Pharmacotherapy for substance use disorders

Abstract Few correctional facilities offer medications for alcohol or other substance use disorders (SUDs) despite the tremendous evidence base supporting the use of pharmacotherapy. Untreated opioid use disorder, both within corrections and in the community, is associated with increased risk of HIV, hepatitis C, acquisitive crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of imprisoned people receive any SUD treatment while incarcerated. Those that do are usually offered behavioral interventions, which, when used alone, lead to suboptimal outcomes relative to pharmacotherapy. Although there are limited studies on the benefits of SUD treatment during incarceration, there are more than fifty years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid use disorder that reduces other opioid use and improves health and quality-of-life outcomes. With the growing recognition of the importance of such treatments, this chapter presents the current state of evidence-based practice for pharmacology for SUD in correctional settings.