Treating Addiction to Opioids in a Criminal Justice Setting: NIH Policy Brief

Treating Addiction to Opioids in a Criminal Justice Setting: NIH Policy Brief

Incarceration Provides a Critical Opportunity for Opioid Addiction Treatment 

• • • • 65 percent of all people incarcerated fit the criteria for a substance use disorder. 
      • Recidivism is associated with the use of opioids, which include prescription pain medications, heroin, and synthetic opioids such as fentanyl. 

Providing Opioid Addiction Medication Improves Outcomes 

First-line treatments for opioid addiction include buprenorphine, methadone, and extended release naltrexone. 

• These drugs REDUCE opioid use, overdose deaths caused by opioids, criminal behavior, and spread of infectious diseases while IMPROVING social functioning and treatment adherence 
•  Medications should be used in conjunction with behavioral counseling in order to achieve a “whole patient” approach referred to as medication-assisted treatment (MAT). 
• Medication-assisted detoxification is ineffective in promoting long-term sobriety. 

Medication facilitates post-release outcomes 

• Prior to release, inmates treated with methadone or buprenorphine are more likely to seek and maintain post-release treatment. 

• A recent NIDA-funded study discovered that treating adults with a history of opioid dependency with extended-release naltrexone lowered relapse rates. 

• Compulsory discontinuation of methadone therapy during incarceration can result in a reluctance to seek future treatment, because of the harsh and prolonged withdrawal symptoms associated with these drugs’ sudden stop. 

• Patients who are allowed to continue methadone treatment while incarcerated had a lower re-arrest rate than those who are detoxified in jail. Over 97 percent of individuals on methadone maintained therapy following discharge.  

Solutions Based on Science 

Savings on Addiction Treatment in the Criminal Justice System 

According to a California crime cost analysis, treating individuals involved in the criminal justice system with methadone or buprenorphine resulted in a cost savings of over $18,000 per person over six months when compared to detoxification alone. 

12 In its first year, a California law allowing qualifying drug offenders to seek treatment rather than jail or prison saved the state about $100 million. 

Medications Contribute to the Survival of Lives 

According to a study conducted in Washington State, the risk of death from drug overdose was 129 times greater in the first two weeks following jail release compared to the general population. Treatment with methadone or buprenorphine during this transitional period reduces the chance of mortality by 75%.  

Inmates in the United States Do Not Receive Adequate Addiction Treatment. 

• Only 11% of convicts in the United States who require substance use disorder therapy obtain it in any kind. 
• According to the World Health Organization, all jails should have methadone and buprenorphine available for treatment, as well as naltrexone for relapse prevention.Nonetheless, drugs continue to be underutilized: 
• While 55% of US prison systems offered methadone treatment in 2009, more than half did so only for pregnant women; only 14% offered buprenorphine treatment to all inmates. 

•  Drug courts underutilize medications.However, beginning of 2015, state drug courts that receive federal funding must enable those getting treatment for opioid addiction to continue using the drugs. 

Dispelling Common Myths About Medications 

Methadone and buprenorphine DO NOT SERVE AS A SUBSTITUTE FOR AN ADDICTION. When someone is treated for opioid addiction, the medication administered does not cause euphoria; rather, it aids in the reduction of opioid cravings and withdrawal symptoms. These drugs rebalance the brain circuits that have been harmed by addiction, allowing the patient’s brain to repair while they work toward recovery. 

Methadone or buprenorphine diversion is uncommon in jail and prison settings. Diversion attempts occur at a rate of 1% and 10%, respectively,20 but proper dosage control can effectively prevent diversion.  

 Science-Based Solutions  

Longer-Lasting Medications for Prison-Initiated Treatment 

The National Institute on Drug Abuse is funding research to determine whether treating convicts with long-acting depot formulations of buprenorphine or naltrexone reduces drug use and criminal behavior. 

HIV/AIDS and the Criminal Justice System 

NIDA-funded research is aimed at improving HIV testing and treatment for HIV positive individuals involved in the criminal justice system, with the goal of ensuring continuous treatment and good disease management following re-entry into the community. 

Reaching Justice-Involved Children, Adolescents, and Young Adults 

Through our Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) effort, NIDA-supported research is creating and testing techniques for improving the delivery of evidence-based preventative and treatment services for juveniles. 

Additional Data 

For additional information on treating substance use disorders in criminal justice settings, please visit the National Institute on Drug Abuse’s Principles of Drug Abuse Treatment for Criminal Justice Populations. 

To read more about drugs used to treat opioid addiction, see the National Institute on Drug Abuse’s Treatment Approaches. 

Our sober house directory is a fantastic resource for finding homes, but ultimately it is up to you to find the appropriate fit. While accreditation and a professional outer look are an excellent start, you should do further research before making a decision. Don’t be afraid to inquire! While many homes provide excellent sober living, we have a particular fondness for Vanderburgh House, which we attribute to the fact that they were involved in the creation of this guide. 

If you’ve ever wondered what it’s like to run a sober house, we invite you to contact Vanderburgh Communities, which was the first organization to give sober living charters in the United States. They can tell you all about it. Keep your chin up and remember to take things one day at a time! 

References 

1. Behind Bars II: Substance Abuse and America’s Prison Population (2010) 

1. Spaulding AC et al. PLoS ONE (2009) 

1. Mattick RP et al. Cochrane Database Syst Rev. (2014) 

1. Mattick RP et al. Cochrane Database Syst Rev. (2009) 

1. Bentzley BS et al. J Subst Abuse Treat (2015) 

1. Kinlock TW et al. Drug Alcohol Dependence (2007) 

1. Zaller N et al. J Subst Abuse Treat. (2013) 

1. Gordon MS et al. Drug Alcohol Depend (2014) 

1. Lee JD et al. N Engl J Med. (2016) 

1. Maradiaga JA et al. J Subst Abuse Treat. (2016) 

1. Westerberg VS et al. J Substance Abuse Treat. (2016) 

1. Krebs E et al. Addiction (2017) 

1. Douglas Anglin M et al. Am J Public Health (2013) 

1. Binswanger IA et al. N Engl J Med. (2007) 

1. Degenhardt L et al. Addiction (2014) 

1. World Health Organization. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence (2009) 

1. Nunn A et al. Drug Alcohol Depend. (2009) 

1. Matusow H, et al. J Subst Abuse Treat. (2013) 

1. Fiscella K, et al. J Urban Health (2004) 

1. Magura S et al. Drug Alcohol Depend. (2009) 

1. Kinlock TW et al. J Offender Rehabil. (2010) 

1. Treating Opioid Addiction in Criminal Justice Settings