Assessment of Attitudes Towards Medication-Assisted Drug Treatment Options among an Incarcerated Population

ABSTRACT

Medication-assisted treatment (MAT) is the state-of-the-art approach to treating opioid use disorder (OUD). Although OUD is prevalent among justice-involved populations, their attitudes toward MAT are largely unknown. Injectable extended release naltrexone (XR-NTX) is a MAT option, that is, unlike others, an opioid antagonist. We assess beliefs about XR-NTX as compared to methadone, a gold-standard pure opioid agonist MAT modality, in a sample of incarcerated men and women. Self-report data were collected from randomly selected adults (n = 1,570) residing in therapeutic communities (TCs) in 23 state correctional facilities. Distinct instruments addressed XR-NTX (n = 830) and methadone (n = 741). Prior knowledge and exposure to XR-NTX, and race, were significantly associated with positive beliefs about XR-NTX. Addiction history, race, beliefs about behavioral change, and a preference for injection over oral medications were positively associated with the average likelihood of opting for post-release XR-NTX treatment. Implications for health and correctional policy are discussed.

KEYWORDS:

• drug treatment
• prison
• medication-assisted treatment (MAT)
• addiction
• opioids

Disclosure statement

Dr. Langleben served on the Scientific Advisory Board of Alkermes Inc in 2018 and 2019.

Notes

1. While it is certainly the case that there are illicit drugs available inside of correctional facilities, the prevalence of usage is likely low enough to preclude daily use, which is a key feature of OUD (see, Ourada & Appelbaum, 2015). Despite this, drug screening, either as part of the TC unit protocol or prior to the imposition of XR-NTX treatment, is clearly warranted as complete abstinence can never be assured.

2. It was not possible to provide assistance to respondents with literacy issues, as this would have undermined the foundational protections of confidentiality and anonymity. Similarly, all participants in the subject TCs needed to have basic proficiency in English in order to participate in the group therapy programming. Therefore, the survey was not translated into any other languages for this administration. Factors of this nature, possibly including other physical, mental or educational challenges, could have contributed to non-systematic survey level non-response.

3. The target sample was approximately 50% of the TC population at the time the study was designed. This represents an approach reflecting both the need to obtain a representative sample and practical restrictions on time and resource usage in the correctional institutions.

4. Given the anonymous nature of survey and the administration procedures described above, it is not possible to identify exactly why the 20.2% of the sample who did not respond chose to do so. The potential reasons are myriad, including literacy, comprehension, lack of time, mistrust of correctional officials and others. Similarly, the lack of identifying information prevented the linking of survey data to administrative records, preventing any comparisons between respondents and non-respondents using those data. This also prevented the identification at which correctional facility the surveys were administered at, preventing these data from being analyzed as nested (e.g., using Hierarchical Linear Modeling approach) and based on facility characteristics (e.g, security level).

5. The response rate to the prior drug abuse item indicates the respondents’ acknowledgment of their previous addictive behaviors. All enrollees in the AOD TC had met clinical criteria for drug abuse and were actively in treatment for these addictions. Although the targeted population were not exclusively opiate users, they were the most likely to have exposure to MATs since at any one time, approximately 75% of the TC population has identified opiates or alcohol as their drug of choice. The anonymized nature of the survey, as well as patient confidentiality rules, prevented additional screening or follow-up inquiry.

6. The relationship between self-reported preferences for an injectable treatment is not significantly associated with a positive increase in the likelihood of volunteering for an MAT program with that characteristic. This is noteworthy, as non-systematic qualitative data, collected both contemporaneously and post-hoc, indicated that many incarcerated persons expressed a strong aversion to the use of injection or needle-based treatments, regardless of their relative value.