title: "I Kicked the Hard Way. I Got Incarcerated." Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments.
abstract: Incarceration is a common experience for individuals with opioid use disorder, including those receiving medication assisted treatments (MAT), such as buprenorphine or methadone. In the United States, MAT is rarely available during incarceration. We were interested in whether challenges with methadone maintenance treatment during incarceration affected subsequent attitudes toward MAT following release. We conducted semi-structured interviews with 21 formerly incarcerated individuals with opioid use disorder in community substance abuse treatment settings. Interviews were audio recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team. The three main themes relating to methadone were: 1) rapid dose reduction during incarceration; 2) discontinuity of methadone during incarceration; and 3) post incarceration aversion to methadone. Participants who received methadone maintenance treatment prior to incarceration reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration. The severe withdrawal during incarceration contributed to a subsequent aversion to methadone and adversely affected future decisions regarding reengagement in MAT. Though MAT is the most efficacious treatment for opioid use disorder, current penal policy, which typically requires cessation of MAT during incarceration, may dissuade individuals with opioid use disorder from considering and engaging in MAT after release from incarceration.
authors.affiliation: Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461. Electronic address: jmaradia@montefiore.org.
authors.forename: Jeronimo A
authors.initials: JA
authors.lastname: Maradiaga
authors.affiliation: Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461; Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467. Electronic address: snahvi@montefiore.org.
authors.forename: Shadi
authors.initials: S
authors.lastname: Nahvi
authors.affiliation: Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461; Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467. Electronic address: ccunning@montefiore.org.
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467. Electronic address: jennsanc@montefiore.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sanchez
authors.affiliation: Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461; Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467. Electronic address: adfox@montefiore.org.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Fox
mesh_terms: D000328:Adult; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009519:New York City; D058850:Opiate Substitution Treatment / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011329:Prisoners; D036301:Qualitative Research; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
chemical_list: D008691:Methadone
keywords: Buprenorphine maintenance treatment; Incarceration; Methadone maintenance treatment; Opioid use disorder; Opioid withdrawal syndrome