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• W1480654072 abstract "In the USA, as in many other settings, the main societal response to the harms of opioid addiction is arrest and imprisonment. The so-called war on drugs has contributed to an era of mass incarceration, in which about one in every 100 US citizens, almost all poor, many from racial minority groups and many who use illicit drugs, are currently detained in jails or prisons. 1 Dumont DM Allen SA Brockmann BW Alexander NE Rich JD Incarceration, community health, and racial disparities. J Health Care Poor Underserved. 2013; 24: 78-88 Crossref PubMed Scopus (77) Google Scholar The USA not only has the world's highest rate of incarceration, but treats opioid-addicted prisoners very differently from those in prisons in other countries. Unlike other serious chronic conditions such as cancer, diabetes, or HIV/AIDS, individuals with opioid dependence will often have their medically effective treatment—such as methadone, the standard treatment for opioid dependence—discontinued on incarceration in most US correctional institutions. 2 Fiscella K Moore A Engerman J Meldrum S Jail management of arrestees/inmates enrolled in community methadone maintenance programs. J Urban Health. 2004; 81: 645-654 Crossref PubMed Scopus (46) Google Scholar , 3 Fiscella K Pless N Meldrum S Fiscella P Alcohol and opiate withdrawal in US jails. Am J Public Health. 2004; 94: 1522-1524 Crossref PubMed Scopus (23) Google Scholar In a nationally representative survey of 500 US prisons, only 12% reported that individuals who enter custody on a methadone treatment programme are maintained on this programme during their time of incarceration. 2 Fiscella K Moore A Engerman J Meldrum S Jail management of arrestees/inmates enrolled in community methadone maintenance programs. J Urban Health. 2004; 81: 645-654 Crossref PubMed Scopus (46) Google Scholar Furthermore, in the prisons that do not provide methadone, most institutions reported that they have no standard protocol to taper individuals off methadone. Therefore, for the estimated 30 000 individuals on methadone who cycle through a correctional facility each year in the USA, the first days of their detention are spent in the pain and discomfort of physical withdrawal. 2 Fiscella K Moore A Engerman J Meldrum S Jail management of arrestees/inmates enrolled in community methadone maintenance programs. J Urban Health. 2004; 81: 645-654 Crossref PubMed Scopus (46) Google Scholar Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trialAlthough our study had several limitations—eg, it only included participants incarcerated for fewer than 6 months, we showed that forced withdrawal from methadone on incarceration reduced the likelihood of prisoners re-engaging in methadone maintenance after their release. Continuation of methadone maintenance during incarceration could contribute to greater treatment engagement after release, which could in turn reduce the risk of death from overdose and risk behaviours. Full-Text PDF" @default.
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• W1480654072 date "2015-07-01" @default.
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• W1480654072 title "Withdrawal from methadone in US prisons: cruel and unusual?" @default.
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• W1480654072 doi "https://doi.org/10.1016/s0140-6736(15)60073-3" @default.
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