Corrections_Today_Summer_2024_Vol.86_No.2

Introduction T he availability of certain health services for incarcerated individuals in the United States (U.S.) is complicated by lack of resources, misconceptions, policies and organizational systems. 1-4 Further, the U.S. does not have a single criminal justice system (CJS), but is broken down into 1,155 state jails, 111 federal prisons, and 411 privately operated facilities. 5 Among facilities who responded to the Census of State and Federal Correctional Facilities survey conducted by the U.S. Department of Justice, there were 1,360,634 people incarcerated in jails and prison in 2019. 5 It has been estimated that 50–85% of incarcerated individuals suffer from opioid use disorder (OUD) or have had a history of opioid abuse prior to incarceration. 6,7 OUD is a treatable, complex, chronic disease in which individuals develop a pattern of uncontrolled or compulsive opioid use despite the negative consequences. 8-10 The evidence-based treatment for OUD includes Food and Drug Administration (FDA) approved pharmacologi cal agents as well as psychosocial services. 11 Despite the established effectiveness of medications for the treatment for opioid use disorder (MOUD) and the close association between the CJS and people with OUD, only approximately 25–32% of incarcerated individuals with OUD receive treatment while in the CJS. 12-14 While a minority of incarcerated individuals with OUD are treated with MOUD, treatment does not always follow current, evidence-based recommendations. 15,16 The American Society of Addiction Medicine (ASAM) has developed an evidence-based National Practice Guideline for the treatment of OUD. 11 The ASAM guidelines are one of the few addressing the management of opioid overdose, withdrawal and OUD specifically mentioning special population categories, including individuals in the CJS. The World Health Organization (WHO) also produced ‘Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence’ that require pharmacological treatment be accessible to all in need, including incarcerated indi viduals, as a best practice. 17 This review focuses on the four pillars of bio ethics (i.e., beneficence, non-maleficence, justice,

autonomy), with the addition of public health ethics, to demonstrate the necessity of reforming policies and overcoming barriers to address the treatment of OUD for individuals within the CJS. Beneficence describes the principles that healthcare providers have a duty to be a benefit to a patient or have a duty to prevent harm to the patient. Beneficence also means individuals should be treated in an ethical manner and efforts must be made to secure their overall well-being. Non maleficence requires intentional harm or injury is not created, either through the acts of commission or omission. Non-maleficence is further described as the act of not intentionally inflicting harm, where harm is defined as an adverse effect. In terms of health care, justice is defined as a form of fairness or the fair distribution of goods. It holds true that persons are equals and should qualify for equal treatment. Au tonomy is the notion of moral decision-making where it is assumed rational agents are involved in making informed and voluntary decisions. It allows a patient or individual with health needs, with capacity to act with intention, understanding, and without externally controlling forces.

It has been estimated that 50–85% of incarcerated individuals suffer from opioid use disorder (OUD) or have had a history of opioid abuse prior to incarceration.

The majority of incarcerated individuals with OUD in jails and prisons do not receive OUD treatment. 7 In addition, individuals with OUD released on probation and parole also experience a lack of appropriate, evi dence-based MOUD therapy. 18,19 Although the literature supports implementing MOUD in CJS, many barriers remain that prevent the implementation or routine use of MOUD in jail and prison settings. →

Opposite page graphic: Pillars: Adobe Stock/Siddharth; Background: Adobe Stock/Felix Pergande

Summer 2024 | Corrections Today

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