THE AMERICAN WAY? –

May 4, 2023 – Unfortunately, our medical system in the United States is violating all four of those principles by not routinely treating substance use disorders in the criminal justice system, particularly those patients with opioid use disorder, given the increased risk of fatal overdose with opioid use disorder compared to other substance use disorders. We, ethically, can no longer stand by and watch the unnecessary suffering and death of patients with substance use disorders in the criminal justice setting. It is time to change how we treat incarcerated patients with substance use. They deserve treatment for their substance use disorders. We will describe two clinical cases that are illustrative of how treatment for substance use disorders in patients in the criminal justice system must change.

Case 1. A 40-year-old male presented to the emergency department (ED) with a chief complaint of a “medication refill.” The patient had a history of opiate use disorder and methamphetamine use disorder. He was incarcerated in the prison system, where he was treated for his opiate use disorder with buprenorphine/naloxone. He, upon discharge from prison, was given a 30-day prescription for buprenorphine/naloxone. As he was due to run out of his prescription, he presented to the emergency department. He was seen in the Emergency Department, where he reported to the provider, “suboxone saved my life.” He had no desire to use opiates, and denied any symptoms of opiate withdrawal. The ED physician provided the patient with a short-term refill of his buprenorphine/naloxone and referred the patient to a local addiction treatment program. The patient, due to conflicts with his new job, was unable to schedule an appointment with the clinic, and had to return to the ED for a refill. However, once settled in his new job, the patient was able to follow up with the addiction medicine clinic and remains in treatment on buprenorphine/naloxone.

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