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Study Finds Pharmacological Treatment of Opiate Dependence Under-Utilized in State and Federal Prisons

In the first national survey of its kind, researchers have documented important attitudes and practices among state and federal correctional medical directors regarding the use of methadone and buprenorphine to treat heroin/opiate addiction in prisoners, both while incarcerated and after release. The importance of the research stems from the prevalence of heroin use among prisoners, estimated (in 2004) at 9% of the federal prison population and 13% of the state prison population. The chain of logic is straightforward: studies show that approximately 55% of those with a history of substance use relapse within one month of release from incarceration; relapse to substance use, in turn, is associated with increased criminal activity, risk of HIV and HCV infection, drug overdose, and reincarceration. Thus, to the extent that treatment during and/or following incarceration can reduce the negative consequences associated with opiate addiction, offering such treatment could potentially lead to significant social and economic benefits. And indeed, research confirms that offering prisoners pharmacological treatment and counseling for opiate dependence prior to and particularly around the time of release does decrease the likelihood of drug relapse, overdose, recidivism, and HIV risk behaviors, and additionally increases the likelihood of remaining in long-term drug treatment after release.

While methadone maintenance therapy has been used in the United States for nearly 50 years, buprenorphine was approved for use by the FDA for the management of opiate addiction by community and correctional physicians only in 2002. Treatment with either drug is formally referred to as opiate replacement therapy (ORT).

The survey found that although methadone ORT is offered more frequently than buprenorphine ORT, only 55% of prison systems offer methadone under any circumstances. By contrast, only seven prison systems (14%) offer buprenorphine, and then only in some circumstances. Post-release, 45% of facilities provide some linkage to methadone treatment, while only 29% offer referrals to community buprenorphine providers.

In terms of raw numbers, the researchers found that no more than 2,000 prisoners nationwide received ORT using either methadone or buprenorphine. That number, however, represents only slightly better than one percent of the estimated total number of state and federal prisoners who reported regularly using heroin (at least in 2004).

The most common reason cited for not offering ORT to prisoners was an institutional preference for drug-free detoxification.

The researchers concluded that pharmacological treatment of opiate dependence remains an important but under-utilized intervention in U.S. prison settings, with the number of opiate-dependent prisoners actually receiving ORT during incarceration quite limited. Source: Nunn, A., et al., Methadone and buprenorphine prescribing and referral practices in U.S. prison systems: Results from a Nationwide Survey. Drug Alcohol Depend. (2009), doi.10.1016/j.drugalcdep.2009.06.015.

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