About JPOP

We hope that JPOP will serve as a hub for the most up-to-date data, toolkits and resources on medication for opioid use disorder (MOUD) in prisons and jails in the United States. Despite the plethora of evidence in favor of the use of MOUD as the most effective treatment for opioid use disorder, only about 12% of jails and prisons in the United States offer any MOUD.1

We encourage you to engage with the resources on this site and advocate for medication for opioid use disorder (MOUD) in your community.

Together we can fight stigma and increase access to MOUD in corrections. Everyone deserves to have access to high quality and lifesaving healthcare regardless of criminal legal status.

References

  1. Calculated by JPOP on 7/30/21.

A Brief Background

How did we get here?

The overprescription of opioids, such as OxyContin, Percocet, and Vicodin, by medical professionals in the late 1990s began the first wave of the modern opioid epidemic. Despite the effectiveness of opioids to relieve pain, prescribers had little knowledge or understanding about the addictive nature of opioids. As regulators, providers and the public grew increasingly aware of people developing addictions and overdosing due to the overprescription of opioids, the legal access to opioids became more constrained.1

Despite, and also because of, the efforts to reduce access to opioids, the illegal supply rapidly expanded to meet the demand, leading to the second wave in the late 2000s. Many people turned to illicit opioids, mostly heroin, which was cheaper and more accessible than the prescription equivalent. Prescription opioid use is a strong predictor of subsequent heroin use; in fact, 80 percent of heroin users have reported previously abusing prescription opioids.2

The third, and current, wave followed shortly thereafter and has been marked by a surge of drug-related deaths linked to synthetic opioids, primarily illicitly manufactured fentanyl. In 2016, there was a sharp rise in overdose deaths as over 20,000 individuals died from synthetic drug use. Preliminary data from 2020 suggest another surge, likely triggered by the COVID-19 pandemic.1,3,4

Opioids and Mass Incarceration?

Drug charges are the most common reason for arrest in the United States and it is estimated that nearly sixty-five percent of all incarcerated individuals meet criteria for a substance use disorder. The use of opioids, including prescription opioids, heroin, and synthetic opioids, is linked to a higher rate of recidivism.5 The current punitive approach to drug use has not only failed to address the root of the problems, but also exacerbated racial disparities that pervade the criminal legal system.6

In response to the worsening opioid crisis and the failure to address it through our criminal legal system, experts are demanding smarter, more effective, and more compassionate approaches to address opioid use disorder. A number of jurisdictions are implementing innovative and evidence-based harm reduction strategies including Naloxone (Narcan) distribution, alternatives to incarceration and ultimately, what our project aims to do, expand access to medications for opioid use disorder among the most vulnerable individuals.

References

  1. CDC. Understanding the Epidemic. Centers for Disease Control and Prevention website. Updated March 17, 2021. Accessed June 10, 2021. https://www.cdc.gov/drugoverdose/epidemic/index.html
  2. National Academies of Sciences, Engineering, and Medicine. Chapter 1: Introduction. In: Leshner AI, Mancher M, eds. Medications for Opioid Use Disorder Save Lives. 1st ed. National Academies Press; 2019:15-32.
  3. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. MMWR Morb Mortal Wkly Rep. 2017; 66: 1197–1202. DOI: http://dx.doi.org/10.15585/mmwr.mm6643e1
  4. CDC. Overdose Deaths Accelerating During COVID-19. Centers for Disease Control and Prevention. Updated December 18, 2020. Accessed June 10, 2021. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
  5. NIDA. Treating Opioid Addiction in Criminal Justice Settings. National Institute on Drug Abuse. Published December 14, 2017. Accessed June 10, 2021. https://www.drugabuse.gov/publications/treating-opioid-addiction-in-criminal-justice-settings#ref
  6. Vera Institute of Justice. Addressing Opioids: A crisis. Vera Institute of Justice website. Updated 2021. Accessed June 10, 2021. https://www.vera.org/spotlights/the-opioid-crisis

Stigma and Opioid Use Disorder

What is stigma?

According to the National Institute on Drug Abuse, “Stigma is a discrimination against an identifiable group of people, a place, or a nation. Stigma about people with substance use disorder [and people who are incarcerated] might include inaccurate or unfounded judgements like they are dangerous, incapable of managing treatment, or at fault for their condition.”1

Why does stigma matter?

Stigma has real and serious effects. For example, stigma can:

  • Deter people from seeking help and treatment for substance use
  • Lead people to believe their illness is their fault
  • Enhance or reinstate drug use
  • Lead others to hold patients with SUD in poor regard relative to other people

What can I do about stigma?

