scholarly journals The impact of the opioid crisis on U.S. state prison systems

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christy K. Scott ◽  
Michael L. Dennis ◽  
Christine E. Grella ◽  
Allison F. Mischel ◽  
John Carnevale
Keyword(s):  
United States ◽  
Criminal Justice ◽  
Technical Assistance ◽  
Sampling Strategy ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
State Prison ◽  
Prison Systems ◽  
The Impact

Abstract Background Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). Methods A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. Results MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. Conclusion Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability.

Seeking Criminal Justice Clarity amid Historic Chaos

2020 ◽  
Vol 33 (1-2) ◽  
pp. 1-2
Author(s):  
Douglas A. Berman
Keyword(s):  
United States ◽  
Criminal Justice ◽  
The United States ◽  
Racial Justice ◽  
Federal Sentencing ◽  
Criminal Justice Systems ◽  
Societal Changes ◽  
Justice Systems ◽  
The Many ◽  
The Impact

The remarkable events of 2020 have disrupted and altered all sorts of plans, and this issue of FSR covers some of the many varied criminal justice and sentencing echoes of the ongoing COVID-19 pandemic and urgent new calls for racial justice. The intense and dynamic topics that have come to define 2020 in the United States necessarily impact, and may even consume our thinking, about modern criminal justice systems generally and federal sentencing realities in particular. Included in this FSR issue are reports and data and commentary that predate spring shutdowns and summer protests and related developments; but these materials now carry distinctive meaning and even a new urgency in light of 2020 challenges. It is impossible to fully assess in short order the impact of massive societal changes on the federal sentencing system, but we are hopeful this FSR issue can provided added perspective to a rapidly changing world that still often seems hard to fully grasp.

scholarly journals If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

2021 ◽  
Author(s):  
Susannah Slocum ◽  
Jenny E. Ozga ◽  
Alexander Y. Walley ◽  
Robin A. Pollini ◽  
Rebecca Joyce
Keyword(s):  
Mixed Methods ◽  
Drug Use ◽  
Support Groups ◽  
Perceived Risk ◽  
The United States ◽  
Opioid Antagonist ◽  
Prescription Opioid ◽  
Opioid Overdose ◽  
Opioid Use ◽  
The Impact

Abstract Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were conducted to inform the development of a subsequent quantitative survey (N=260). Results: Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.Conclusions: Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

Assessing the impact of clinical pharmacists on naloxone coprescribing in the primary care setting

2020 ◽  
Vol 77 (7) ◽  
pp. 568-573
Author(s):  
Alexandra Watson ◽  
Kyle Guay ◽  
Dara Ribis
Keyword(s):  
United States ◽  
Primary Care ◽  
Care Setting ◽  
The United States ◽  
Care Group ◽  
Healthcare Team ◽  
Opioid Overdose ◽  
Ambulatory Care Setting ◽  
Clinical Pharmacists ◽  
The Impact

Abstract Purpose Opioid use and overdose are epidemic in the United States. While there is concern regarding the abuse of illegal opioids, overdose is also strongly associated with prescription opioids. The Centers for Disease Control and Prevention supports coprescribing of naloxone with opioids; however, a review of naloxone prescriptions recorded within a primary care group indicated limited use of the reversal agent. Methods Through the collaboration of pharmacy and information services personnel, a report was created to identify all patients receiving chronic opioid therapy. To assess the risk of overdose, a validated risk scoring method was used. If patients were determined to be at high risk for overdose, outreach by a clinical pharmacist was conducted to educate them on the benefits of naloxone. For patients agreeable to receiving naloxone, prescriptions were entered into the electronic health record for primary care provider (PCP) verification. Contact was made following order verification to ensure patient understanding of proper naloxone use and naloxone accessibility. Results Prior to the project (ie, in calendar year 2016), only 5 prescriptions for naloxone had been prescribed within the medical group. During the naloxone coprescribing initiative, 230 patients were identified by clinical pharmacists as being at elevated risk for opioid overdose. Of these, 86 (37%) were deemed ineligible for naloxone. Out of the 144 patients determined to be eligible, 63 (44%) were agreeable to receiving naloxone. Further review determined that 7 additional patients were agreeable after a follow-up conversation with their PCP. Of the patients that agreed to receive naloxone, 48 (76%) confirmed that they had picked up naloxone from their pharmacy. Conclusion The naloxone coprescribing initiative was an innovative project that focused on an epidemic that affects communities across the United States. This program embraced the strengths of multiple departments for the good of the patient, in keeping with the idea of team-based care. The pharmacy-driven approach highlighted the importance of having pharmacists within an ambulatory care setting and allowed high-level pharmacist practice without adding to the workload of other members of the healthcare team.

