This study examined the state of the literature on the effectiveness of medication assisted treatment (MAT; methadone, buprenorphine, naltrexone) delivered in prisons and jails on community substance use treatment engagement, opioid use, recidivism, and health risk behaviors following release from incarceration. Randomized controlled trials (RCTs) and quasi-experimental studies published through December 2017 that examined induction to or maintenance on methadone (n=18 studies), buprenorphine (n=3 studies), or naltrexone (n=3 studies) in correctional settings were identified from PsycINFO and PubMed databases. There were a sufficient number of methadone RCTs to meta-analyze; there were too few buprenorphine or naltrexone studies. All quasi-experimental studies were systematically reviewed. Data from RCTs involving 807 inmates (treatment n = 407, control n = 400) showed that methadone provided during incarceration increased community treatment engagement (n=3 studies; OR = 8.69, 95% CI = 2.46; 30.75), reduced illicit opioid use (n=4 studies; OR = 0.22, 95% CI = 0.15; 0.32) and injection drug use (n=3 studies; OR = 0.26, 95% CI = 0.12; 0.56), but did not reduce recidivism (n=4 studies; OR = 0.93, 95% CI = 0.51; 1.68). Data from observational studies of methadone showed consistent findings. Individual review of buprenorphine and naltrexone studies showed these medications were either superior to methadone or to placebo, or were as effective as methadone in reducing illicit opioid use post-release. Results provide the first meta-analytic summary of MATs delivered in correctional settings and support the use of MATs, especially with regard to community substance use treatment engagement and opioid use; additional work is needed to understand the reduction of recidivism and other health risk behaviors.

Objective: The aim of this project was to provide a comprehensive overview and quantitative synthesis of the links between alcohol, drugs, and violence with established meta-meta-analysis methodology. Gender, psychotic illness (present vs. absent), role (perpetrator vs. victim), substance (alcohol, drugs, or both), operationalizations of violence (e.g., laboratory observed violence, community reported violence, homicide records, etc.), and study design (experimental, case-control, cross-sectional, and longitudinal) were evaluated as potential moderators. Method and Results: An extensive literature search resulted in 32 meta-analyses that met our inclusion criteria (i.e., quantitatively synthesized research assessing the link between alcohol or illicit drug use and violence perpetration/victimization) demonstrated a significant relationship between substance use and violence (grand weighted mean effect size of d ϭ 0.45, 95% CI [0.36, 0.54], p Ͻ .001). Male gender, psychotic illness, experimental study design, and combined alcohol and illicit drug use increased the associations between substance use and violence. More important, the degree of association was similar across the types of violence assessed and roles (victim/perpetrator). Conclusions: The current study shows that with respect to alcohol, illicit drugs, and violence, the overall relationship is a medium effect size that is robust across different populations, substances, types of violence, and both perpetration and victimization.

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