TY - JOUR
KW - buprenorphine
KW - Criminal justice settings
KW - Massachusetts Justice Community Opioid Innovation Network (MassJCOIN)
KW - Medication diversion
KW - Medications for opioid use disorder (MOUD) treatment
KW - Qualitative design
AU - E. A. Evans
AU - E. Pivovarova
AU - T. J. Stopka
AU - C. Santelices
AU - W. J. Ferguson
AU - P. D. Friedmann
A1 - 
AB - INTRODUCTION: Correctional officials often cite diversion of medication for opioid use disorder (MOUD) treatment (e.g., buprenorphine) as a reason for not offering MOUD treatment in jails and prisons, but it is poorly understood whether these fears are justified. We aimed to understand staff perceptions of medication diversion from jail-based MOUD programs and the factors that contribute to and prevent diversion. METHODS: We conducted qualitative analyses of semi-structured in-depth interviews and focus groups performed in 2019-20 with 61 administrative, security, behavioral health, and clinical staff who implement MOUD programming in seven Massachusetts jails. RESULTS: Contrary to staff expectations, buprenorphine diversion was perceived to occur infrequently during MOUD program implementation. The MOUD program changed staff views of buprenorphine, i.e., as legitimate treatment instead of as illicit contraband. Also, the program was perceived to have disrupted the illicit buprenorphine market in jail and reduced related coercion. Proactive strategies were essential to prevent and respond to buprenorphine diversion. Key components of diversion prevention strategies included: staff who distinguished among different reasons for diversion; comprehensive and routinized but flexible dosing protocols; communication, education, and monitoring; patient involvement in assessing reasons for diversion; and written policies to adjudicate diversion consequences. CONCLUSION: With appropriate protocols, buprenorphine diversion within correctional programs designed to provide MOUD treatment is perceived to be uncommon and preventable. Promising practices in program design help limit medication diversion and inform correctional officials and lawmakers as they consider whether and how to provide MOUD treatment in correctional settings.
AD - Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA 01003, United States of America. Electronic address: eaevans@umass.edu.; Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.; Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, United States of America.; Urban Health Research and Practice, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States of America.; Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States of America.; University of Massachusetts Medical School (UMMS), Baystate and Baystate Health, 3601 Main Street, Springfield, MA 01199, United States of America.
BT - Journal of substance abuse treatment
C5 - Opioids & Substance Use
CY - United States
DO - 10.1016/j.jsat.2022.108746
JF - Journal of substance abuse treatment
LA - eng
M1 - Journal Article
N2 - INTRODUCTION: Correctional officials often cite diversion of medication for opioid use disorder (MOUD) treatment (e.g., buprenorphine) as a reason for not offering MOUD treatment in jails and prisons, but it is poorly understood whether these fears are justified. We aimed to understand staff perceptions of medication diversion from jail-based MOUD programs and the factors that contribute to and prevent diversion. METHODS: We conducted qualitative analyses of semi-structured in-depth interviews and focus groups performed in 2019-20 with 61 administrative, security, behavioral health, and clinical staff who implement MOUD programming in seven Massachusetts jails. RESULTS: Contrary to staff expectations, buprenorphine diversion was perceived to occur infrequently during MOUD program implementation. The MOUD program changed staff views of buprenorphine, i.e., as legitimate treatment instead of as illicit contraband. Also, the program was perceived to have disrupted the illicit buprenorphine market in jail and reduced related coercion. Proactive strategies were essential to prevent and respond to buprenorphine diversion. Key components of diversion prevention strategies included: staff who distinguished among different reasons for diversion; comprehensive and routinized but flexible dosing protocols; communication, education, and monitoring; patient involvement in assessing reasons for diversion; and written policies to adjudicate diversion consequences. CONCLUSION: With appropriate protocols, buprenorphine diversion within correctional programs designed to provide MOUD treatment is perceived to be uncommon and preventable. Promising practices in program design help limit medication diversion and inform correctional officials and lawmakers as they consider whether and how to provide MOUD treatment in correctional settings.
PP - United States
PY - 2022
SN - 1873-6483; 0740-5472
SP - 108746
T1 - Uncommon and preventable: Perceptions of diversion of medication for opioid use disorder in jail
T2 - Journal of substance abuse treatment
TI - Uncommon and preventable: Perceptions of diversion of medication for opioid use disorder in jail
U1 - Opioids & Substance Use
U2 - 35249789
U3 - 10.1016/j.jsat.2022.108746
VO - 1873-6483; 0740-5472
Y1 - 2022
Y2 - Feb 23
ER -