Initiation of buprenorphine during incarceration and retention in treatment upon release

Abstract

We report here on a feasibility study of initiating buprenorphine/naloxone prior to release from incarceration and linking participants to community treatment providers upon release. Study consisted of a small number of Rhode Island (RI) prisoners (N=44) diagnosed with opioid dependence. The study design is a single arm, open-label pilot study with a 6-month follow up interview conducted in the community. However, a natural experiment arose during the study comparing pre-release initiation of buprenorphone/naloxone to initiation post-release. Time to post-release prescriber appointment (mean days) for initiation of treatment Outside Rhode Island Department of Corrections (RIDOC) vs. Inside RIDOC was 8.8 and 3.9, respectively (p=.1). Median post release treatment duration (weeks) for Outside RIDOC vs. Inside RIDOC was 9 and 24, respectively (p=.007). We conclude that initiating buprenorphine/naloxone prior to release from incarceration may increase engagement and retention in community-based treatment.

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

“…These results are comparable to those reported by Zaller et al (2013) in their small-scale feasibility study. It is noteworthy that rates of post-release treatment entry were similar for the In-Prison Buprenorphine Conditions and the Condition in which participants did not start buprenorphine in prison and were referred to the OTP in the community, (44%, 51%, and 44%, respectively) as the Condition involving counseling only in prison and referral to the CHC had by far the lowest rate of community treatment entry (22%).…”

“…All 9 were on relatively low doses (1–3 mg) when they discontinued. In the study by Zaller et al (2013), 12 non-tolerant participants with pre-incarceration opioid dependence were on buprenorphine for, on average, one week until release from incarceration; of these, 11 continued buprenorphine treatment in the community; one participant (8.3 %) did not like the effects of the medication and entered drug-free treatment. Garcia et al (2007) reported that of the 45 participants (most of whom were opioid-tolerant) who began buprenorphine treatment in prison, two (4.4%) withdrew because of side effects attributed to the medication.…”

“…However, buprenorphine patients were significantly more likely than methadone patients to be terminated from treatment in prison for attempted diversion of medication. Finally, Zaller et al (2013) conducted a small-scale ( n =44) feasibility study with buprenorphine/naloxone for Rhode Island prisoners who were previously, but not currently opioid-tolerant, with the intention to initiate medication up to two weeks before anticipated release. Because 32 inmates were released earlier than expected, Zaller and colleagues compared community-treatment entry and retention for these 32 who did not receive buprenorphine/naloxone in prison to 12 who began induction while incarcerated.…”

“…Setting is important also because, unlike newly-incarcerated jail inmates in the US and longer-term prisoners in some other countries, most prisoners with pre-incarceration heroin dependence in the United States may not be regularly using heroin in prison (Kinlock et al, 2011); nearly all participants in studies cited in Section 1.2 except for Zaller et al (2013) were opioid-tolerant when medication began. Consequently, it is important to examine whether buprenorphine provided to non-opioid tolerant male and female prison inmates with heroin dependence histories would be feasible and would facilitate community-based substance abuse treatment entry.…”

The Criminal Justice Experience of African American Cocaine Users in Arkansas

“…This is particularly the case for individuals with substance use disorders who may have insufficient access to addiction treatment within correctional settings and poor linkage to substance use treatment upon release (McKenzie, Macalino, McClung, Shield, & Rich, 2005). The incarcerated setting represents a significant public health opportunity to engage drug-involved offenders in substance use treatment as well as other evidence based re-entry services (Boutwell, Nijhawan, Zaller, & Rich, 2007; Perry et al, 2013; Zaller et al, 2013). …”