Corrections_Today_Summer_2024_Vol.86_No.2

medication with fairness and do not recognize all people with OUD in the CJS as equal /qualified for equitable treatment. Buprenorphine treatment is also unequally distributed among correctional systems. In 2021, 1.5% of all buprenorphine use nationwide occurred in correctional systems, with only 3.6% of incarcerated individuals receiving buprenorphine treatment. 36 By limiting methadone treatment to select individuals, prison systems do not provide a just and fair distribu tion of MOUD among incarcerated individuals. The lack of fair distribu tion of MOUD among individuals with OUD who are incarcerated in prisons nationwide is further dem onstrated in a study including 583 prisons. 37 While some prisons offer MOUD, many only offer certain types of medication, rather than provid

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ing incarcerated individuals with the same medications available to the general public. 37 As mentioned, stigma regarding OUD is a signifi cant barrier for the implementation of MOUD in CJS. Discriminating against incarcerated individuals with OUD and not accepting the medical necessity of MOUD is an injustice. Although sublingual buprenorphine is formulated in combination with naloxone to reduce the likelihood of diversion and/or abuse, the CJS continues to focus on preventing diversion, resulting in the lack of availability of MOUD for incarcerated individuals. 38,39 It is estimated diversion occurs between 1% to 10% in CJS, 40 which is lower than the diversion that occurs in the general public. 41 The fear regarding diversion typical ly occurs in CJS where contraband is highly prevalent, 42 however, findings from diversion-related studies were produced prior to the established of MOUD treatment programs in this setting. 43 Few studies examine the motivation for using non-prescribed MOUD in CJS. 44,45 Reasons for using non-prescribed MOUD include inability to access prescribed buprenorphine treat ment, self-treatment for withdrawal or self-initiated detoxification. 46,47

Autonomy While being detained in a criminal justice institution inherently removes some autonomy such that incarcer ated individuals do not experience the same freedom of choice as the public, individuals within the CJS still have the right to make unbiased and informed choices regarding their healthcare. 24 The primary component of autonomy involves making informed decisions, which is best executed through ensuring the patient or individual is educated on the matter. In terms of OUD, education is the first and most important step for both individu als suffering with OUD and the individuals responsible for providing MOUD. Research demonstrates indi viduals with OUD frequently have an incomplete or biased understanding of their health condition and the medications available to help. 48-50 Authorities and health care professionals involved in making decisions for individuals with OUD in CJS similarly display altered perceptions and lack of education on MOUD that affects the treatment of incarcerated individuals with OUD. 18 While education services are offered in some criminal justice institutions, it is not enough when provided with out treatment. 51 →

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