Rare and Preventable: A Qualitative Study of Diversion of Medication for Opioid Use Disorder in Jail
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Qualitative Data Analysis using an Inductive Approach
Abstract*(Up to 325 Words)
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Abstract Background: Correctional officials often cite diversion of medication to treat opioid use disorder (MOUD) (e.g., buprenorphine) as a reason for not offering MOUD treatment in jails and prisons, but it is poorly understood whether these fears are justified. Objectives: We aimed to understand staff perceptions of medication diversion from jail-based MOUD programs and the factors that contribute to and prevent diversion. Methods: We conducted semi-structured in-depth interviews and focus groups in 2019-20 with 61 administrative, security, behavioral health, and clinical staff who implement MOUD programming in seven Massachusetts jails. We conducted qualitative data analysis in Dedoose using an inductive approach. Results: Contrary to staff expectations, buprenorphine and methadone diversion occurred infrequently after MOUD program implementation. The MOUD program changed staff views of buprenorphine, i.e., as legitimate treatment instead of as illicit contraband. Also, the program was perceived to have disrupted the illicit buprenorphine market in jail and reduced related violence. Proactive strategies were essential to prevent and respond to buprenorphine diversion. Key components of diversion prevention strategies included: staff who distinguished among different reasons for diversion; comprehensive and routinized but flexible dosing protocols; communication, education, and monitoring; patient involvement in assessing reasons for diversion; and written policies to adjudicate diversion consequences. Conclusion: With appropriate protocols, buprenorphine diversion within correctional MOUD programs is rare and preventable. Best practices in program design help limit medication diversion and inform correctional officials and lawmakers as they consider whether and how to provide MOUD treatment in correctional settings.
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Financial support: The National Institute on Drug Abuse (NIDA) 3UG3DA044830-02S1 and 1UG1DA050067-01 Conflicts of interest: The authors report no conflicts of interest.