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Medication-assisted treatment in criminal justice systems: a qualitative study on treatment orientation, barriers, and facilitators of Allegheny County Jail

Silva, Jose (2019) Medication-assisted treatment in criminal justice systems: a qualitative study on treatment orientation, barriers, and facilitators of Allegheny County Jail. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Justice-involved populations have high rates of opioid dependency and are at most risk for overdose events, especially in the immediate post-release period. Excessive mortality rates are largely attributed to these overdose events. Medication-assisted treatment (MAT) has been underutilized in the treatment of opiate-dependent criminal justice populations. Consequently, health care policies within this sector often fail to provide evidence-based treatment that may hinder or disrupt the rehabilitation of detained offenders.
Purpose: Opioid-related fatal overdoses are a significant public health concern in Allegheny County, Pennsylvania, especially among justice-involved populations reentering into society. Despite the effectiveness of pharmacological intervention, Allegheny County Jail has limited the provision of MAT to expectant mothers. Understanding local jail policy and its implications on the general rehabilitation of its returning citizens in the community is important for addressing barriers to efficacious treatment, facilitating effective service utilization, and informing policy.
Methods: To understand Allegheny County Jail’s barriers to facilitating MAT and its related treatment implications on the greater community, we examined the perceptions, experiences, and knowledge of 15 stakeholders. Semistructured interviews and a survey were used to gather qualitative data from a convenience sample of respondents. A qualitative matrix analysis was then developed to organize categorical constructs from responses across different groups of stakeholders.
Results: These findings have a great public health significance as they show how Allegheny County can target and mitigate treatment gaps associated with the detoxification of an individual in active community recovery. Methadone and buprenorphine should be provided to prevent lapses in treatment as well as timely linkage to community-based providers during incarceration. Many expressed views consistent with stigmatized beliefs about methadone and buprenorphine, and cited the jail administration’s punitive approach to substance abuse treatment. Other major factors included the difficulty in treating a transient jail population, associated cost of medication, and security concerns with administration and management of a controlled substance. These factors were found to negatively impact the provision and continuity of MAT practice in Allegheny County. Public health interventions will require criminal justice systems alike to reform policy that improves health outcomes of opiate-dependent offenders and reduces their involvement in the criminal justice system.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Silva, Josejes292@pitt.edujes2920000-0002-0081-2178
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHawk, Maryemfelter@pitt.eduemfelter
Committee MemberFelter, Elizabethmary.hawk.pitt.edumary.hawk
Committee MemberNewhill, Christinanewhill@pitt.edunewhill
Date: 19 June 2019
Date Type: Publication
Defense Date: 17 April 2019
Approval Date: 19 June 2019
Submission Date: 4 April 2019
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 101
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Draft
Date Deposited: 19 Jun 2019 20:26
Last Modified: 01 May 2020 05:15


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