Jessica Vechinski, MSW
Project Manager, Justice Community Opioid Innovation Network (JCOIN)
Center for Health Enhancement Systems Studies, UW-Madison
A new National Institutes of Health and National Institute
on Drug Abuse study conducted by the University of Wisconsin’s Center for
Health Enhancement and Systems Studies (CHESS) and George Mason University’s
Center for Advancing Correctional Excellence! are testing
ways to expand use of medications such as buprenorphine, naltrexone, and
methadone for OUD in criminal justice settings. The study, titled Justice
Community Opioid Innovation Network (JCOIN), is exploring two evidence-based coaching interventions for
disseminating MOUD in justice-involved populations: the NIATx model for process improvement and Extension for Community
Healthcare Outcomes (ECHO).
As part of the NIATx
intervention, sites are asked to identify a project “aim.” A recurring primary aim
that jails have identified is establishing policies and procedures for
continuing a prescribed buprenorphine regimen when a person enters the jail
setting. Jails and prisons around the country face multiple barriers to use of
MOUD for persons with SUD, forcing those individuals into detox rather than
continuing care.
This is a topic of considerable
debate within jails, justice systems, and state governments. Our study team
feels that providing justice-involved individuals with continuing MOUD care is
ethical medical practice. Like diabetes, heart disease, or cancer, SUD is a
chronic condition caused by behavioral, psychological, biological, and
environmental factors. When a person with diabetes enters jail, they receive insulin
and continuity of care. But a person on a prescribed buprenorphine regime for
their SUD often has no choice upon entering jail other than to suffer through
detox and withdrawal.
Two chronic conditions.
One receives continuity of care, but the other does not. Why is that?
Barriers to MOUD in
jail settings
Stigma
The view that addiction
is a moral failing and not a medical condition is a top reason, combined with
the view that public resources should not go to treating a moral failing. A
second factor is the pervasive misconception of MOUD as “just replacing one
drug with another.” A third significant barrier that keeps jails from providing
buprenorphine is the risk of diversion: the person receiving buprenorphine will
sell or give the medication to other incarcerated individuals. Yet jails that
have administered buprenorphine either by strips or crushed pills have found
ways to decrease diversion. Strategies include having the individual eat
crackers and drink water or conduct post-dose “mouth checks.”
Lawsuits against jails:
Addiction is a disability
The evidence for
continuing buprenorphine in jail settings far outweighs the reasons for discontinuing
care. The most substantial support comes from cases of justice-involved
individuals suing jails on the grounds that addiction is a disability, and that
being denied treatment is a violation of the Americans with Disabilities Act.
The Act requires that public places or services be accessible to all, including
those recovering from alcoholism and drug addiction. Justice-involved
individuals have claimed that denying medication while incarcerated is discrimination
based on their disability. Even though justice-involved individuals are winning
their cases and states are starting to take note, many jails disagree with this
position.
One last point to consider
Isn’t rehabilitation one
of the main reasons for incarceration? By not allowing an individual who has
taken the responsible steps to be on a prescribed buprenorphine regimen to continue
care, the jail is not providing adequate healthcare or an environment conducive
to rehabilitation.
What do you think?
Should jails be required to continue providing medication to those already on a prescribed buprenorphine regimen when entering the jail?
Jessica Vechinski is a member of Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin. She serves as the Project Coordinator for a five-year study with the Justice Community Opioid Innovation Network (JCOIN), an initiative funded by NIDA/NIH. The study is testing the combination and dosages of two evidence-based strategies to implement or improve Medications for Opioid Use Disorder (MOUD) programming within justice settings around the country. You can reach Jessica at jvechinski@wisc.edu.
