Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics Proceedings of a Workshop (2018) / Chapter Skim
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4 Exploring Opportunities in Correctional Health, Law, and Law Enforcement
4 Exploring Opportunities in Correctional Health, Law, and Law Enforcement
Pages 95-120
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From page 95... ...
Leo Beletsky of Northeastern University's School of Law and Bouvé College of Health Sciences and the University of California, San Diego, School of Medicine explored the use of law as a tool for addressing addiction and its consequences. Captain Katie Goodwin of the Anne Arundel County Police Department, Maryland, provided a law-enforcement perspective on the opioid epidemic.
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From page 96... ...
Prisons and jails across the country have a huge amount of turnover, with around 10 million people coming in and out of incarceration each year. A study on the percent of the total burden of infectious disease passing through correctional facilities in 1997 found that between 20–26 percent of people with HIV/acquired immunodeficiency syndrome (HIV/AIDS)
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From page 97... ...
Even though care is provided inside the prisons and outside the prisons, he added, the transition out of prison is a critical point at which care is interrupted. Opioid Epidemic Turning to the opioid epidemic, Rich emphasized that drug overdoses are now the leading cause of death for Americans under the age of 50.
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However, medications for addiction treatment can and do save lives. Baltimore ramped up opioid agonist therapy (OAT)
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An estimated 20,000 of Rhode Island's population of 1 million people have opioid use disorder, so the taskforce decided to provide medications for addiction treatment in every possible setting -- emergency departments, hospitals, mental health clinics, and addiction treatment clinics. He noted that when emergency departments start patients on MAT, the rate of treatment success 1 month later is doubled.
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From page 100... ...
Among people who had been released from incarceration within the previous 12 months, there was a 65 percent absolute decrease, representing a relative risk reduction of 61 percent in overdose mortality by connecting people with medications for addiction treatment in incarceration within 1 year of starting the program. He argued that based on these results, providing MAT in correctional facilities is clearly the right direction.
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From page 101... ...
That is morally wrong." USING LAW TO ADDRESS ADDICTION AND ITS CONSEQUENCES In his presentation, Leo Beletsky explored how law can be used as a tool to address infectious diseases and other negative health consequences of opioid use and misuse. Law and its enforcement are structural determinants of drug user health that have shaped the current opioid crisis faced today.
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. Legal interventions that have been advanced and propagated to reduce infectious disease risk include 1.
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From page 103... ...
Policy interventions, such as changes in the prescription drug supply, have shaped a range of negative collateral consequences in terms of infectious disease risk (Broz et al., 2018)
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. Progress has been made, he said, but much work remains in translating effective policy interventions into an enabling policy environment for infectious disease prevention.
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From page 105... ...
HepC = hepatitis C; NEP = needle exchange program. SOURCES: As presented by Leo Beletsky at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018; Meehan and Kanik, 2017.
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From page 106... ...
SOURCE: As presented by Leo Beletsky at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018.
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From page 107... ...
OPPORTUNITIES FOR LAW ENFORCEMENT AND FIRST RESPONDERS Like many communities across the country, Anne Arundel County in Maryland has faced rising numbers of overdoses and fatalities related to opioid use since around 2014. The police department soon realized that they would not be able to "arrest their way out of the problem," said Katie Goodwin.
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From page 108... ...
, which we know isn't going to do any good for them or for the system." She reported that the law has encouraged more people to call emergency services in a range of settings where they would otherwise have been reluctant to call, such as parking lots, convenience store bathrooms, or residences. Heroin Taskforce and Fatal Overdose Unit To strengthen the law enforcement approach to addressing the increasing numbers of opioid-related overdoses and fatalities, the Anne Arundel County Police Department created a heroin taskforce and a fatal overdose unit.
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From page 109... ...
All drugs found at a scene are packaged using safety precautions and sent to a laboratory for testing. SOURCE: As presented by Captain Katie Goodwin at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018.
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From page 110... ...
As an additional form of outreach, everyone arrested in Anne Arundel County for any reason is issued a letter that provides information about how to get help for a drug or alcohol problem. Educating Communities and Providers Educating communities is critical in stemming the tide of opioidrelated overdoses and fatalities in the county, said Goodwin.
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From page 111... ...
Then she got introduced to something that was put into her marijuana, which happened to be cocaine, which led to heroin. And now she is 6 years sober, but she has gone through six recoveries." SOURCE: As presented by Captain Katie Goodwin at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018.
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From page 112... ...
PANEL DISCUSSION ON LAW AND LAW ENFORCEMENT Goodwin remarked that when safe needle exchange programs were first being discussed, her initial reaction was that such programs would be enabling and encouraging users, but she came to realize that people are going to use drugs until they can get treatment whether there are programs or not, so it would be better to try to prevent infectious disease and overdosing. She noted that Baltimore City has a robust SEP program in place already.
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From page 113... ...
In the context of the opioid crisis, he said, there is a concerning disconnect between these sorts of drug-induced homicide prosecutions and Good Samaritan laws designed to encourage health seeking (Latimore and Bergstein, 2017)
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. The intervention has been associated with an increase in receptive syringe sharing among PWID, and subsequent modeling work has shown that expanding those programs could fuel the HIV epidemic among PWID, compounding the problems of overdose and infectious diseases (Rafful et al., 2018)
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From page 115... ...
They have women-only residential facilities, which some women enter voluntarily, with their children, to receive help in overcoming their substance abuse. Anne Arundel County law enforcement visits the facilities regularly to discuss opioids as well as resources for support in deal
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From page 116... ...
He noted that many other elements of the policy environment, such as public housing policies around substance use, should be better aligned with advances in public health. Carlos del Rio, professor of global health, epidemiology, and medicine at Emory University, remarked that there are tensions at play in communities over the change in law enforcement's approach to the opioid epidemic.
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2011c. The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs.
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2002. The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997.
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From page 119... ...
2018. Increased non-fatal overdose risk associated with involuntary drug treatment in a lon gitudinal study with people who inject drugs.
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