Corrections_Today_Summer_2024_Vol.86_No.2

HEALTH CARE

Autonomy encompasses informed and voluntary decisions, which assumes informed and voluntary deci sions apply not only to the initiation and availability of a treatment, but also the cessation of MOUD. While it is true individuals experiencing withdrawal or active drug use have limited capacity to execute informed decisions, a diagnosis of OUD does not automatically deem an in dividual to be without decision making capacity. 52,53 The concept of forced abstinence by the CJS is a violation of personal autonomy. 33 Limited availability of MOUD violates the personal autonomy of justice involved indi viduals. This is because they are not provided with the capacity to act with intention, where intention is related to treating their OUD. Education is a major component in making informed decisions. Education should be routinely provided, both for individuals with OUD and providers of MOUD so informed decisions can be made to improve the overall health of the individuals. Legally, providing healthcare for incarcerated in dividuals in federal prison is mandated by Title 42 section 250 from the U.S. Federal Code of Regulations as authorized by section 4005 of Title 18. 54,55 Although regulations between states are not uniform, state laws

do exist that legally require state funded criminal justice institutions to provide medical treatment for incarcerat ed individuals. 4,56 Even with laws established to provide incarcerated individuals in prisons and jails with health care, a plethora of barriers exist hindering the universal implementation of MOUD in CJS or within justice involved populations. 57 Table 1 describes applicable lawsuits related to MOUD access within CJS. Stigma and informed consent assumptions are the most discussed barriers used to justify policies limiting MOUD. Conclusion There is a clear disconnect between healthcare for the general public and healthcare for incarcerated individu als in terms of access to MOUD. 62 Several factors limit the availability of MOUD, including: stigma, security concerns, differences in MOUD favorability, CJS staffing availability and lack of OUD-related training/educa tion. 22,46,62,63 Stigma and informed consent assumptions are the most discussed barriers used to justify policies limiting MOUD. 63 Security concerns are the next biggest factor limiting MOUD; however, many CJS offer opioids for the treatment of pain for incarcerated individuals, and thus, have established security measures to prevent diversion. 22 Because this narrowly focused, targeted literature, policy and legal case review was limited to evi dence within the scope of our search and located only in the U.S., the findings may not be applicable for a broader, more general audience. The content is for informational purposes only and should not be considered legal advice. By examining the barriers limiting MOUD in CJS and their application to the four pillars of bioethics, state and federal authorities should establish policies aiding and demanding for the universal implementation of MOUD in CJS where appropriate. 37 CT

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Corrections Today | Summer 2024

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