title: Medication-assisted treatment for opioid use disorders in correctional settings: an ethics review.
abstract: Opioid use disorders are a pressing health concern that disproportionately impacts the United States (U.S.) correctional population. Medication-assisted treatment (MAT) is an evidence-based standard of care for opioid use disorders. Despite its availability in the community, MAT and MAT medications (buprenorphine and methadone) are largely unavailable and/or inaccessible for the treatment of opioid use disorders in U.S. prisons and jails. Given that the ethical principles have served as justification for limiting access to MAT on "moral" grounds, this article examines the implications of current correctional policies through the ethical principles of: (1) beneficence/non-maleficence; (2) distributive justice (equivalence-of-care); and (3) autonomy (informed consent). Special attention is paid to the five components of informed consent (capacity, disclosure, understanding, voluntariness, and access), as this facet has been used most often to justify policies that limit access to MAT in the past. Findings highlight that these core ethical principles support the adoption of correctional policies that include MAT. Furthermore, our findings demonstrate that autonomy is maximized during the informed consent process when MAT is available as a treatment option.
authors.affiliation: Institute for the Medical Humanities, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA. Electronic address: arludwig@utmb.edu.
authors.forename: Ariel S
authors.initials: AS
authors.lastname: Ludwig
authors.affiliation: Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
authors.forename: Roger H
authors.initials: RH
authors.lastname: Peters
mesh_terms: D006801:Humans; D007258:Informed Consent / Q000941:ethics; D058850:Opiate Substitution Treatment / Q000941:ethics*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D026684:Personal Autonomy; D011330:Prisons / Q000941:ethics*
keywords: Ethics; Jail; Medication-assisted treatment; Opioid; Prison