Integrating injectable opioid agonist treatment into a drug treatment court program: A case study

Abstract

Background: A substantial proportion of individuals involved with the North American criminal justice system are convicted for drug-related activities. Drug treatment court (DTC) programs were developed as an alternative to incarceration for drug-related offences and aim to prioritize addiction treatment and improve health and social outcomes; however, only a fraction of DTC participants have access to first-line medications for opioid use disorder (OUD). Further, despite emerging evidence for the efficacy of injectable opioid agonist therapy (OAT) in treating individuals with severe OUD where past treatment attempts with first-line therapies have been unsuccessful, this treatment has never, to our knowledge, been implemented in correctional settings. Case: An individual in their 50s with a history of severe OUD, multiple interactions with the criminal justice system, and prior unsuccessful treatment attempts with methadone was initiated on injectable treatment with diacetylmorphine. The patient received 300 mg of diacetylmorphine witnessed 3 times daily at a supervised injection clinic. During a 1.5-year stabilization phase, the patient’s illicit opioid use significantly reduced. They subsequently enrolled in a DTC program for drug-related charges preceding initiation on injectable OAT and remained on this therapy during 16 months in DTC. Following graduation from DTC, the patient continued to receive treatment and returned to gainful employment in the community, with no further charges or episodes of incarceration. Discussion: This case describes the successful completion of a DTC program by an individual prescribed injectable OAT for severe OUD. The patient’s treatment plan played an integral role in DTC graduation and long-term adherence, leading to improved health and social outcomes, including cessation of illicit drug use, enhanced quality of life, and improved social functioning. The case highlights the potential benefits of a stepped and integrated approach to addiction treatment in DTC programs.

Keywords:

• Diacetylmorphine
• injectable opioid agonist treatment
• injection drug use
• opioid use disorder
• public health
• treatment outcomes

Acknowledgments

We thank the individual described in this case report for allowing us to share the details of his case. The individual described in this case has reviewed and approved the final draft of the manuscript.

Author contributions

Both co-authors prepared the draft of the manuscript.

Additional information

Funding

Dr. Nadia Fairbairn is supported by a Scholar award from the Michael Smith Foundation for Health Research/St. Paul’s Foundation, a Canada Addiction Medicine Research Fellowship [US National Institute on Drug Abuse, R25-DA037756], and the Research in Addiction Medicine Scholars Program [US National Institute on Drug Abuse, R25-DA033211]. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.