A randomized controlled trial of prison-initiated buprenorphine: Prison outcomes and community treatment entry

Abstract

Background Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. Methods This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3–9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. Results There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%). Conclusions Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.

Interim methadone and patient navigation in jail: Rationale and design of a randomized clinical trial

“…Buprenorphine appears to be much easier to divert during treatment than methadone because it must be administered sublingually, and if diversion is to be minimized, the patient must be observed for 5–10 minutes until the dose is absorbed (in tablet or film form). A study using buprenorphine in a Maryland prison with sentenced prisoners expected to be released within several months found that more than 10% of participants attempted to divert the medication and hence were discontinued from receiving the medication [60]. This rate of attempted buprenorphine diversion was similar to that found by Magura and colleagues in a study at Rikers Island comparing methadone to buprenorphine treatment for sentenced jail inmates [21].…”

In their own voices: Breaking the vicious cycle of addiction, treatment and criminal justice among people who inject drugs in Ukraine

“…This paradoxical ability to describe this cycle of addiction with incarceration and a lack of recognition that “being in a controlled setting” like prison, jail or even in a voluntary drug treatment program where they undergo supervised withdrawal from opioids, is consistent with the new qualifier to the Fifth Edition of the Diagnostic and Statistical Manual definition of having an opioid use disorder (American Psychiatric Association, 2013). Future framing of having an opioid use disorder in this manner will be crucial for expanding OAT in community settings, but also to motivate PWIDs to either continue (Rich et al, 2015) or initiate it during periods of confinement (Dolan et al, 2005; Gordon et al, 2014; Kinlock et al, 2009; Larney, Toson, Burns, & Dolan, 2012; Macalino et al, 2004) in order to optimize health post-release, whether to reduce overdose (Hedrich et al, 2012; Kinner et al, 2012) or improve HIV treatment outcomes (Springer et al, 2010; Springer et al, 2012)…”

“I Kicked the Hard Way. I Got Incarcerated.” Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments

“…At the time of incarceration, identifying individuals who receive methadone in the community, confirming methadone dosages, and rapidly reinitiating treatment presents a logistical challenge; however participants reported that security staff was inattentive to their needs, so better training and reporting protocols could have an impact. Additionally, because of the evidence supporting initiation of methadone or buprenorphine prior to release from prison, if methadone is not offered to individuals with long sentences, at least reinitiating MAT before release could improve rates of treatment entrance in the community (Rich et al, 2015; Gordon et al, 2014; Kinlock et al, 2007). …”