Gaps in Screening and Treatment of Opioid Use Disorder and Related Infections in Carceral Settings

The US is experiencing a syndemic of substance use disorders and associated infections (e.g., HIV and viral hepatitis). There is a high prevalence of these conditions in correctional settings, where rates of screening and treatment for both opioid use disorder (OUD) and chronic infections remain low. Researchers reviewed the evidence regarding the screening and treatment of OUD and associated chronic infections in US correctional settings, identifying existing challenges and making suggestions for improvement.

  • HIV and viral hepatitis screening in correctional settings is not universal. Implementation of universal screening may be a way to improve the identification of HIV and viral hepatitis infections.
  • Many prisons or jails cannot afford to offer HIV and HCV medications, so the availability of treatment varies between institutions. Novel approaches are needed to source medications for a reasonable cost, via either competitive contract bidding, or bulk purchase across institutions.
  • Medication for OUD (MOUD) is unavailable in most jails and prisons, despite the known benefits. Use of long-acting injectable MOUD (i.e., extended-release buprenorphine) may address the reasons often cited for not offering daily dose methadone or buprenorphine in these settings (e.g., diversion, overdose risk, need for regular dose adjustments, etc.).
  • Integration of telemedicine in correctional settings should be considered to improve access to specialty service consultations (e.g., infectious diseases and addiction medicine).

Comments: Despite the high prevalence of OUD and chronic infections in correctional settings, screening and treatment rates for both conditions remain low. Implementing broader screening, nuanced approaches to procuring medications, more widespread use of long-acting medications for the treatment of HIV and OUD, and expanding access to specialty care may improve the management of these conditions.

Piper Dickhout, BSc† and Seonaid Nolan, MD

† Contributing Editorial Intern

Reference: Krsak M, Montague BT, Trowbridge P, et al. Opioid use and chronic infections: the value of addressing the syndemic in correctional settings via telemedicine guidance and broader use of long-acting medications. J Infect Dis. 2020;222(Suppl 5):S486–S493.

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