Dosing and Misuse of Buprenorphine in the New Jersey Department of Corrections.

Opioid use disorder is common in incarcerated persons, and concern about the diversion of buprenorphine is a barrier to treatment. We conducted a retrospective chart review of incarcerated persons in the New Jersey Department of Corrections who received charges for misuse of medication, including buprenorphine, hypothesizing that the prescription of buprenorphine monoproduct, multiple tabs or films of buprenorphine, or higher doses of buprenorphine would be associated with more diversion incidents. Within the dosing range of 2 to 12 mg, there were more incidents of diversion of buprenorphine monoproduct (24.

Prescribing Psychotropic Medications for Justice-Involved Juveniles.

Psychiatric disorders are exceedingly common in justice-involved youth. Relevant justice systems are varied, evolving, complex, and underserved. The intent of this article is to highlight the research and best practices related to managing the psychiatric disorders of justice-involved youths with a particular focus on pharmacotherapy.

Practice Patterns in Prescribing Buprenorphine in the New Jersey Department of Corrections.

Inmates have high rates of opioid use disorder and are at risk for morbidity and mortality both during incarceration and after release. We conducted a retrospective chart review to assess prescribers' fidelity to the New Jersey Department of Corrections practice guideline for prescribing maintenance or prerelease buprenorphine. We compared the entire group of inmates prescribed buprenorphine at the conclusion of 2019 ( = 875) with a sample of inmates diagnosed with opioid use disorder (OUD) but not prescribed buprenorphine ( = 396) and a sample of inmates not diagnosed with OUD ( = 367).

Mischief, Mayhem, and Remediation.

Institutional rules are necessary to preserve safety and security in correctional systems. An assessment of relevant mental health problems is a key element of a fair disciplinary process. Though these hearings are administrative in nature, we recommend that mental health evaluations related to disciplinary matters be completed by qualified and well-trained professionals using consistent standards.

Criminal Recidivism in Inmates with Mental Illness and Substance Use Disorders.

The relative contributions of mental illness and substance use disorders to criminal recidivism have important clinical and policy implications. This study reviewed 36 months of postrelease data for nearly 10,000 New Jersey state inmates released in 2013 to ascertain the rearrest rate of those diagnosed with mental illness, substance use disorders, both, or neither. We also examined whether certain characteristics suggestive of higher risk of psychiatric decompensation were associated with higher rates of rearrest.

Prescribing for Women in Corrections.

Prescribing for women in jails and prisons requires special consideration and should be informed by extant evidence. Incarcerated women have higher rates of mental illness than both females in the community and incarcerated men. Medication administration concerns that may disproportionately affect female prisoners include drug-drug interactions with contraceptives, intermittent dosing schedules, and concerns about metabolic side effects.

The American Academy of Psychiatry and the Law Practice Resource for Prescribing in Corrections.

The practice of prescribing in jails and prisons is often different from that in the community. Serious mental illness is common among inmates, and so are co-morbidities such as substance use, impulse-control, attention-deficit/hyperactivity, and personality disorders. Operational requirements, staffing, and the physical plant of the institution may complicate the provision of treatment according to community standards.

Characteristics of Inmates Who Initiate Hunger Strikes.

A hunger strike is a common, expensive, and potentially lethal event within a correctional institution. In this study, we describe the characteristics of inmates who initiated hunger strikes in a state prison system. Electronic medical records for a state prison system were reviewed for documentation of hunger strikes from January 2005 through September 2015.

Characteristics of Inmates Who Misuse Prescription Medication.

Substance use disorders are common among incarcerated individuals, and prescribed medications have been reported as abused, diverted, or otherwise misused in correctional settings. We conducted a retrospective chart review of electronic medical records and reports on institutional charges for misuse of authorized medication by inmates in the New Jersey Department of Corrections between 2003 and 2013. The most frequently cited medications for misuse were gabapentin, diphenhydramine, clonidine, and ibuprofen.

Metabolic Syndrome Prevalence and Reduction in Inmates Prescribed Antipsychotic Medications.

The principal aim of this study was to establish whether a metabolic monitoring program implemented for second-generation antipsychotic medications (SGAs) was associated with any reduction in the prevalence of metabolic syndrome in adult inmates treated with antipsychotic medications in the New Jersey Department of Corrections. The average prevalence of metabolic syndrome in those prescribed SGAs decreased from 17.9% during the years before metabolic monitoring to 14.

Correctional mental health administration.

Mental health administrators in correctional facilities have the complex task of balancing the clinical needs of incarcerated individuals and the safety and security missions of the facilities. This article describes the various structures of mental health administration within correctional facilities, the tasks commonly required of these professionals, and the skills necessary to be effective in this role. This editorial discusses the legal framework for mental healthcare in jails and prisons, staffing, cost containment, quality assurance and quality improvement, accreditation, peer review, morbidity and mortality reviews, utilization management, medication formularies, electronic health records, and innovative strategies as they apply to administrators of mental health services in correctional facilities.

Better Prescribing in Correctional Facilities.

Serious mental illness is highly prevalent in jails and prisons, and treatment with psychiatric medications is often required. However, operational factors and patient characteristics make prescribing in correctional settings uniquely challenging. The American Academy of Psychiatry and the Law has approved the formation of a working group to create a Resource Document examining best practices for prescribing psychiatric medications in these settings.

The prevalence of delusional disorder in prison.

Delusional disorder has important implications for forensic psychiatrists, as delusions are not infrequently related to criminal behavior. Thus, we hypothesized that delusional disorder is over-represented in correctional populations. We conducted a retrospective chart review of the electronic medical records from 2000 to 2012 of New Jersey Department of Corrections inmates who remained incarcerated as of March 2012.

Commentary: bridging the gaps for former inmates with serious mental illness.

Serious mental illness is a prominent and vexing problem within the correctional systems of North America. Simpson and colleagues draw attention to the epidemiology, special characteristics, and management problems relevant to Canadian inmates with serious mental illness. Of great interest to those in the forensic psychiatric field is the matter of continuation of care for mentally ill prisoners, in that untreated or undertreated psychiatric problems are strongly associated with poor social functioning and criminal recidivism.

Successful removal of quetiapine from a correctional formulary.

The abuse of medications in prison is a phenomenon well known among correctional health care professionals, and quetiapine has emerged as a drug of abuse in these settings. Considering the risks of abuse and diversion and the high cost compared with effective alternative antipsychotic medications, the New Jersey Department of Corrections (NJDOC) Pharmacy and Therapeutics Committee voted to remove quetiapine from the formulary. In a retrospective chart review, clinically relevant outcome measures were evaluated in patients prescribed quetiapine at the time of this change.

Diversion to the mental health system: emergency psychiatric evaluations.

In Maryland, any citizen may petition to have individuals brought against their will for an examination by a physician. In this retrospective chart review, we evaluated the characteristics of 300 persons referred to the Johns Hopkins Hospital on emergency petitions. Sixty-one percent of petitions described individuals who made verbal or physical threats of self-harm.