Abstract
Over 10 million individuals pass through U.S. detention centers on an annual basis, with nearly two-thirds meeting criteria for drug dependence/abuse. Despite proven efficacy, treatment with medications for opioid use disorder (MOUD) is underutilized in jail settings—a gap that could be addressed using telemedicine. Here we describe a new program of telemedicine-based clinical provision of new/continuing buprenorphine treatment for individuals detained in a rural jail. Implementation objectives were completed between January and August 2020, and patient encounters were conducted between August 2020 and February 2021. We established (i) telemedicine hardware/software capability; (ii) a screening process; (iii) buprenorphine administration methods; (iv) necessary medical release procedures; (v) telemedicine encounter coordination and medication prescription procedures; and (vi) a research platform. Seven incarcerated patients have been treated, two of whom were referred from community treatment. Patients were mostly male (71%), non-Hispanic White (86%), and averaged 33 years old. All patients tested positive for an opioid upon intake and began/continued buprenorphine treatment in the jail. Average time to first MOUD appointment was 9 days and patients were maintained in treatment an average 21 days. Referrals for continuing community treatment were offered to all patients prior to discharge. We report successful implementation of telemedicine MOUD in a rural detention center, with treatment engagement and initiation occurring prior to the high-risk period of discharge. The fact that this program was launched during the height of the pandemic highlights the flexibility of telemedicine-based buprenorphine treatment. Challenges and obstacles to implementation of buprenorphine treatment in a correctional system are discussed.
Highlights
The United States is entrenched in an opioid epidemic that has disproportionally impacted rural areas of the United States [1, 2]
The only individuals who were offered medications for opioid use disorder (MOUD) within the jail were pregnant women who were already engaged in treatment within the community; otherwise, supervised withdrawal management with medications for symptom relief was the standard operating procedure for individuals presenting with an opioid use disorder at jail intake
A total of seven incarcerated patients with OUD were offered the opportunity to enroll into the telemedicine-based buprenorphine program from December 15, 2020 to February 15, 2021, and all seven patients accepted and consented to treatment
Summary
The United States is entrenched in an opioid epidemic that has disproportionally impacted rural areas of the United States [1, 2]. Buprenorphine, and long-acting naltrexone are FDA-approved frontline treatments in community and hospital settings for opioid use disorder (OUD); but in rural areas of the U.S, their availability and uptake is limited [5, 6]. This lack of access poses a acute problem for treatment within the criminal justice system. Jail and detention center settings oversee individuals struggling with substance use disorders and withdrawal but are in a unique position to initiate treatment in a controlled, safe environment. Criminal justice detainees have the least access to MOUD treatment [15]— in rural areas [16]
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