughout the [United States],” Thersilla Oberbarnscheidt, MD, PhD, assistant professor of psychiatry at the University of Pittsburgh, told Healio at the American Society of Clinical Psychopharmacology annual meeting.

As approximately one-third of all heroin users in the U.S. are incarcerated at least once and previous studies have shown that 82% of incarcerated opioid users return to prison within 4 years, researchers performed a systematic literature review examining current practices and utilization of medication-assisted treatments for incarcerated individuals to assess their effectiveness.

Oberbarnscheidt and colleagues initiated a search using ORVID, PubMed, WEB and Embase to find approximately one dozen research articles centering on sociodemographic information, implementation, treatment and outcomes of medication-assisted treatments (MAT) in a wide range of correctional facilities.

Among current practices, the most common is forced withdrawal as few facilities offer MAT, and Medicaid is prohibited by law from paying for MAT in correctional facilities. Individuals released from prison with opioid use disorder who were not subject to medication treatment possess a risk 40 times higher for overdose within the first 2 weeks after release, despite prior evidence having established that medications such as buprenorphine, naltrexone and methadone save lives in cases of OUD and overdose.

Regarding efficacy, a randomized controlled trial in a correctional facility in Baltimore showed MAT with methadone reduced likelihood of reincarceration during a 3-month follow-up but did not maintain that effect over 6 months. Data further revealed MAT led to a 74% reduction in overdose-related deaths for those who use opioids recreationally, while there was a 12.3% decrease in overdose deaths after MAT implementation in Rhode Island.

Additionally, researchers found a lack of routine OUD screening at time of admission, and noted that physicians in correctional facilities would benefit from MAT training. Treatment and continuity of MAT are higher when linked to community treatment options and improve birth outcomes for pregnant women with OUD.

“Currently, medication-assisted treatments are underutilized,” Oberbarnscheidt noted. “And with this research, I want to point out what needs to change towards utilization.”