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      The impact of the opioid crisis on U.S. state prison systems

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          Abstract

          Background

          Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD).

          Methods

          A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance.

          Results

          MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications.

          Conclusion

          Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40352-021-00143-9.

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          Most cited references62

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          Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

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            Stigma as a fundamental hindrance to the United States opioid overdose crisis response

            Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis.
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              Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders.

              Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited.
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                Author and article information

                Contributors
                cscott@chestnut.org
                mdennis@chestnut.org
                cegrella@chestnut.org
                afmischel@chestnut.org
                john@carnevalleassociates.com
                Journal
                Health Justice
                Health Justice
                Health & Justice
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2194-7899
                24 July 2021
                24 July 2021
                December 2021
                : 9
                : 17
                Affiliations
                [1 ]GRID grid.413870.9, ISNI 0000 0004 0418 6295, Chestnut Health Systems, ; 221 W. Walton St, Chicago, IL 60610 USA
                [2 ]GRID grid.413870.9, ISNI 0000 0004 0418 6295, Chestnut Health Systems, ; 448 Wylie Dr, Normal, IL 61761 USA
                [3 ]Carnevale Associates LLC, 4 Belinder Rd, Gaithersburg, MD 20878 USA
                Author information
                http://orcid.org/0000-0002-5233-4702
                Article
                143
                10.1186/s40352-021-00143-9
                8310396
                34304335
                4ace48ad-1d2b-4929-9a0a-ff82f58b990f
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 February 2021
                : 28 June 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: U01DA036221
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                opioid use disorder (oud),medications for opioid use disorder (moud),state prison systems,oud service cascade

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