(62) Use of Prescription Medicines Among Incarcerated Individuals in The United States

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 393

Presenting Author(s)

Jill Curran
– Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Co-Author(s)

Brendan Saloner
– Johns Hopkins Bloomberg School of Public Health, United States
Matthew Tajanlangit
– Johns Hopkins University, Baltimore, MD, United States
G. Caleb Alexander, MD
– Professor of Epidemiology and Medicine, JHSPH Center for Drug Safety & Effectiveness, Baltimore, Maryland, United States

Background. Although rates of chronic disease are higher among individuals who are incarcerated compared with those who are not, little is known regarding the use of prescription medicines in jails and prisons in the United States.

Objective. To characterize how common chronic diseases, including diabetes, asthma, hypertension, Hepatitis B and C, HIV, depression, and severe mental illness are treated with prescription drugs in jails and prisons relative to non-correctional settings in the United States.

Methods. We used 2018-2020 data from the National Survey on Drug Use and Health (NSDUH) to estimate the prevalence of disease among recently incarcerated and non-incarcerated populations in the United States. We used IQVIA’s National Sales Perspective (NSP) to quantify the distribution of medications to incarcerated and non-incarcerated populations from 2018 to 2020. The NSP provides national dollar and unit sales of prescription medications across multiple distribution channels including prisons and jails (correctional facilities).

Results. The U.S. incarcerated population accounted for 0.44% of estimated individuals with Type 2 diabetes in the U.S., yet only 0.12% of anti-hyperglyemic pharmaceutical volume from 2018-2020, representing a 3.8 fold difference between diabetes burden and medication treatment in correctional facilities. Only 1.8% of diabetes therapies distributed to correctional facilities reflected therapies more recently brought to market, such as sodium-glucose cotransporter-2 (SLGT-2) and glucagon-like peptide-1 (GLP-1) agonists, whereas such treatments accounted for 12.3% of all diabetes therapies used among the non-incarcerated population. Under-utilization was also present for six other conditions, including asthma, hypertension, Hepatitis B or C, human immunodeficiency virus (HIV), depression, and severe mental illness (7.3, 3.2, 2.5, 4.0, 5.5, and 5.5 fold differences between disease burden and medication distribution, respectively).

Conclusions. Our analysis suggests prescription medications for chronic diseases are underused in correctional facilities relative to the substantial burden of disease in these settings. These findings may reflect delayed care among other access barriers, representing a critical public health issue.