Corrections_Today_Summer_2024_Vol.86_No.2

HEALTH CARE

Literature, policy, and legal proceedings review

during and after incarceration experience a greater reduction in recidivism (i.e., reincarceration, probation violation, arraignment) and the absence of MOUD in CJS increases recidivism risk. 22,31 Therefore, treating incarcerated individuals with OUD provides additional benefits of protection against subsequent drug-related incarceration. 32 Any lack of effort from criminal justice institutions to provide MOUD and secure the overall well-being of the incarcerated individual with OUD is not aligned with the pillar of beneficence. Non-maleficence Non-maleficence is further described as the act of not intentionally inflicting harm, where harm is defined as an adverse effect. 24 Due to the nature of withdrawal from methadone, studies have frequently examined the omission of treatment for individuals on methadone maintenance treatment prior to incarceration. Abrupt cessation of methadone results in the precipitation of painful withdrawal symptoms frequently requiring medical assistance. 33 The availability of buprenorphine treatment and referrals to community centers post release demonstrate the criminal justice institution’s willingness to remove intentional harm for incarcerated individuals with OUD. Even with treatment and com munity referrals, it is important to note the distance an individual must travel from their place of residence to the treatment center impacts the engagement with the treatment center. 34,35 Justice Federal law requires incarcerated individuals be treated for health problems since they have no other way to access medical care. 11 Injustice occurs when a health benefit, such as MOUD, which should be an avail able treatment option for people with OUD, is denied without good reason. 24 Injustices regarding methadone treatment have been extensively studied in criminal justice. Based on a survey conducted in 2009, out of 28 state prison systems that offered methadone treat ment, over half limited treatment to pregnant women or individuals with chronic pain. 7 Correctional systems that restrict methadone treatment to a limited number of patient populations are unjust, as they do not provide

The literature review focused on published, peer reviewed articles, grey literature and applicable law cases in the U.S. The review of academic journals used a protocol-driven approach of key terms related to MOUD and CJS and a snowball approach to identify supple mentary literature, termed “grey literature.” The review of recent, applicable law cases used a similar approach of utilizing key terms on Westlaw™ (Thomson Reuters; Eagan, MN). Article 12 of The International Covenant on Econom ic, Social and Cultural Rights (ICESCR) establishes that everyone has the right to enjoy “the highest attain able standard of physical and mental health,” which includes the “prevention, treatment, and control” of an epidemic disease, such as OUD. 20,21 In accordance with ICESCR, failure to grant MOUD to incarcerated individuals with OUD violates their right as individu als, forces them to experience painful withdrawals, puts them at risk for relapse, increases possible recidivism and decreases opioid tolerance related to premature death by overdose. 22,23 Further, the ways in which MOUD access barriers violate the pillars of bioethics within the CJS are described below. Beneficence According to the pillar of beneficence, individu als should be treated in an ethical manner and efforts must be made to secure their overall well-being. 24 With holding MOUD from incarcerated individuals violates the concept of beneficence because these individuals are not protected from harm or treated in a manner beneficial to their health. 22,23 The risk of death from overdose post-incarceration compared to the general population is reported to be 40 times higher (50 times higher with synthetic opioids) two weeks after release and 12.7 times higher within the first four weeks after release. 25,26,27,28 The relationship between criminal activ ity and subsequent incarceration among individuals with substance use disorder is well documented. 29 For most individuals with drug-related offenses, reincar ceration typically involves an additional drug-related offense. 30 Individuals with OUD receiving MOUD

Corrections Today | Summer 2024

26