
==== Front
Lancet Reg Health Am
Lancet Reg Health Am
Lancet Regional Health - Americas
2667-193X
Elsevier

S2667-193X(24)00198-4
10.1016/j.lana.2024.100871
100871
Comment
Serving justice-involved persons and the opioid epidemic
Kang Augustine Augustine_kang@stanford.edu
ab∗
Martin Rosemarie b
a Stanford University School of Medicine, Stanford, CA, USA
b Brown University School of Public Health, Providence, RI, USA
∗ Corresponding author. Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA. Augustine_kang@stanford.edu
19 8 2024
10 2024
19 8 2024
38 1008717 5 2024
27 7 2024
9 8 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
==== Body
pmcBrenda Smith began using opioids at the age of 18.1 Her opioid use limited her ability to maintain employment or care for her family, leading her to lose custody of her four children. However, in 2009, with the help of medications for opioid use disorders (MOUD), Brenda began her journey of active recovery which allowed her to regain her footing.2 She obtained an education, employment, stable housing, and even the custody of her children. Unfortunately, in 2014, Brenda was briefly incarcerated in York County Jail for seven days for pocketing an errant $40 from a store's self-checkout that turned out to be an unexpected prosecutable act. While incarcerated, however, Brenda was not provided MOUD and was forced to detox—which she describes to be the worst pain she has ever endured and recalls experiencing suicidal thoughts for the first time in her life. Brenda further recalls a cellmate, who was also on MOUD but did not return to treatment after release, died shortly after due to an overdose. Individuals like Brenda and her cellmate need help, and we believe that medicine can do more in the justice system.

The United States is currently grappling with multiple public health crises, with the COVID-19 pandemic remaining at the forefront of public discourse. In the background, however, the opioid epidemic has continued to ravage the country since the 1990s. Shocking projections indicate that opioid overdose could result in the deaths of anywhere from 543,000 to 842,000 Americans between 2020 and 2032.3 Despite each year seeing new historic highs in opioid-related fatalities, there has been a lack of effective measures to curb this epidemic.

Fortunately, there is hope. Over half of individuals with OUD have some interaction with the criminal justice system.4 Working with people with justice involvement is a crucial but overlooked strategy to address this ongoing crisis. MOUD, such as buprenorphine, methadone, and naltrexone, are the most effective evidence-based treatments for OUD, working by blocking the effects of opioids and preventing drug cravings. However, MOUD is underutilized, denying life-saving care to people with OUD. Fewer than 12% of correctional facilities in the US provide MOUD, and many restrict treatment to those who are pregnant or were already on MOUD before incarceration.5 Despite evidence that MOUD can reduce overall opioid use and death and mitigate criminal behaviour,6 this remains standard practice.

Jail stays are typically brief (often less than 30 days), disrupting treatment continuity as individuals move between carceral settings and the community. Those who are on MOUD when entering prison frequently undergo forced withdrawal, resulting in decreased treatment retention and an increased risk of death. A study by Brown University showed that providing MOUD, particularly after release from incarceration, is life-saving.7 Thus, increasing investments in MOUD for people with justice involvement is crucial to combat this epidemic, as most incarcerated individuals are eventually released, and the lack of OUD treatment places a debilitating burden on society.

More than 4.5 million formerly incarcerated individuals are directed to community supervision programs, including probation and parole, each year.8 Probation and parole officers often lack the necessary training to identify people who would benefit from MOUD or connect them with appropriate care. Early intervention and improving continuity of care and the trajectory of people's involvement with the criminal justice system can improve health outcomes.

Although improving MOUD delivery in all stages of the justice system has challenges, such as concerns about MOUD diversion and logistical issues in delivering once-a-day medications, there are potentially viable solutions, such as providing long-acting, injectable buprenorphine.

Therefore, it is crucial that the United States implement major reforms to address OUD in the criminal justice system and make evidence-based treatment available to a population long neglected by the public health infrastructure. Implementation research can serve as a guiding model towards this goal, improving the continuum of care and meaningfully reducing the burden of opioid overdoses and deaths on society. Increasing OUD screening and referral services within correctional operations (such as is done in Rhode Island), can lead to a future where effective interventions are in place to combat opioid addiction in people with justice involvement, resulting in improved health outcomes.

Contributors

AK: Conceptualization, Writing- Original draft preparation. RM: Conceptualization, Writing- Original draft preparation, Supervision.

Declaration of interests

The authors declare no competing interests.
==== Refs
References

1 No. 1:18-cv-352-NT 2019 https://www.govinfo.gov/content/pkg/USCOURTS-med-1_18-cv-00352/pdf/USCOURTS-med-1_18-cv-00352-0.pdf
2 Gardner M. Frysh P. Kicking opioids in prison https://www.webmd.com/mental-health/addiction/story/kicking-opioids-in-prison
3 Reardon S. Mega-model predicts US opioid deaths will soon peak Nature 2022 10.1038/d41586-022-01519-z
4 Winkelman T.N. Chang V.W. Binswanger I.A. Health, polysubstance use, and criminal justice involvement among adults with varying levels of opioid use JAMA Netw Open 1 3 2018 e180558
5 Jordan A.O. National drug control strategy highlights opportunities, barriers to MOUD in corrections. National Commision on Correctional Health Care https://www.ncchc.org/national-drug-control-strategy-highlights-opportunities-barriers-to-moud-in-corrections/
6 Deck D. Wiitala W. McFarland B. Medicaid coverage, methadone maintenance, and felony arrests: outcomes of opiate treatment in two states J Addict Dis 28 2 2009 89 102 19340671
7 Martin R.A. Alexander-Scott N. Berk J. Post-incarceration outcomes of a comprehensive statewide correctional MOUD program: a retrospective cohort study Lancet Reg Health Am 18 2023 100419
8 Jones A. Correctional control 2018: incarceration and supervision by state Prison Policy Initiative 12 11 2018
