Medical treatment

Massachusetts prisons found ‘innovative solutions’ to implement medical treatment for opioid use disorder

In two new papers, a team of Massachusetts researchers, including professors from UMass Chan Medical School, examined the implementation of a groundbreaking opioid use disorder treatment program in seven prisons in state, as part of a $155 million nationwide effort to address the opioid crisis. in criminal justice circles.

Ekaterina Pivovarova, PhD

The research has been published in Drug and Alcohol Dependence and in the Journal of Substance Abuse Treatment.

“Our findings demonstrate the positive impact that legislative mandates and correctional intent have on changing practice in providing gold standard treatments for those incarcerated and with substance use disorder. opioids,” said lead author Ekaterina Pivovarova, PhD, assistant professor of family medicine and community health.

“These articles distill what we’ve learned about the barriers and facilitators to implementing a program like this,” said Elizabeth Evans, associate professor at the UMass Amherst School of Public Health and Health Sciences.

Evans is co-principal investigator, with Peter Friedmann, MD, MPH, associate dean of research at UMass Chan Medical School-Baystate and director of research at Baystate Health, of a $10 million grant from the National Institutes of Health (NIH), which formed the Justice Community Opioid Innovation Network (JCOIN) in 2019.

Massachusetts JCOIN research represents an important and ongoing collaboration across the Commonwealth. The authors of both papers are based at Tufts University School of Medicine and Northeastern University, in addition to UMass Amherst, UMass Chan Medical School, and Baystate Health.

In 2018, Massachusetts became the first state in the United States to pass legislation mandating a treatment program, including FDA-approved drugs, for incarcerated people with opioid use disorders. The treatment program includes community care after release from prison for inmates with opioid use disorder, a time when they typically face a high risk of fatal overdose.

“This research involved talking to prison staff and others who implement the treatment program to learn from their experiences. We can use this knowledge to identify promising practices that other prisons could use. Massachusetts is at the forefront of offering this type of treatment program to incarcerated populations,” Evans says. “We’ve seen the range of implementation options. types of people and places.

Researchers interviewed 61 clinical, prison, and senior administrators involved in rolling out the Opioid Use Disorder Treatment Program, which provides incarcerated individuals with an FDA-approved medication, such as buprenorphine or methadone. Researchers have found that the state mandate leads to staff acceptance.

“Prisons are highly structured and quasi-military organizations in their hierarchies,” Friedmann said. “Legislative mandate and court orders have been critical in overcoming any drug resistance for opioid use disorder.”

The terms of reference indicated support for the program from above, which translated into an atypical flexibility to seek “innovative solutions” and create new routines, practices and policies for providing the drugs to incarcerated people who wished to participate.

The JCOIN grant funded on-site research staff at each prison to monitor program progress and assist with data collection. It was more difficult for older prison staff who had previously confiscated the drugs they were now going to offer to inmates.

“The staff had to change their mindset to see it as a treatment drug and not an illicit substance,” says Evans.

The research team was somewhat surprised to find that one of the big concerns about the program – that the drug might end up in the wrong hands due to intimidation, coercion or other reasons – did not seem be a significant problem.

“Staff reported, at least initially, that drug diversion is quite rare, and that’s not what we expected to hear,” Evans said, adding that protocols around where and when the medicine is supplied help to ensure that it is taken correctly by the person for whom it is intended.

The next step will be talking to people who received the drugs while incarcerated, evaluating follow-up care in the community, and measuring the health outcomes of the program.