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Nwanaji-Enwerem U, Beitel M, Oberleitner DE, Gaeta Gazzola M, Eggert KF, Oberleitner LMS, Jegede O, Zheng X, Redeker NS, Madden LM, Barry DT. Correlates of Perceived Discrimination Related to Substance Use Disorders Among Patients in Methadone Maintenance Treatment. J Psychoactive Drugs 2023:1-11. [PMID: 37399330 PMCID: PMC10761588 DOI: 10.1080/02791072.2023.2230571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
This study sought to examine demographic, treatment-related, and diagnosis-related correlates of substance use disorder (SUD)-related perceived discrimination among patients receiving methadone maintenance treatment (MMT). Participants were 164 patients at nonprofit, low-barrier-to-treatment-access MMT programs. Participants completed measures of demographics, diagnosis-related characteristics (Brief Symptom Inventory (BSI-18) and Depressive Experiences Questionnaire (DEQ)), and treatment-related characteristics. Perceived discrimination was measured on a seven-point Likert-type scale ranging from 1 ("Not at all") to 7 ("Extremely") in response to the item: "I often feel discriminated against because of my substance abuse." Given the variable's distribution, a median split was used to categorize participants into "high" and "low" discrimination groups. Correlates of high and low discrimination were analyzed with bivariate and logistic regression models. Ninety-four participants (57%) reported high SUD-related perceived discrimination. Bivariate analyses identified six statistically significant correlates of SUD-related perceived discrimination (P < .05): age, race, age of onset of opioid use disorder, BSI-18 Depression, DEQ Dependency, and DEQ Self-Criticism. In the final logistic regression model, those with high (versus low) SUD-related perceived discrimination were more likely to report depressive symptoms and be self-critical. Patients in MMT with high compared to low SUD-related perceived discrimination may be more likely to report being depressed and self-critical.
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Affiliation(s)
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - David E Oberleitner
- Department of Research, APT Foundation, New Haven, CT, USA
- Psychology Department, University of Bridgeport, Bridgeport, CT, USA
| | - Marina Gaeta Gazzola
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lindsay M S Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Xiaoying Zheng
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | | | - Lynn M Madden
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Research, APT Foundation, New Haven, CT, USA
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Haney JL. Treatment interrupted: factors associated with incarceration during opioid use disorder treatment in the United States. Journal of Substance Use 2022. [DOI: 10.1080/14659891.2022.2120431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Jolynn L. Haney
- Deerfield Data Management, LLC, Collegeville, Pennsylvania, USA
- Department of Social Work Education, Widener University, Chester, Pennsylvania, USA
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Ray B, Victor G, Cason R, Hamameh N, Kubiak S, Zettner C, Dunnigan M, Comartin E, Costello M. Developing a cascade of care for opioid use disorder among individuals in jail. J Subst Abuse Treat 2022. [DOI: 10.1016/j.jsat.2022.108751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
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Berk J, Del Pozo B, Rich JD, Lee JD. Injecting Opioid Use Disorder Treatment in Jails and Prisons: The Potential of Extended-release Buprenorphine in the Carceral Setting. J Addict Med 2022; 16:396-8. [PMID: 34954747 DOI: 10.1097/ADM.0000000000000942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT As the opioid overdose cases rise, policy-makers and researchers should target interventions to populations at highest risk. Incarceration serves as a risk factor for opioid overdose (Gan et al. Addiction 2021) and a large portion of recent overdose deaths have had encounters in the criminal justice system.Medications for opioid use disorder in the criminal justice system can save lives, though unique administrative barriers in jails and prisons hinder access. As facilities expand medications for opioid use disorder access (due to new legislation and court rulings across states), extended-release buprenorphine offers an opportunity to overcome these barriers including logistics of administration, diversion concern, patient stigma, and an increased bridge of treatment during re-entry to the community.As extended-release buprenorphine has practical advantages in correctional health delivery, future research and policy discussions should investigate its optimal role in treating opiate addiction in a carceral setting.
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Abstract
Opioid use disorder (OUD) is highly prevalent among persons who are incarcerated. Medication treatment for opioid use disorder (MOUD), methadone, buprenorphine, and naltrexone, is widely used to treat OUD in the community. Despite MOUD's well-documented effectiveness in improving health and social outcomes, its use in American jails and prisons is limited.Several factors are used to justify limited access to MOUD in jails and prisons including: "uncertainty" of MOUD's effectiveness during incarceration, security concerns, risk of overdose from MOUD, lack of resources and institutional infrastructure, and the inability of people with OUD to provide informed consent. Stigma regarding MOUD also likely plays a role. While these factors are relevant to the creation and implementation of addiction treatment policies in incarcerated settings, their ethicality remains underexplored.Using ethical principles of beneficence/non-maleficence, justice, and autonomy, in addition to public health ethics, we evaluate the ethicality of the above list of factors. There is a two-fold ethical imperative to provide MOUD in jails and prisons. Firstly, persons who are incarcerated have the right to evidence-based medical care for OUD. Secondly, because jails and prisons are government institutions, they have an obligation to provide that evidence-based treatment. Additionally, jails and prisons must address the systematic barriers that prevent them from fulfilling that responsibility. According to widely accepted ethical principles, strong evidence supporting the health benefits of MOUD cannot be subordinated to stigma or inaccurate assessments of security, cost, and feasibility. We conclude that making MOUD inaccessible in jails and prisons is ethically impermissible.
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Affiliation(s)
- Emma R Brezel
- Department of Pediatrics, Montefiore Medical Center, New York, New York, USA
| | - Tia Powell
- Montefiore-Einstein Center for Bioethics, Montefiore Medical Center, New York, New York, USA
| | - Aaron D Fox
- Department of Internal Medicine, Montefiore Medical Center, New York, New York, USA
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Abstract
This article seeks to shed light on civil commitment in the context of the opioid crisis, to sketch the existing legal landscape surrounding civil commitment, and to illustrate the relevant medical, ethical, and legal concerns that policymakers must take into account as they struggle to find appropriate responses to the crisis.
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Affiliation(s)
- Ish P Bhalla
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Nina Cohen
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Claudia E Haupt
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Kate Stith
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
| | - Rocksheng Zhong
- Ish Prasad Bhalla, M.D., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his B.S. from Case Western Reserve University and his M.D. from University of Toledo College of Medicine. Nina Cohen, J.D., received her A.B. from Bryn Mawr College and her MSc from the University of Oxford. She received her J.D. from Yale Law School in May 2018. Claudia E. Haupt, Ph.D., J.S.D., is a Resident Fellow at the Information Society Project and a Research Fellow at the Solomon Center for Health Law & Policy, both at Yale Law School. She received her first law degree and Ph.D. from the University of Cologne, her LL.M. from George Washington University, and her J.S.D. from Columbia Law School. Kate Stith, J.D., is the Lafayette S. Foster Professor of Law at Yale Law School. She received her B.A. from Dartmouth College, and her M.P.P. and J.D. from Harvard University. Rocksheng Zhong, M.D., M.H.S., is a fellow in forensic psychiatry in the Department of Psychiatry, Yale School of Medicine. He received his A.B. from Harvard College and his M.D. and M.H.S. from the Yale School of Medicine
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