New Position Statement on Substance Use Disorder Treatment

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Posted Nov 16, 2016

Scientific evidence has firmly established that substance use disorders represent a chronic, relapsing disease requiring effective treatment with a view toward long-term management. NCCHC's newly updated position statement reflects this science and new national guidelines for treatment of opioid use disorder and is intended to ensure that people with substance use disorders in custody receive evidence-based care in accordance with national medical standards.

The statement advocates the following principles for care of adults and adolescents with substance use disorders in correctional facilities; these principles reinforce and expand on principles articulated in NCCHC’s Standards for Health Services. Several points are of primary medical focus in this position statement: screening and identification, continuation or initiation of MAT while incarcerated, monitoring and withdrawal according to national medical standards (if needed), prerelease initiation of treatment and care coordination, and linkage of medication treatment programs with nonpharmacological treatment options.

The position statement puts forth 14 guiding principles:

Screening, Evaluation, and Care Coordination Upon Entry

1. Universal screening of all inmates for risk factors and symptoms of withdrawal must be conducted upon entry into the facility from the community.

2. All inmates who screen positive should receive a comprehensive medical assessment that includes the following:

a. Evaluation of current use and status.

b. Pregnancy test for all females reporting opiod use, and an opiate use history for all pregnant females.

c. Assessment for comorbidity and confirmation of medications and dosing.

d. Formal assessment for withdrawal severity using validated, standardized instruments.

Medication-Assisted Treatment

3. Continuation of prescribed medications for substance use disorders.
 
4. Inmates not receiving MAT prior to entry, or whose MAT is discontinued while incarcerated, should be offered MAT prerelease when postrelease continuity can be arranged.
 
5. Appropriate prerelease planning with community OTPs and community buprenorphine prescribers is critical to ensure there is no interruption of treatment.
 
6. Correctional facilities should have several strategies for provision of buprenorphine or methadone to inmates, including during pregnancy. These strategies differ in the level of planning and licensing required.

a. Transport inmates to community OTPs or a hospital (this is sometimes used during pregnancy).

b. Partner with community OTPs for dosing of inmates within the facility. In this case, the dosing is done under the license of the community OTP.

c. Have correctional physicians obtain buprenorphine licenses. This license permits use of buprenorphine for MAT as well as for medication-assisted withdrawal.

d. Obtain an OTP license for the facility. This permits use of methadone and buprenorphine for both treatment and withdrawal. (Note: NCCHC accredits facilities for OTP.)

e. Obtain state and DEA licensing as a health care facility. This entitles the facility to the same exemptions as hospitals for use of methadone or buprenorphine during pregnancy or to ensure treatment of other conditions, e.g., HIV, mental illness.

7. Attention to the needs of pregnant women with substance use disorders, including following national standard of care to provide MAT, and not withdrawal, to pregnant women with opiate dependence, is essential.

Psychosocial Treatments

8. Correctional facilities should provide nonmedication-based therapies as part of a comprehensive substance use disorder treatment plan.

Medication-Assisted Withdrawal When Indicated

9. Inmates with clinically significant alcohol, opiate, or other drug withdrawal should be treated with evidence-based effective medications, including opioid agonists for severe withdrawal.

10. Inmates should be evaluated and appropriately treated for physical and mental health comorbidity, including concurrent mental health disorders, by qualified health care professionals trained and experienced in managing comorbid disorders.

11. If a patient is on pharmacotherapy for substance use disorders while incarcerated, referral and coordination of community resources is provided for continued treatment for substance use and mental health disorders after release.

12. For individuals who screen positive for substance abuse and are not already involved in a community treatment program, a prerelease evaluation should occur to determine referral and coordination of community resources for treatment for substance use and mental health disorders.

13. Facilities ensure the availability of naloxone (Narcan®) and personnel trained to use it when opioid overdoses occur. Consideration may be given to providing naloxone to high-risk inmates upon release.

14. NCCHC supports high-quality research regarding best practices related to treatment of substance use disorders in corrections. Although a substantial evidence base exists for such treatment, there is a high need for research to determine the best practices for provision of treatment in different types of correctional facilities. Such research is needed to inform optimal treatment type, intensity, timing, and postrelease coordination for different populations (e.g., adolescents, those with chronic persistent mental illness, and those with different types of substance use disorders). Research should also address issues related to risk stratification as well as composition and training of substance use disorder teams.

The statement also lists numerous sources for research and policy in this area.

View the statement, titled Substance Use Disorder Treatment for Adults and Adolescents »

View all NCCHC position statements »