Table 1:

Recommendations for preventive care among people who use opioids in the criminal justice system

Screening		Vaccination		Harm reduction
Disease	Recommendations	Disease	Recommendations	Disease	Recommendations
HIV	Opt-out screening on intake for all individuals55	Tetanus	Td recommended every 10 years and TDaP once for all adults (especially important for PWID given ongoing risk)77	Blood-borne pathogens	•Avoid sharing of needles and equipment (including cottons, cookers, etc.) • Avoid using syringes to avoid drugs • Smoke, snort, swallow or “booty bump” (rectal administration) drugs instead of injecting • Reduce number of sharing partners
HBV	HBsAg, HBsAb and HBcAb recommended for all PWID77	HBV	Administer vaccine series to all PWID without evidence of HBV immunity (negative Hepatitis B surface Antibody)77	Severe bacterial infections	• Use a new needle every time (avoid even personal reuse) • Wash hands, use gloves and sterilize injection sites with alcohol prior to every use • Avoid licking needles or other equipment prior to injection
HCV	Opt-out screening on intake for all individuals [authors’ opinion and USPSTF recommendation to screen all adults]76	HAV	Administer vaccine with booster dose at 6 months to all PWID (serology not necessary prior to vaccination)77	Overdose	• Naloxone distribution • Use a small test dose to assess drug potency prior to use • Avoid using alone • • Avoid mixing opioids with benzodiazepines or other sedating drugs • Counseling regarding overdose risk associated with loss of tolerance and cue-associated cravings upon release from incarceration
STDs	Screen all people who use drugs for chlamydia, gonorrhea, and syphilis77	Other: HPV, Pneumococcus, Meningococcus, Pertussis	As indicated based on age and HIV status
Latent TB infection	Annual PPD or interferon-gamma release assay84	Seasonal influenza	Indicated annually for all adults