Changes in the availability of medications for opioid use disorder in prisons and jails in the United States during the COVID-19 pandemic

Abstract

Background During the COVID-19 pandemic, federal agencies relaxed buprenorphine prescribing restrictions including for incarcerated individuals. The impact of COVID-19 on the supply of MOUD in U.S. prisons and jails is not known. Methods We used cross-sectional national monthly data from the IQVIA National Sales Perspective (NSP) for the total volume of medicines supplied to city, county and state prisons and jails and other types of institutional facilities in the U.S. We measured the total monthly supply (or volume) as extended units (EUs) for MOUDs overall and by type. We used interrupted time series analysis to evaluate changes in monthly volume of MOUDs in prisons and jails and other types of facilities (hospitals, clinics and long-term care) before (January 2018-February 2020) and during the COVID-19 (March 2020-October 2020) pandemic. Results The availability of MOUD in jails and prisons increased by 471.3% between January 2018 (52,784 EU) and October 2020 (333,226 EU). This increase was largely driven by increased volume of buprenorphine/naloxone and was not observed in other institutional facilities, including hospitals, clinics and long-term care, and. Specifically, the mean monthly volume of buprenorphine/naloxone at prisons/jails increased every month before the pandemic by 1,860 EU (95% CI, 1,110-2,360). In March 2020, the mean volume of buprenorphine/naloxone increased by 81,930 EU (95% CI, 59,040-104,820) per month, followed by a significant increase of 24,010 EU (95% CI 19,530-28,490) per month during the pandemic vs before the pandemic. Conclusion These findings may indicate increased availability of buprenorphine/naloxone, a safe and effective MOUD, in prisons and jails since the start of the COVID-19 pandemic in the U.S. despite previous barriers in its use.

The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study

“…These changes to carceral MOUD programs reported by EXIT-CJS study sites parallel changes occurring in other carceral programs during the early months of the COVID-19 pandemic (Bandara et al, 2020 ; Donelan et al, 2021 ; Duncan et al, 2021 ). Across the US, the mean monthly volume of MOUD at carceral sites increased throughout the pandemic, while MOUD volume at other residential healthcare programs remained relatively stable (Dadiomov et al, 2022 ). The increases observed at carceral sites were largely related to increased availability of buprenorphine/naloxone (Dadiomov et al, 2022 ).…”

“…Across the US, the mean monthly volume of MOUD at carceral sites increased throughout the pandemic, while MOUD volume at other residential healthcare programs remained relatively stable (Dadiomov et al, 2022 ). The increases observed at carceral sites were largely related to increased availability of buprenorphine/naloxone (Dadiomov et al, 2022 ). Despite challenges presented by the pandemic, legislation and recent court decisions supporting the provision of MOUD in carceral settings (Toyoshima et al, 2021 ) coupled with funding mechanisms, including State Opioid Response (SOR) grants (Substance Abuse and Mental Health Services Administration (SAMHSA), 2021 ) and enhanced telemedicine services, may have supported the ongoing provision of MOUD during the pandemic at EXIT-CJS sites and in other carceral settings (Dadiomov et al, 2022 ).…”

“…The increases observed at carceral sites were largely related to increased availability of buprenorphine/naloxone (Dadiomov et al, 2022 ). Despite challenges presented by the pandemic, legislation and recent court decisions supporting the provision of MOUD in carceral settings (Toyoshima et al, 2021 ) coupled with funding mechanisms, including State Opioid Response (SOR) grants (Substance Abuse and Mental Health Services Administration (SAMHSA), 2021 ) and enhanced telemedicine services, may have supported the ongoing provision of MOUD during the pandemic at EXIT-CJS sites and in other carceral settings (Dadiomov et al, 2022 ). Several carceral and CTP sites also increased the provision of extended-release buprenorphine and naltrexone.…”

“…Across the US, the mean monthly volume of MOUD at carceral sites increased throughout the pandemic, while MOUD volume at other residential healthcare programs remained relatively stable (Dadiomov et al, 2022). The increases observed at carceral sites were largely related to increased availability of buprenorphine/naloxone (Dadiomov et al, 2022). Despite challenges presented by the pandemic, legislation and recent court decisions supporting the provision of MOUD in carceral settings (Toyoshima et al, 2021) sites also increased the provision of extended-release buprenorphine and naltrexone.…”

The next frontier of combating drug addiction in America

“…This is a significant development that reduces the burden on patients for accessing MAT, especially those living in rural areas, who can now be enrolled virtually or over the phone. This development, along with recent mandates and litigation at the state-level [19], has also opened the door to increased MAT availability in jails and prisons (by over 450% between 2018 and 2020 [20]), where nearly 1 in 3 individuals have opioid use disorder [21].…”