Anticipated Barriers to Sustained Engagement in Treatment With Medications for Opioid Use Disorder After Release From Incarceration

Abstract

BackgroundAlthough the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist.MethodsWe conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12.ResultsParticipants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release.ConclusionOur findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.

“Just fighting for my life to stay alive”: a qualitative investigation of barriers and facilitators to community re-entry among people with opioid use disorder and incarceration histories

“…Third, participants reported feeling unprepared for release and suggested changes to improve the re-entry process for people with OUD, including improved treatment facilitation. Our findings build on the few prior studies examining the incarceration experience among people with OUD by evaluating the first 24-h post-release and re-entry preparation and focusing on individuals who are no longer incarcerated and engaged in methadone treatment [ 14 , 20 , 26 ].…”

“…These barriers provide an opportunity for actionable policy and practice. For example, Kaplowitz et al found that participants suggested transportation options such as subsidized bus passes could facilitate treatment in the community post-release [ 26 ].…”

“…Other studies demonstrate a range of material barriers after release for individuals with and without OUD, including a lack of both personal resources and information on how to access resources [ 26 , 34 – 36 ]. It is notable that many participants felt that the lack of resources ultimately set them up to return to prison or jail, emphasizing how social and structural factors influence criminal legal system involvement [ 37 ].…”

“…An element of Welsh and Rajah’s (2014) qualitative framework “re-entry work” is echoed in respondents’ stories—the difficulty of caring for oneself, establishing housing, and renewing family relationships [ 38 ]. In another qualitative study, people experiencing homelessness were afraid they would return to substance use after release [ 26 ]. Moreover, Hyde et al, found that veterans recently released from prison expressed “transitional anxiety” which accompanied seeking housing and employment [ 39 ].…”

“…They reported experiencing fear of returning to past social and behavioral patterns and of being released into settings that make substance use impossible to avoid. In a similar study, Kaplowitz et al noted that such variables can impact engagement and retention in MOUD [ 26 ]. Additionally, participants perceived inadequate notice of their release, an absence of transitional programs to prepare them for re-entry, and inadequate education about how to avoid return to substance use post-incarceration.…”