Background: Hospitalists often care for patients who have substance use disorders as well as patients who are incarcerated. Availability of medications for substance use disorders (MSUD) varies based on state law and access varies based on facility, city, and county. Since hospitalization presents a unique opportunity to prevent negative consequences of substance use disorders, it is important for hospitalists to evaluate each patient with one or more these diagnoses for medical treatment. Similarly, hospitalists should offer MSUD to those who are incarcerated for whom it is indicated. One barrier to doing so, however, is not knowing if that medication will be continued when the patient is discharged from the hospital back to prison. In this study, we sought to determine what medications for substance use disorders are available in the prisons throughout New Mexico.
Methods: Each of 11 prisons in New Mexico were contacted in August 2021. The caller requested to speak with an inpatient unit and was advised that a hospital physician was seeking to understand what MSUDs were available in the prison to determine what medications may safely be started in the hospital and continued in prison. The caller asked ‘does the prison have a formulary they can share via email?’ and if so it was asked to be faxed or emailed. If there was not a formulary that could be shared, the caller asked: – is Suboxone available?- is methadone available?- is Sublocade shot available?- is naltrexone shot available?- is naltrexone pills available?- is acamprosate available?- is buproprion with naltrexone shot for methamphetamine use disorder for inmates?Up to 3 attempts were made to obtain responses.
Results: No one could be reached to answer the questions above in 3 of 11 state prisons. Four of 11 prisons had medications for opioid use disorder; 4 had buprenorphine (3 had buprenorphine extended release and one had intramuscular buprenorphine/naloxone); none could give methadone; 1 had intramuscular naltrexone available. One prison indicated they could order buprenorphine if needed. One prison had intramuscular naltrexone, one carried oral naltrexone, and one could order it to treat alcohol use disorder. No prison had recommended medical treatment for methamphetamine use disorder available of dual therapy with intramuscular naltrexone and bupropion.
Conclusions: Medications for substance use disorders (MSUD) are first line treatments, and hospitalists are increasingly involved in starting these medications during admissions. In one predominantly rural state with a high prevalence of substance use disorders, there were barriers to determining what MSUD are available in prisons and there was wide variability between MSUD availability. Furthermore, standard treatments hospitalists would recommend and order were infrequently available.The results of this study highlight that in at least one state’s prisons there are multiple barriers to hospitalists ensuring patients who are incarcerated can receive MSUD. Given the heterogeneity of treatments available after discharge, hospitalists may not know what to prescribe out of concern the medical treatments they offer will be stopped. Most significantly, patients who released to prison uncommonly have MSUD available to them. Hospitalists may wish to collaborate with interprofessional teams to determine MSUD availability in prison, and also cultivate relationships with prison health officials to improve communication about treatments and also access to care.