Individuals who are incarcerated are a vulnerable population and withholding evidence-based opioid use disorder (OUD) treatment increases risk for death during detainment and upon release. ASAM recognizes that correctional settings are diverse and that not all resources are universally available. This policy statement describes the standard of care that ASAM believes all detained and incarcerated individuals with OUD should receive. ASAM also advocates for systemic changes to ensure universal access to such care within correctional institutions....

Recommendations: (July 2020)
The American Society of Addiction Medicine recommends: 

1. Access to evidence-based OUD treatment including all FDA-approved medications, either on site or through transport, is the standard of care for all detained or incarcerated persons. In many areas of the country, this treatment remains inaccessible, so expansion in jails and prisons should happen in concert with other expansion efforts at the community level. 

• Achieving this vision will require a major cultural and practical shift for correctional systems, and should include the establishment of:
• New/expanded partnerships with community treatment providers to continue medication treatment for pre-trial detainees and sentenced persons, confirm prescribing and dosing on prison entry, and initiate treatment through community providers when treatment is not directly available within the facility.
• New policies and procedures for connecting detained and incarcerated persons to treatment services either through provision within the facility, mobile treatment units, transition clinics,19 telehealth or community transport,
• Suitable space for medication storage, administration and monitoring,
• Extensive training of health care and corrections staff, and
• Education of patients with OUD who are incarcerated regarding OUD, medications for OUD treatment, and recovery. 

2. All detainees at jails and prisons should be screened for OUD and other substance use disorders upon entry using a validated assessment tool.20 Those who were being treated with medication for OUD prior to incarceration should be allowed to continue on their same medication at a generally equivalent dose. When that is not feasible, then the patient should be able to continue a medication in the same class. Incoming detainees with previously untreated OUD and/or who experience opioid withdrawal upon incarceration should be assessed and offered medication and psychosocial treatment as clinically indicated. 

3. All correctional facilities should have naloxone readily available throughout the facility to reverse opioid overdoses. Correctional and healthcare staff should be trained to recognize the signs and symptoms of an opioid overdose and to use naloxone to reverse an overdose. Correctional facilities should provide overdose recognition and response training to all interested detainees and distribute naloxone at time of release. 

4. Counseling services, case management and peer support services should be offered to detained and incarcerated persons with OUD as part of a comprehensive treatment plan. Medications should be offered even if the full complement of services cannot be or the incarcerated person chooses not to engage in other services. 

5. Telemedicine/telehealth should be expanded as a means of increasing access to medication management and non-pharmacological, behavioral health services in correctional facilities that cannot offer such treatments on-site. 

6. The “inmate exclusion” that bars the use of federal Medicaid matching funds from covering healthcare services in jails and prisons should be repealed and the inmate limitation on benefits under Medicare should be removed. Continuation of healthcare coverage during detention and incarceration will facilitate treatment continuity and retention. 

7. The federal government should make legislative or regulatory changes to create a special registration exemption for jails, prisons, and their authorized personnel to prescribe and otherwise dispense controlled medications for initiation, maintenance or withdrawal management of OUD that is significantly less burdensome than the applicable registration requirements in the Controlled Substances Act and related regulations. The special registration should not limit the number of detained or incarcerated persons who can be treated with such medications by a qualified practitioner. 

8. Community-correctional partnerships, including low-threshold transitional clinics that emphasize engagement and harm reduction to bridge the gap between incarceration and community treatment, should be supported and financed to coordinate care upon entry and release to avoid dangerous interruptions in treatment. 

9. Correctional settings should collect data on numbers of people screened for OUD and SUD, numbers formally assessed and treated, including types of medications for opioid use disorder, and use these data for continuous quality improvement of services. Aggregated, de-identified data should be shared with public health officials to monitor trends in prevalence and treatment of substance use disorders among incarcerated individuals to inform policy changes that can improve individual and public health. 

10. Correctional facilities should be viewed as part of the community treatment continuum and included in partnerships and coalitions that are addressing OUD. Public funding, training and technical assistance supporting medication treatment access should be inclusive of jails and prisons.