Opioid Treatment in Jails Reaches Only Quarter of US Facilities

New research reveals that just over one in four American jails provide comprehensive opioid treatment in jails, with 27.6% offering all three FDA-approved medications for opioid use disorder to select individuals, according to a study published in JAMA.

The JCOIN research found that only 16.9% of US jails make all three medications available to anyone with opioid use disorder. The medications include methadone, buprenorphine, and naltrexone, which provide essential support for individuals struggling with substance dependency.

Providing medication for opioid use disorder during incarceration creates an opportunity to initiate care and supports continuity of treatment as individuals transition back into the community, according to the study authors. However, even within jails that offer some form of treatment, many people do not receive recommended care whilst detained due to policy, regulatory, financing, staffing, and educational barriers.

The comprehensive survey involved 1,028 jails between June 2022 and April 2023, with a follow-up study of 462 facilities that reported offering some form of medication for opioid use disorder. Of these, 265 jails completed the detailed survey conducted between February and July 2023.

Geographic and Demographic Factors Influence Treatment Access

The study reveals significant factors associated with comprehensive opioid treatment in jails. Availability correlates positively with jails situated in more urban counties or in Medicaid expansion states, their county opioid overdose rate, and their county social vulnerability based on CDC’s 2020 Social Vulnerability Index.

The presence of healthcare professionals available to administer medication also increases the likelihood of comprehensive treatment provision.

Among jails offering at least one type of medication, 65.3% provided buprenorphine, 45% provided methadone, and 52% provided naltrexone, according to the research findings.

“Jails are a key touchpoint for engaging people with opioid use disorder in treatment services,” says Dr Lori J. Ducharme, former health scientist administrator at the National Institute on Drug Abuse. “Availability of medication in jails can provide an opportunity for individuals to initiate treatment and ensure continuity of care as people transition between detention and the community.”

Treatment Access Varies by Population Groups

The study found significant variations in which populations receive medication-assisted treatment. At least one form of medication was most commonly provided to anyone already taking treatment at the time of incarceration, affecting 79.7% of relevant cases.

Pregnant people receiving medication at the time of incarceration had access in 70.9% of cases. However, fewer jails extended access to anyone with opioid use disorder, at 43.7%, and only 20% provided treatment to individuals within several months of release.

Most jails that offer buprenorphine or methadone provide only continuation for those already receiving treatment in the community, rather than offering both initiation for new patients and continuation services.

Policy and Staffing Challenges Impede Expansion

Policy and procedure barriers emerged as significant challenges for implementing both buprenorphine and methadone programmes. The research found that 78.7% of jails reported these issues for buprenorphine and 73.5% for methadone.

Specific challenges include concerns about Drug Enforcement Agency regulations, prohibitive state, county, or jail policies and regulations, security and diversion of medications within facilities, policies restricting who can receive medication, funding constraints, and jails not hosting a licensed Opioid Treatment Programme.

Despite these barriers, at least half of the jails reported that their existing policies and procedures supported the provision of opioid treatment in jails.

Staffing and Educational Needs

Staffing shortages represent a critical barrier to expansion. The research found that 60.7% of jails identified the need for more medical staff to expand services within their facilities.

Educational requirements also emerged as significant needs, with 57% of jails expressing requirements for education on substance use disorders and evidence-based treatments. One-third of facilities reported needing support in addressing stigma and negative attitudes around medication-assisted treatment.

Recommendations for Universal Access

The study authors recommend that jurisdictions seeking universal jail-based medication treatment should leverage Medicaid reentry Section 1115 waivers to reimburse in-custody treatment, provide targeted funding and training in high-vulnerability counties, and foster peer learning networks among jails that have overcome policy and staffing barriers.

These findings highlight the significant gaps in access to evidence-based opioid treatment in jails across the United States, despite the critical role these facilities could play in initiating and maintaining treatment for individuals with substance use disorders.

Source: jcoinctc.org