title: Attitudes and practices regarding the use of methadone in US state and federal prisons.
abstract: In the United States, vigorous enforcement of drug laws and stricter sentencing guidelines over the past 20 years have contributed to an expanded incarcerated population with a high rate of drug use. One in five state prisoners reports a history of injection drug use, and many are opiate dependent. For over 35 years, methadone maintenance therapy has been an effective treatment for opiate dependence; however, its use among opiate-dependent inmates in the United States is limited. In June 2003, we conducted a survey of the medical directors of all 50 US states and the federal prison system to describe their attitudes and practices regarding methadone. Of the 40 respondents, having jurisdiction over 88% (n =1,266,759) of US prisoners, 48% use methadone, predominately for pregnant inmates or for short-term detoxification. Only 8% of respondents refer opiate-dependent inmates to methadone programs upon release. The results highlight the need to destigmatize the use of methadone in the incarcerated setting, expand access to methadone during incarceration, and to improve linkage to methadone treatment for opiate-dependent offenders who return to the community.
authors.affiliation: The Miriam Hospital, Brown Medical School, 164 Summit Avenue, Providence, RI 02906, USA. jrich@lifespan.org
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
authors.forename: Amy E
authors.initials: AE
authors.lastname: Boutwell
authors.forename: David C
authors.initials: DC
authors.lastname: Shield
authors.forename: R Garrett
authors.initials: RG
authors.lastname: Key
authors.forename: Michelle
authors.initials: M
authors.lastname: McKenzie
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Clarke
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
mesh_terms: D004363:Drug Utilization; D035082:Federal Government; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011330:Prisons; D013219:State Government; D014481:United States
chemical_list: D009294:Narcotics; D008691:Methadone