|Updated Position Statement Focuses on Treatment of Substance Use Disorder in Correctional Facilities|
|By Katie Przychodzen, NCCHC|
Effective treatment for substance use disorders is key to halting the national epidemic of drug abuse, particularly opioid use disorder, and interrupting the costly cycle of incarceration and recidivism resulting from this underlying disorder.
The National Commission on Correctional Health Care, the nation’s leading authority on health care systems in jails, prisons and juvenile detention facilities, has updated its position statement on the treatment of substance abuse disorder for incarcerated individuals.
Scientific evidence has firmly established that substance use disorders represent a chronic, relapsing disease requiring effective treatment with a view toward long-term management. NCCHC's position statement reflects this science and the latest national guidelines. It is intended to ensure that people with substance use disorders in custody receive evidence-based care in accordance with national medical standards.
"This is a landmark position statement for treatment of substance use disorders within the nation’s jails and prisons. In issuing this statement, the National Commission recognizes that correctional facilities can become major partners in combating addiction in America through use of scientifically based treatment,” said Kevin Fiscella, MD, MPH, the American Society of Addiction Medicine’s liaison to NCCHC’s board of directors.
“Among a number of important recommendations, the National Commission calls for expanded use of medications that have proven effective in treating opioid addiction. Greater use of these medications coupled with linkage to community treatment programs prior to inmate release will reduce drug relapse, recidivism and death and help halt the deadly opioid epidemic that is affecting countless communities," Dr. Fiscella said.
Addiction experts agree that with proper medical care in the form of medication-assisted therapy – the use of approved medications such as methadone or buprenorphine in combination with counseling and behavioral therapies – opioid users can break the cycle of addiction. Studies overwhelmingly associate MAT with positive postincarceration outcomes: reductions in mortality, illicit substance use, crime, recidivism and health problems like HIV and HCV (due to reductions in needle sharing). Unfortunately, many jails and other facilities do not use MAT, or provide it only in limited circumstances.
This position statement advocates 14 principles for care of adults and adolescents with substance use disorders in correctional facilities; these principles reinforce and expand on principles articulated in NCCHC’s Standards for Health Services. Recommendations address screening and identification, continuation or initiation of MAT while incarcerated, monitoring and withdrawal according to national medical standards, prerelease initiation of treatment and care coordination, and linkage of medication treatment programs with nonpharmacological treatment options.
The statement primarily focuses on alcohol, benzodiazepine, and opioid use disorders because of the high rates of death from withdrawal and overdose from these substances. However, the principles of screening, evaluation, provision of evidence-based treatment, and prerelease coordination of care apply to all substance use disorders.
Consequences of drug use in prison and jail may include drug-related overdose deaths, suicides, increased criminal activity related to drugs and distribution, disciplinary actions, self-harm and spread of blood-borne infections through needle sharing. Inmates released from prison without MAT are at high risk of dying from overdose in the first 2 weeks following their release.
“We have an obligation to give medical care, and to balance this care with compassion, good medical evidence, patient safety, institutional safety and security, and planned return to a nonincarcerated life. This position statement addresses these issues,” said Steven Shelton, MD, CCHP-P, CCHP-A, head of the NCCHC working group responsible for this updated position statement.
The position Statement on Substance Use Disorder Treatment for Adults and Adolescents was developed by a committee of experts representing medicine, psychiatry, nursing and law. It was approved by the NCCHC Board of Directors in October at the National Conference on Correctional Health Care.
Read the entire position statement at www.ncchc.org/position-statements.
NCCHC position statements serve to augment the organization’s Standards for Health Services for jails, prisons and juvenile facilities, and express NCCHC's expert opinion on important issues that are not addressed in the Standards.
About the National Commission on Correctional Health Care
NCCHC is a not-for-profit 501(c)(3) organization working to improve the quality of care in our nation’s jails, prisons, and juvenile detention and confinement facilities. NCCHC establishes standards for health services in correctional facilities; operates a voluntary accreditation program for institutions that meet these standards; produces and disseminates resource publications; conducts educational trainings and conferences; and offers a certification program for correctional health professionals. NCCHC is supported by the major national organizations representing the fields of health, law and corrections. Each of these organizations has named a representative to the NCCHC Board of Directors.
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