Intent to Refer: Exploring Bias Toward Specific Medication-Assisted Treatments by Community Corrections Employees

ABSTRACT

Background: As opioid use increases in the United States, especially in the correctional population, the most effective treatment approaches need to be utilized. Research has shown that medication-assisted treatment (MAT) provides better outcomes than traditional treatment approaches alone, but is underutilized among correctional-supervised populations. Objective: This article looks at how previously identified barriers to implementing MAT can create potential biases regarding the intent to refer individuals to either buprenorphine or methadone among treatment and correctional staff within community corrections. The varying advantages of each medication are discussed to highlight the importance of individualized treatment planning. Methods: Data were collected from 959 treatment specialists and community-corrections officers between 2010 and 2013. The participants were employed by one of 20 community corrections agencies that were selected and randomized within a cluster design. The data were part of a larger study that tested how the experimental condition of organizational linkages impacted the use of MAT in the criminal justice system. In order to analyze the data, multinomial logistic regression was used. Results: Results showed that some community corrections employees were likely to refer clients to use methadone, but not buprenorphine (or vice versa) which was influenced by work setting, level of education, training, and negative perceptions of MAT as a substitute addiction. However, these biases could be minimized by proper training. Conclusion: These findings suggest that proper training should be mandatory for these employees and include information about various MATs while also addressing the negative perception that MAT is a substitute addiction.

KEYWORDS:

• Medication-assisted treatment
• barriers to treatment
• methadone
• buprenorphine
• community corrections

Acknowledgments

I would like to sincerely thank Dr. Ronet Bachman for her feedback in previous drafts of this article as well as Drs. Christy Visher and Lana Harrison for their guidance in the early stages of the publication process. I would also like to thank the anonymous reviewers for their constructive suggestions to improve this work.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.

Financial disclosure

There was no financial support given for this project.

Notes

1 Often in the form of combined buprenorphine-naloxone.

2 All participants were invited to attend a three-hour training that consisted of “background on the neurobiology of addiction, the form and appropriate uses of FDA-approved MAT, the compatibility of MAT and behavioral counseling, and the availability of MAT in the local area.” (Friedmann et al., 2015). Although all were invited, less than a quarter of participants felt they had received “somewhat” or “a lot” of training regarding MAT in the baseline survey.

3 The variables were tested for multicollinearity using a variance inflation factor test. The vif mean was 1.43 (buprenorphine related variables) and 1.33 (methadone related variables). Multicollinearity did not appear as an issue for this model.

4 The model was run twice, using “uncertain” and “likely” as the reference group. After analyzing both models, it made more interpretive sense to use “likely” as the reference group.

5 Cross tabulations are not supported using the MI (multiple imputation) command, so these models are based on the non-imputed data.