Where can I learn more about stigma and substance use?

References

  1. NIDA. Words Matter – Terms to Use and Avoid When Talking About Addiction. National Institute on Drug Abuse website. Updated May 25, 2021. Accessed June 11, 2021. https://www.drugabuse.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction

Key Terminology

Opioids: A class of drugs that work in the brain to produce a variety of effects, including the relief of pain. Opioids include prescription drugs, such as OxyContin, and illicit drugs, such as fentanyl and heroin. Learn more →

Opioid Use Disorder (OUD): Often referred to as opioid addiction is characterized by ongoing use despite adverse consequences. It is defined in the DSM-5 as a problematic pattern of opioid use leading to clinically significant impairment or distress. Learn more →

A Person with Opioid Use Disorder: The most respectful and accurate way to talk about a person with the disease or is receiving treatment for opioid use disorder. This is an example of person-first language. It is important to note that not all people who use illicit opioids or take opioids for recreational purposes have an opioid use disorder.  Learn more →

Medication for Opioid Use Disorder (MOUD): There are three drugs approved by the Food and Drug Administration (FDA) for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone. All three of these treatments have been demonstrated to be safe and effective, and are the best treatments we have currently. They are often prescribed in combination with counseling and psychosocial support, although they are effective by themselves. The lack of availability of appropriate counseling and support is not a reason to withhold MOUD. Learn more →

Medication for Addiction Treatment (MAT): The use of medications to treat addictive disorders, including alcoholism and nicotine use disorders. MAT also has been used to describe “Medication Assisted Therapy” however this term is falling out of favor because it implies that the medications are merely assisting the therapy, when in fact the real effective therapy is the medications and the counseling and behavioral therapies assist in the treatment of substance use disorders.

Jail: Usually run by local law enforcement and/or local government agencies, and are designed to hold inmates awaiting trial or serving a short sentence (less than a year). Learn more →

Prison: Correctional facilities run by the state or the Federal Bureau of Prisons (BOP) that typically houses individuals serving more serious chargers, or sentences longer than one year. Learn More →

Detoxification: Detoxification is the halting of opioid consumption when a person is physically dependent. “Detox” can be a slow process where one is slowly tapered off the opioid, or simply given other medications to treat the symptoms of withdrawal, often administered under medical supervision. Detoxification alone can lead to rates of relapse of nearly 90% and the accompanying loss of tolerance can increase the risk of overdose and fatal overdose. Detoxification is not the recommended treatment for opioid use disorder. Learn more →

Medications for Opioid Use Disorder (US)

The United States Food and Drug Administration (FDA) has approved three medications to treat opioid use disorder. While the medications vary in how they function and affect the body, they have all been extensively proven to effectively treat opioid use disorder and reduce overdose mortality. They all block the effects of opioids at the receptor level and work if the patient takes them.

  • Methadone: clinic-based opioid agonist that requires daily oral dosing dispensed only in specialty, highly regulated clinics, commonly referred to as opioid treatment programs (OTPs). The strict structure, including in person daily visits at first, is helpful to some who benefit from that structure and an enormous burden to others.1
  • Buprenorphine (Suboxone): office-based opioid agonist/ antagonist that blocks other narcotics while reducing withdrawal risk; daily dissolving tablet, cheek film, monthly subcutaneous injection or 6-month implant under the skin.2
  • Naltrexone (Vivitrol): office-based non-addictive opioid antagonist that blocks the effects of other narcotics; daily pill or monthly injection. This has been studied the least and does not have as strong a track record as methadone and buprenorphine.3

The National Academies of Science, Engineering and Medicine published a report to support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis. The report showcases the findings that MOUD is an effective treatment for opioid use disorder and saves lives.

Opioid Overdose Reversal

  • Naloxone (Narcan): An opioid antagonist that can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing.4

References

  1. SAMHSA. Methadone. Substance Abuse and Mental Health Services Administration website. Updated June 8, 2021. Accessed June 11, 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone
  2. SAMHSA. Buprenorphrine. Substance Abuse and Mental Health Services Administration website. Updated May 14, 2021. Accessed June 11, 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine
  3. SAMHSA. Naltrexone. Substance Abuse and Mental Health Services Administration website. Updated September 15, 2020. Accessed June 11, 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone
  4. NIDA. Naloxone DrugFacts. National Institute on Drug Abuse website. Updated June 1, 2021. Accessed June 11, 2021. https://www.drugabuse.gov/publications/drugfacts/naloxone