In this episode of ASAM Practice Pearls, Dr. Stephen Taylor hosts Dr. Justin Berk to discuss addiction care for individuals involved in the criminal justice system, including patients in custody and those transitioning back to the community. The conversation explores practical strategies for building therapeutic alliances with incarcerated patients, advocating for evidence-based treatment in correctional settings, and navigating common barriers to care. The episode covers opportunities for clinicians to provide compassionate, patient-centered care that improves outcomes for this high-risk population. ----more---- Looking for this episode's transcript? Download it HERE Get credit for listening! Claim your 0.5 CEs HERE Have an idea for a future episode? Share it with us at education@asam.org. Host Stephen M. Taylor, MD, MPH, DFAPA, DFASAM Dr. Stephen M. Taylor is ASAM's President and is board certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. Expert Justin Berk, MD, MPH, MBA, FASAM Dr. Justin Berk is an addiction medicine physician-researcher and the former Medical Director of the Rhode Island Department of Corrections. He is an Associate Professor in the Departments of Medicine and Pediatrics at the Alpert Medical School at Brown University and the Director for the Center of Health and Justice Transformation at Brown University Health. He completed residency at the Urban Health Combined Internal Medicine – Pediatrics Residency Program at Johns Hopkins Hospital and is Board Certified in Internal Medicine, Pediatrics, and Addiction Medicine. His research and advocacy focus on the intersection of addiction medicine, correctional health, and health equity. 📖 Show Segments 00:05 - Introduction 03:09 - Building Rapport with Patients in Custody 08:23 - Evidence for MOUD in Jails and Prisons 11:05 - Overcoming Implementation Barriers for Evidence-based Treatment 13:11 - Advocating for Patients in Custody 17:25 - Reentry and Continuity of Care 19:44 - Addressing Diversion Concerns 23:22 - Privacy, Autonomy, and Care Coordination 24:50 - Lightning Round Q&A 28:05 - Practice Pearls 29:58 - Conclusion and Additional Learning Opportunity 📋 Key Takeaways Recognize the justice system as a critical treatment touchpoint: Approximately 58% of individuals in state prisons and 63% of individuals in jails meet criteria for substance use disorder, making correctional settings an important, and often underutilized, opportunity to initiate evidence-based addiction care. Tailor clinical management to the correctional setting: Jails and prisons present distinct clinical challenges, with jails more commonly managing acute intoxication, withdrawal, and trauma, while prisons often focus on chronic disease management and long-term care. Use humanistic, patient-centered care to improve engagement and outcomes: Small actions, such as requesting the removal of handcuffs during clinical encounters, advocating for privacy, facilitating necessary evaluations, and coordinating directly with correctional facilities during transitions of care, can build trust and strengthen therapeutic relationships. Use hospitalization to close care gaps for patients in custody: When feasible, initiate evidence-based treatments during hospitalization rather than deferring care. Consider starting HCV treatment, optimizing medication for opioid use disorder (MOUD), addressing rehabilitation needs, completing necessary diagnostic workups, and documenting ongoing care requirements. Support access to MOUD in correctional settings: Evidence demonstrates that methadone and buprenorphine save lives, reduce overdose risk, improve treatment retention, and improve outcomes, yet many of these treatments remain unavailable in many correctional facilities. Recommend and document evidence-based treatment regardless of anticipated barriers: When MOUD is clinically indicated, formally prescribe or recommend treatment, even if continuation is uncertain, to create a clear record of the standard of care and support future treatment access. Balance diversion concerns against the benefits of treatment: While diversion of medications such as buprenorphine can occur, concerns are often overstated and should not prevent patients from receiving evidence-based treatment for opioid use disorder. Prioritize overdose prevention during the reentry period: Individuals face an exceptionally high risk of fatal overdose immediately after release, making reentry planning, continuity of care, and ongoing treatment engagement essential components of addiction treatment. Plan for reentry early and proactively: Because 95% of incarcerated individuals return to their communities, clinicians should address barriers such as insurance coverage, identification, housing, transportation, and continuity of care before release whenever possible. Maintain a high index of suspicion for alcohol withdrawal in custody settings: Alcohol withdrawal is a high-risk situation in jails, and is often underrecognized and potentially fatal, requiring early identification, monitoring, and treatment. 🔗 Resources The ASAM Criteria, Fourth Edition, Volume 3: Correctional Settings and Community Reentry Volume Public comment open until August 31, 2026 Expected release early 2028 (tentative) Treatment of SUD in Jails and Prisons (FREE) ASAM Clinical Tips: Treating SUD in Jails and Prisons Implementing MOUD Improves Safety, Culture, and Public Health Managing Alcohol Withdrawal in Jail Settings Additional Treatment Courts Education (FREE) Learning Collaborative Sessions (Mentoring) - A Whole Person Approach: Adding Addiction Medicine Services to a Drug Treatment Court Program Resources: Job Aids Treatment Court Resources & Toolkits MOUD Guides ASAM Public Policy Statement on Treatment of Opioid Use Disorder in Corrections Settings - Adopted by the ASAM Board of Directors on July 15, 2020; revised on January 23, 2025 Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals - Bureau of Justice Assistance, Office of Justice Programs, US Department of Justice; June 2023 Jail and Prison Opioid Project: This website provides data, research, implementation resources, and an interactive database documenting which correctional facilities offer evidence-based treatments such as methadone, buprenorphine, and naltrexone to individuals with opioid use disorder. Justice Community Overdose Innovation Network (JCOIN): An NIH-funded national initiative focused on improving how the criminal justice system responds to substance use disorders by advancing research, evidence-based practices, and partnerships between healthcare and justice systems. This website provides research, training, technical assistance, and educational resources to expand access to effective addiction treatment for justice-involved populations. Association Between Jail-Based Methadone or Buprenorphine Treatment for Opioid Use Disorder and Overdose Mortality After Release From New York City Jails 2011-17 - Lim S, Cherian T, Katyal M, et al. Addiction. 2023;118(3):459-467. doi:10.1111/add.16071 Carceral Health Care - Brinkley-Rubinstein L, Berk J, Williams BA. N Engl J Med. 2025;392(9):892-901. doi:10.1056/NEJMra2212149 Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009 (Revised 2020) - Bronson J, Stroop J, Zimmer S, Berzofsky M. Bureau of Justice Statistics, US Department of Justice; June 2017. NCJ 250546 Hospitalization Through the Lens of Incarceration - South AM, Haber LA, Berk J. J Gen Intern Med. 2024;39(10):1905-1909. doi:10.1007/s11606-024-08805-8 Injecting Opioid Use Disorder Treatment in Jails and Prisons: The Potential of Extended-Release Buprenorphine in the Carceral Setting - Berk J, Del Pozo B, Rich JD, Lee JD. J Addict Med. 2022;16(4):396-398. doi:10.1097/ADM.0000000000000942 Reentry Trends in the United States - Hughes TA, Wilson DJ. U.S. Department of Justice, Bureau of Justice Statistics; 2004 Uncommon and Preventable: Perceptions of Diversion of Medication for Opioid Use Disorder in Jail - Evans EA, Pivovarova E, Stopka TJ, Santelices C, Ferguson WJ, Friedmann PD. J Subst Abuse Treat. 2022;138:108746. doi:10.1016/j.jsat.2022.108746 📢 Join the Discussion Share your thoughts using #ASAMPracticePearls — we’d love to hear from you! In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