NIOSH Responds to the U.S. Drug Overdose Epidemic

2021 ◽  
pp. 104829112110407
Author(s):  
Jamie C. Osborne ◽  
L. Casey Chosewood
Keyword(s):  
United States ◽  
Substance Use ◽  
Drug Overdose ◽  
Drug Users ◽  
Illicit Drugs ◽  
Occupational Safety ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use

The United States is experiencing an evolving and worsening drug overdose epidemic. Although the rate of drug use among workers has remained relatively stable, the risk of overdose and death among drug users has not, as illicit drugs have increased in potency and lethality. The cumulative impacts of COVID-19 and the opioid crisis increase the likelihood of illness and death among workers with opioid use disorder. Workplaces represent a critical point of contact for people living in the United States who are struggling with or recovering from a substance use disorder, and employment is a vital source of recovery “capital.” The benefits of addressing substance use in the workplace, supporting treatment, and employing workers in recovery are evident. The National Institute for Occupational Safety and Health has published research to inform policy and practice toward prevention efforts and has developed accessible resources and toolkits to support workers, employers, and workplaces in combatting the opioid overdose crisis and creating safer, healthier communities.

scholarly journals Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses

2018 ◽  
Vol 69 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Robert Heimer ◽  
Kathryn Hawk ◽  
Sten H Vermund
Keyword(s):  
United States ◽  
The United States ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Virus Infections ◽  
Opioid Use ◽  
Illicit Markets ◽  
Oral Consumption ◽  
Immunodeficiency Virus ◽  
Overdose Mortality

Abstract The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was undertreated. The crisis grew not only from overprescribing, but also from other sources, including insufficient research into nonopioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply-side regulatory approaches. Restricting opioid prescribing perversely accelerated narco-trafficking of heroin and fentanyl with consequent increases in opioid overdose mortality As injection replaced oral consumption, outbreaks of hepatitis B and C virus and human immunodeficiency virus infections have resulted. This viewpoint explores the origins of the crisis and directions needed for effective mitigation.

Therapeutic Jurisprudence in International and Comparative Perspective

2020 ◽  
Author(s):  
Nigel Stobbs
Keyword(s):  
United States ◽  
Criminal Justice ◽  
First Nations ◽  
Legal System ◽  
Due Process ◽  
The United States ◽  
Therapeutic Jurisprudence ◽  
Offender Treatment ◽  
The Law ◽  
The Impact

Therapeutic jurisprudence (TJ) is a multidisciplinary approach to assessing the impact of the law itself on the emotional and psychological experiences of all those who have contact with the legal system. Variously described as a theory, a method, a lens, or a process of analysis, its distinguishing feature is to conceive of the law as a “therapeutic agent.” That agency can cause both therapeutic and antitherapeutic consequences. By investigating and assessing the social, professional, and political contexts in which laws are made and applied, TJ seeks to identify how unintentional harms are caused and suggests ways to remedy them. It also identifies opportunities to enhance psychological strengths and positive emotional experiences to improve legal outcomes. It has commonalities with positive criminology, restorative justice, procedural justice, and other less adversarial approaches within the criminal justice system. Since being founded by David Wexler and Bruce Winick in the 1980s as a project to improve the experiences of those subjected to mental disability law in the United States, the theory and methodology of TJ has evolved, and its influence has expanded to virtually every major legal system and jurisdiction. TJ was at the core of the operating philosophy of the problem-solving court movement, which now operates across nine countries. It is increasingly influential in new approaches to probation and offender treatment models in the United States, Europe, Australia, and New Zealand, and in influencing access to justice policies in India and Pakistan. It offers some common conceptual principles for the development of First Nations courts, tribunals, and dispute resolution programs seeking to eradicate systemic, monocultural bias in postcolonial criminal justice systems which tend to lead to intractable, carceral overrepresentation. TJ is currently undergoing a process of “mainstreaming” across disciplines and internationally. This involves encouraging lawyers and other criminal justice workers outside specialist court and diversion jurisdictions to adopt therapeutic outlooks and practices. So far there have been projects to mainstream TJ principles in police interviewing, risk assessment, diversion, criminal settlement conferences, bail, sentencing, conditional release from custody, and appeals. The sorts of reforms, innovations, and changes in mindsets suggested by TJ work has also sparked resistance and criticism. The latter ranges from constructive concerns about conceptual vagueness, risks of paternalism, and coercion to absolute ideological opposition on the grounds that TJ allegedly advocates for the complete abandonment of the adversarial system and strongarms defendants into surrendering their constitutional and due process rights.

Influence of religiosity and studying law on college students’ punitive attitudes in China

2020 ◽  
pp. 174889582095124
Author(s):  
Doris C Chu ◽  
Michael A Cretacci ◽  
Yandong Gao
Keyword(s):  
United States ◽  
Criminal Justice ◽  
The United States ◽  
Future Research ◽  
Punitive Attitudes ◽  
Criminal Justice Students ◽  
Criminal Sanctions ◽  
Scant Attention ◽  
Using Data ◽  
The Impact

A number of studies in the United States examine the impact of religiosity on attitudes towards various types of criminal sanctioning. Research seems to indicate that more conservative denominations and faiths have a more punitive preference for criminal sanctions. Previous studies have also examined these attitudes between criminal justice and non-criminal justice students. While this area of inquiry has drawn attention in the United States, only scant attention has been paid to this phenomenon in other countries. To the best of our knowledge, no study has addressed this issue in China and our research seeks to serve as a foundation for examining this topic in that country. Using data collected from students attending universities in China, we examine the relationship between respondents’ religiosity and their punitive attitudes. We also compare the punitive attitudes between law and non-law majors. Findings indicate that students with higher levels of religious behaviour were less likely to support the death penalty. In addition, law majors were found to be less likely to endorse severe sentences. Suggestions for future research are discussed.

A scoping review of acupuncture insurance coverage in the United States

2020 ◽  
pp. 096452842096421
Author(s):  
Roselle Bleck ◽  
Emma Marquez ◽  
Melanie A Gold ◽  
Carolyn L Westhoff
Keyword(s):  
United States ◽  
Scoping Review ◽  
Insurance Coverage ◽  
Research Priorities ◽  
The United States ◽  
Subject Area ◽  
Published Data ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
The Impact

Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

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