Abstract
BackgroundSubstance use and substance use disorders are common in people who experience detention or incarceration in Canada, and opioid agonist treatment (OAT) may reduce the harms associated with substance use disorders. We aimed to define current physician practice in provincial correctional facilities in Ontario with respect to prescribing OAT and to identify potential barriers and facilitators to prescribing OAT.MethodsWe invited all physicians practicing in the 26 provincial correctional facilities for adults in Ontario to participate in an online survey.ResultsTwenty-seven physicians participated, with representation from most correctional facilities in Ontario. Of participating physicians, 52% reported prescribing methadone and 48% reported prescribing buprenorphine/naloxone to patients in provincial correctional facilities. Nineteen percent of participants reported initiating methadone treatment and 11% reported initiating buprenorphine/naloxone for patients in custody. Participants identified multiple barriers to initiating OAT in provincial correctional facilities including concerns about medication diversion and safety, concerns about initiating treatment in patients who are not currently using opioids, lack of linkage with community-based providers and the Ministry of Community Safety and Correctional Services policy. Identified facilitators to initiating OAT were support from institutional health care staff and administrative staff, adequate resources for program delivery and access to linkage with community-based OAT providers.ConclusionsThis study identifies opportunities to improve OAT programs and to improve access to OAT for persons in provincial correctional facilities in Ontario.
Highlights
Research in Canada has consistently identified high rates of substance use disorders among people in jails and prisons [1,2,3,4,5,6,7,8,9,10,11,12,13]
Substance use and substance use disorders are common in people who experience detention or incarceration in Canada, and opioid agonist treatment (OAT) may reduce the harms associated with substance use disorders
This study identifies opportunities to improve OAT programs and to improve access to OAT for persons in provincial correctional facilities in Ontario
Summary
Research in Canada has consistently identified high rates of substance use disorders among people in jails and prisons [1,2,3,4,5,6,7,8,9,10,11,12,13]. Recent observational studies found that OAT was associated with a reduced risk of death in persons after release from prison; two studies found absolute risk differences between those exposed and unexposed of 27.4 and 30.3 deaths, respectively, per 1,000 person years in the four weeks after release [50, 51]. In this context, the World Health Organization has recommended that all prisoners with opioid use disorders should have access to methadone or other agonist treatment [52].
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