Systemic biases: Attitudes of correctional staff toward incarcerated people receiving opioid agonist treatment

Background: The incarcerated population undergoing opioid agonist treatment (OAT) faces systemic discrimination within the criminal justice system. Despite the proven efficacy of OAT in managing opioid use disorder (OUD), many institutions fail to provide comprehensive addiction treatment, perpetuating a punitive rather than rehabilitative approach. This systemic bias is reinforced by correctional officers who may harbor negative attitudes toward those individuals, viewing addiction as a moral failing rather than a medical condition. Correctional officers, at times, contribute to the discrimination by perpetuating stereotypes and biases. Discriminatory practices may manifest in stigmatizing language, lack of understanding about addiction issues, differential treatment, denial of medical services, or isolation of individuals on OAT, further exacerbating their vulnerability. While many studies discuss the lived experiences of incarcerated people, only a few are about the perspective of the correctional staff toward the incarcerated people. Given this lack of knowledge, this scoping review aims to identify and map the available evidence on the perceptions, attitudes and practices of correctional staff toward inmates on OAT.
Methods:  To provide a holistic perspective, this ongoing scoping review will include qualitative, quantitative, and mixed-methods studies from 2010 to 2024. With the help of a criminology specialist, we will develop a rigorous search strategy using relevant keywords. Two independent reviewers will use two databases (PubMed and PsycINFO) and explore grey literature to perform study screening and selection, as well as data extraction.
Results: First, it is expected to find a high variability within the attitudes and perceptions among correctional staff members, which can be explained by differences regarding the facilities, philosophies, personal beliefs and experiences, etc. On one hand, it is expected that some correctional agents hold negative attitudes and perceptions toward them, which can create additional barriers to effective care and rehabilitation. On the other hand, is it also expected that other correctional agents’ attitudes align with a patient-centered care approach for incarcerated individuals receiving OAT, which can have a positive impact on their overall well-being.
Conclusion: This review seeks to contribute to the development of evidence-based strategies aimed at mitigating prejudice and discrimination, fostering a more supportive environment for individuals undergoing OAT within the criminal justice system. More precisely, our results could help improve institutional policies and staff training, while reducing stigma and discrimination toward this underrepresented group. Identifying, recognizing and acknowledging these elements can guide the development of interventions to improve OAT acceptance.