A randomized clinical trial of buprenorphine for prisoners: Findings at 12-months post-release

Abstract

Background This study examined whether starting buprenorphine treatment prior to prison and after release from prison would be associated with better drug treatment outcomes and whether males and females responded differently to the combination of in-prison treatment and post-release service setting. Methods Study design was a 2 (In-Prison Treatment Condition: Buprenorphine Treatment Vs. Counseling Only) X 2 [Post-Release Service Setting Condition: Opioid Treatment Program (OTP) Vs. Community Health Center (CHC)] X 2 (Gender) factorial design. The trial was conducted between September 2008 and July 2012. Follow-up assessments were completed in 2014. Participants were recruited from two Baltimore prerelease prisons (one for men and one for women). Adult pre-release prisoners who were heroin-dependent during the year prior to incarceration were eligible. Post-release assessments were conducted at 1, 3, 6, and 12-month following prison release. Results Participants (N=211) in the in-prison treatment condition effect had a higher mean number of days of community buprenorphine treatment compared to the condition in which participants initiated medication after release (P=.005). However, there were no statistically significant hypothesized effects for the in-prison treatment condition in terms of: days of heroin use and crime, and opioid and cocaine positive urine screening test results (all Ps>.14) and no statistically significant hypothesized gender effects (all Ps>.18). Conclusions Although initiating buprenorphine treatment in prison compared to after-release was associated with more days receiving buprenorphine treatment in the designated community treatment program during the 12-months post-release assessment, it was not associated with superior outcomes in terms of heroin and cocaine use and criminal behavior.

Effectiveness of medication assisted treatment for opioid use in prison and jail settings: A meta-analysis and systematic review

“…Magura and colleagues (2009) found no differences in opioid use 3 months post-release between participants inducted to buprenorphine-naloxone sublingual tablets during incarceration and a methadone control group (53% vs. 66% respectively). Similarly, a follow up to an RCT (Gordon et al, 2017; treatment n = 104, control n = 107) found no differences in opioid use at 1 (23.5% vs. 24.6%), 3 (28.8% vs.…”

Review: Sex‐Based Differences in Treatment Outcomes for Persons With Opioid Use Disorder

“…Several additional studies have reported no sex-based differences in retention outcomes. A 1-year follow-up of MMT treatment outcomes (N=290) reported no association between sex and treatment retention 36 , and a clinical trial comparison of buprenorphine induction in prison versus in the community (following incarceration) (N=211) reported no differences in buprenorphine induction rates as a function of sex 37 .…”

“…Two retrospective chart review studies of MMT patients (N=290 and N=435) reported no sex-based differences in overall relapse to opioids, though one study did note that women in the study were more likely to relapse if they had a history of sexual victimization 36 . The final trial evaluated outcomes following buprenorphine induction in prison or in the community (N=211) and reported no sex-based differences in opioid relapse 37 .…”

Routes of non-traditional entry into buprenorphine treatment programs

“…An earlier pilot study [34] reported on the feasibility of initiating buprenorphine prior to release on a small group (n = 44) of prisoners. Initiation of buprenorphine prerelease resulted in faster engagement with a prescriber post-release, as well as much longer treatment duration (24 vs 9 weeks).…”