Buprenorphine, methadone and naltrexone are the leading medicinal treatments for opioid use disorder, dulling cravings and offering a foothold in the path to recovery.
But for incarcerated individuals with opioid use disorder, access to those medications is inherently controlled by a given prison or jail’s personnel.
A multidisciplinary team of University of Wisconsin-Madison researchers set out to find whether staff attitudes toward medications for opioid use disorder affected treatment services in a subset of prisons and jails.
Perhaps not surprisingly, in a paper published in the journal Drug and Alcohol Dependence Reports, they found that staff opinions did correlate with actions: Facilities whose staff members reported positive attitudes toward all three medications had higher rates of screening and diagnosing individuals with opioid use disorder and referring them for treatment. Meanwhile, prisons and jails with staff who expressed positive attitudes toward naltrexone but negative attitudes toward methadone were less likely to screen, diagnose or refer individuals for treatment, as well as less apt to provide the medications or refer individuals for treatment after their release.
Gabriel Zayas-Caban
“We hypothesized that there was something going on like this, perhaps not to the extent,” says Gabriel Zayas-Caban, an assistant professor of industrial and systems engineering and senior author on the paper. “We wanted to just provide data support for it.”
Study lead author Aly Pfaff (BS ’19 in biochemistry, MS ’23 in epidemiology), who completed the work as part of her graduate work in the Department of Population Health Sciences, analyzed survey data from 43 jails and prisons in 14 states. That data emerged from a large study led by the Center for Health Enhancement Systems Studies (CHESS), housed in the Department of Industrial and Systems Engineering at UW-Madison.
Zayas-Caban, whose research group previously analyzed the effectiveness of a local substance use disorder treatment diversion program, was eager to collaborate with CHESS and found an ideal lead researcher in Pfaff, whose master’s program advisor was Amy Cochran, an assistant professor of population health sciences and math and Zayan-Caban’s wife.
Pfaff had already been looking into questions around the accessibility of opioid use disorder treatment when Cochran mentioned the project.
“I quickly learned that there were a lot of barriers—not just attitudes, but financial barriers, staffing barriers. But I kept coming back to attitudes,” says Pfaff, who now works as a research cyberinfrastructure specialist in the Center for Health Disparities Research at UW-Madison. “I kind of always thought that has to impact it somehow, but I couldn’t really find a lot of studies that had actually quantified or assessed that.”
Previous studies have shown that treatment with medications for opioid use disorder can lower incarcerated individuals’ risk of both overdose and heroin or injection drug use after their release. Individuals who receive medications while incarcerated are also more likely to continue treatment upon release.
“My hope is that there are more studies like this, that this is the tip of the iceberg,” says Pfaff. “I think there has to be some sort of behavioral change at an individual level, also perhaps at an institutional level.”
The research was supported by the National Institute on Drug Abuse (award number U2CDA050097) and the Clinical and Translational Science Award program, through the National Center for Advancing Translational Sciences (grants UL1TR002373 and KL2TR002374). CHESS researchers Todd Molfenter and Jessi Vechinski were also authors on the paper.
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