Recent Incarceration and Buprenorphine Maintenance Treatment Outcomes among Human Immunodeficiency Virus–Positive Patients

Abstract

Background Opioid use disorder is a common cause of morbidity and mortality among people living with HIV/AIDS. Buprenorphine maintenance treatment (BMT) is an effective means of therapy, but patients with recent criminal justice involvement may need more support during BMT than other patients. We hypothesized that recently incarcerated BMT patients who initiated treatment in primary care would have poorer treatment outcomes than those who were not recently incarcerated. Methods We analyzed data from a multi-site cohort study of BMT integrated into HIV care. Patients were stratified by self-reported incarceration in the 30 days before initiation of BMT. The outcomes of interest were 6 and 12-month treatment retention and self-reported opioid use. We used multivariable logistic regression and hierarchical linear model, respectively, to evaluate the association between recent incarceration and these outcomes while adjusting for potential confounding variables. Results Among 306 BMT patients living with HIV/AIDS, 39 (13%) reported recent incarceration. Patients with recent incarceration (vs. without) were more likely to be homeless, unemployed, and previously diagnosed with mental illness. Recent incarceration was not significantly associated with differences in 6-month (OR = 0.95; 95% CI = 0.46–1.98) and 12-month treatment retention (OR = 0.57; 95% CI = 0.27–1.18) or in self-reported opioid use (OR = 0.99; 95% CI = 0.51–1.92) after adjustment for potential confounding variables. Conclusions Those with incarceration in the 30 days prior to BMT initiation were more likely to be homeless, unemployed, and previously diagnosed with mental illness than those without recent incarceration. However, we did not detect a difference in in self-reported opioid use, 6-month or 12-month retention in treatment between those with and without recent incarceration. Future studies should confirm these findings with larger sample sizes. Encouraging formerly incarcerated individuals with opioid use disorder to initiate evidence-based treatments, including BMT, should be part of efforts to confront the opioid addiction epidemic in the United States.

Opioid-related treatment, interventions, and outcomes among incarcerated persons: A systematic review

“…Two studies evaluated the impact of post-release MMT continuation on all-cause and overdose mortality [69] and on criminal recidivism [71]. Five studies evaluated the impact of BPN-based opioid pharmacotherapy post-release on access to and/or retention in addiction treatment, levels of illicit opioid use, and criminal recidivism [70,72,73,76,77]. One RCT compared the efficacy of MMT and naltrexone implants post-release in reducing illicit drug use and criminal recidivism [78], and 3 studies evaluated the impact of NLX kit provision in preventing overdose-related deaths post-release [74,75,79].…”

“…Five studies evaluated the impact of post-release BPN-based treatments on treatment retention, illicit opioid use, and criminal recidivism [70,72,73,76,77]. Springer et al [76,77] examined data from a group of HIV-positive incarcerated persons with OUD who received BPN/NLX treatment post-release.…”

“…Riggins et al [73] analyzed data from a cohort of HIV-positive patients diagnosed with opioid dependence who were receiving BMT. Among patients incarcerated in the previous 30 days, those who were retained in BMT had lower rates of subsequent incarceration at 6 months (8.4% versus 27.9%, p < 0.01), 9 months (4.9% versus 20.4%, p < 0.01), and 12 months of follow-up (6.2% versus 24.8%, p < 0.01), compared to those who were not retained in BMT.…”

A conceptual model for understanding post-release opioid-related overdose risk

“…HIV infection and incarceration may interact to augment the underlying pathways leading to opioid-related overdose through cumulative disadvantage. Individuals living with HIV and with a recent history of justice involvement were more likely to be homeless, unemployed and previously diagnosed with a mental illness relative to those with a recent history of justice involvement without HIV [38]. Among people who inject drugs living with HIV, those with recent criminal justice exposure had 25% greater adjusted odds of lapses in medical care relative to those without criminal justice exposure [39].…”

Routes of non-traditional entry into buprenorphine treatment programs

“…In another multisite cohort study, they found that recent incarceration was not associated with any differences in 6-or 12month treatment retention or self-reported opioid use [38]. A large multi-site retrospective cohort study (n = 48, 689) examined national Veterans Health Administration (VHA) clinical and pharmacy records of veterans diagnosed with opioid use disorder and found that veterans with criminal justice involvement had reduced odds of receiving MOUD compared to others [39].…”