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. 2023 Apr 7;4(4):e230482.
doi: 10.1001/jamahealthforum.2023.0482.

Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US

Jill Curran  1   2 , Brendan Saloner  3 , Tyler N A Winkelman  4   5 , G Caleb Alexander  1   2   6
Affiliations

Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US

Jill Curran et al. JAMA Health Forum. .

Abstract

Importance: Although incarcerated individuals experience higher rates of chronic conditions, little is known regarding the use of prescription medications in jails and prisons in the US.

Objective: To characterize treatment with prescription medications in jails and state prisons relative to noncorrectional settings in the US.

Design, setting, and participants: This cross-sectional analysis using 2018 to 2020 data from the National Survey on Drug Use and Health (NSDUH) estimated the prevalence of disease among recently incarcerated and nonincarcerated adults in the US. The study used 2018 to 2020 IQVIA's National Sales Perspective (NSP) to quantify the distribution of medications to incarcerated and nonincarcerated populations. The NSP provides national dollar and unit sales of prescription medications across multiple distribution channels, including prisons and jails. The study population included incarcerated and nonincarcerated individuals from NSDUH. Seven common chronic conditions were assessed. Data were analyzed in May 2022.

Exposures: Medications being sent to correctional facilities vs all other settings in the US.

Main outcomes and measures: The main outcomes were distribution of medications to treat diabetes, asthma, hypertension, hepatitis B and C, human immunodeficiency virus (HIV), depression, and severe mental illness to incarcerated and nonincarcerated populations.

Results: The proportion of pharmaceuticals distributed to jails and state prisons to treat type 2 diabetes (0.15%), asthma (0.15%), hypertension (0.18%), hepatitis B or C (1.68%), HIV (0.73%), depression (0.36%), and severe mental illness (0.48%) was much lower compared with the relative burden of disease among this population. The incarcerated population in state prisons and jails accounted for 0.44% (95% CI, 0.34%-0.56%) of estimated individuals with diabetes, 0.85% (95% CI, 0.67%-1.06%) of individuals with asthma, 0.42% (95% CI, 0.35%-0.51%) of hypertension, 3.13% (95% CI, 2.53%-3.84%) of hepatitis B or C, 2.20% (95% CI, 1.51%-3.19%) of HIV, 1.46% (95% CI, 1.33%-1.59%) of depression, and 1.97% (95% CI, 1.81%-2.14%) of severe mental illness. After adjusting for disease prevalence, the relative disparity was 2.9-fold for diabetes, 5.5-fold for asthma, 2.4-fold for hypertension, 1.9-fold for hepatitis B or C, 3.0-fold for HIV, 4.1-fold for depression, and 4.1-fold for severe mental illness.

Conclusions and relevance: In this cross-sectional, descriptive study of the distribution of prescription medications for chronic conditions in jails and state prisons, the findings suggest that there may be underuse of pharmacological treatment in correctional facilities relative to the nonincarcerated population. These findings, which require further investigation, may reflect inadequate care in jails and prisons and represent a critical public health issue.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Saloner reported grants from the Greenwall Foundation during the conduct of the study. Dr Alexander reported being past Chair and a current member of the US Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee; a co-founding Principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation, for whom he has served as a paid expert witness; and a past member of OptumRx’s National Pharmacy & Therapeutics Committee. Dr Alexander’s arrangements have been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. No other disclosures were reported.

Figures

Figure.
Figure.. Prevalence Rates of Select Conditions Among Recently Incarcerated and Nonincarcerated Individuals in the US
Sources: 2018-2020 National Survey on Drug Use and Health, the US Census Bureau. Error bars represent 95% CIs.
See this image and copyright information in PMC

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