NCJ Number
206134
Journal
Journal of Drug Issues Volume: 34 Issue: 2 Dated: Spring 2004 Pages: 451-480
Date Published
2004
Length
30 pages
Annotation
This paper reviews the pharmacological treatment options for opiate-dependent inmates, along with their potential application to community-to-correctional approaches; attention is given to the use of the recently FDA-approved prescription drug buprenorphine in substance abuse treatment in correctional settings.
Abstract
Multiple therapeutic modalities have proven effective in treating opiate dependence. These modalities can be classified into two broad classes: drug-free therapeutic communities and pharmacological therapies (methadone, LAAM, naltrexone, and buprenorphine). Prison-based therapeutic communities that do not use pharmacological interventions are common, and there is generally little use of pharmacological treatments of opiate-dependent inmates. This is due primarily to the logistical failures of such programs in the 1970's and the increased societal demands to reduce the "coddling" of criminal offenders. Sufficient data from well-controlled studies are not yet available for a systematic comparison of the various treatments. This paper presents some preliminary data on the effectiveness of the various interventions and some of the obstacles to their successful implementation in the community and in corrections. The emphasis is on outcome-oriented research that focuses on interventions within a continuum model of prison-to-community treatment. Sections of this paper review the characteristics and effectiveness of naltrexone, methadone, LAAM, and buprenorphine (BUP) in treating opiate addiction. BUP has long been used in pain management, and since 1978 it has been studied as an opiate addiction medication. Unlike full agonists like methadone and LAAM, BUP is a partial m-receptor that enhances its safety profile compared to full agonists and reduces its likelihood for street diversion. Several randomized, controlled trials have demonstrated BUP's efficacy in managing opiate withdrawal and opiate dependence. These studies led to FDA approval of Suboxone and Subutex in October of 2002. The relative lack and high cost of methadone maintenance slots in most communities, the unique pharmacological properties of BUP as a partial opiate agonist, and the less stringent regulation of BUP compared to methadone are compelling reasons to consider BUP substitution therapy for the correctional and transitional settings. This paper discusses some of the structural obstacles that must be addressed, communication among providers, the need for psychosocial and health-care services, communication among providers, and the use of pharmacological therapy in prison to serve as an effective link to treatment in the community after release for those offenders with a high risk for relapse. 125 references and an appended table that provides an overview of prison and transitional opiate treatment for various treatment modalities