Prison Study to Focus on Substance Use and Hepatitis C Treatments

A group of health professionals and researchers have received grants to study treatments for substance use disorders and hepatitis C among people incarcerated in state prisons.

Experts in implementation science will guide treatment teams working in designated US prison and jail systems to offer evidence-based care for opioid use disorders and later for screening and treatment of hepatitis C, according to a news release from the University of Massachusetts Medical School.

The university will partner with other academic medical centers to undertake the initiative.

“This is our first effort to bring prison and jail systems together to work on a breakthrough collaborative,” Warren J. Ferguson, MD, a University of Massachusetts Medical School professor and founder of the Academic and Health Policy Conference on Correctional Health states in the release.

“Experts and providers who are in the trenches providing or coordinating care in correctional settings will work together and learn from each other,” Ferguson said. “In concentrating on substance use disorder and hepatitis C, we strive toward care improvements that will have the largest impact on justice-involved populations.”

Chronic infection of the bloodborne hepatitis C virus can lead to serious liver damage such as cirrhosis and liver cancer. An estimated 500,000 incarcerated people in the US are infected with hepatitis C, according to a Weill Cornell Medicine study published earlier this year in the journal Hepatology.

Substance use disorder is common among inmates, affecting about 80% of the prison population and research indicates that more than 17% are infected with hepatitis C. However, most prisons and jails have not adopted effective treatments and best practices, according to the university release.

“If we release inmates with these untreated health conditions to the community, there are several risks,” states Ferguson in the release. “They could spread hepatitis C infection to others, and evidence from Washington State suggests that those with substance use disorders are 125 times more likely to die from an overdose during the first two weeks after release.”

The collaborative involves two sequential projects with the first part focused on substance use disorder and testing implementation of evidence-based practices and the second project, planned for 2017, devoted to improvements for hepatitis C screening and treatment. The work will be done at four sites that are expected to be publically identified in the coming weeks.

“Our job will be to coach and facilitate the teams to implement treatment systems,” and to document what they did and how they did it, Ferguson, the project principal investigator, said in a telephone interview.

One goal is to craft a strategy to increase adherence to care standards particularly among high risk populations such as people infected with hepatitis C. It’s clearly a community standard of care that people infected with the virus who have any signs of liver dysfunction be treated with the new direct acting antiviral drugs but how the prisons will pay for the costly drugs remains an issue, Ferguson said.

Negotiating lower prices with drug companies or seeking federal funding pricing are techniques that can be helpful in some circumstances, noted Ferguson. But ultimately it will be important to get across the message that paying for treatment up front could be much less costly than paying later to defend court challenges from untreated patients, he said.

The National Institute of Drug Abuse and the Agency for Health Care Research and Quality are funding the initiative.