28
Special Populations
Î MAJOR REVISION – Initiation or maintenance of pharmacotherapy
for the treatment of OUD is recommended for individuals within the
criminal justice system (including both jails and prisons).
• Criminal justice staff should coordinate care and access to pharmacotherapy to
avoid interruption in treatment.
• Patients should not be forced to transition from agonist (methadone or
buprenorphine) to antagonist (naltrexone) treatment.
Î MAJOR REVISION – Individuals in the criminal justice system who
have OUD or who are experiencing opioid withdrawal should be offered
a combination of pharmacotherapy and psychosocial treatment (based
on an assessment of their individual psychosocial needs).
• A patient's decision to decline psychosocial treatment or the absence of available
psychosocial treatment should not preclude or delay pharmacological treatment
of OUD, with appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients
to engage in psychosocial treatment services appropriate for addressing their
individual needs.
Î NEW – If an OTP is not accessible, providers may need to transition
individuals from methadone to buprenorphine.
• Effectively transitioning from methadone to buprenorphine can be challenging
but can be achieved safely if managed by a provider experienced in the procedure.
Î MAJOR REVISION – Risk for relapse and overdose is particularly high
in the weeks immediately following release from prison and jails.
• Patients being treated for OUD while in prison or jail should be stabilized on
pharmacotherapy (methadone, buprenorphine or naltrexone) and continue in
treatment after their release.
• Patient care on reentry to the community should be individualized and
coordinated with treatment providers in the community.
Î NEW – Naloxone kits should be available within correctional facilities.
Individuals with OUD should receive a naloxone kit prior to release,
and individuals and families should be educated in how to administer
naloxone.
