Medications for opioid use disorder during incarceration and post-release outcomes

Abstract

Background Continuation or initiation of MOUDs during incarceration could improve post-release outcomes by preventing return to opioid use and reducing risk of overdose. People with OUD involved in the criminal legal system are a vulnerable population, yet little research has comprehensively examined post-release outcomes associated with receiving MOUDs in jail and prison settings. Methods The authors conducted a review of published peer-reviewed literature on post-release outcomes associated with the use of MOUDs in correctional settings to determine implications for further research and policy. Results Results showed compelling evidence supporting the use of MOUDs for currently incarcerated populations, with almost all studies showing that MOUDs provided during incarceration increased community-based treatment engagement post-release. There is also evidence that initiating or continuing MOUDs during incarceration is associated with decreased opioid use and overdoses post-release, without increasing criminal involvement. Conclusions Findings indicate that forcing tapering and withdrawal during incarceration can have dire consequences upon release into the community. Initiating or continuing MOUDs during incarceration reduces the risk for opioid use and overdose upon release by maintaining opioid tolerance and increasing community treatment engagement.

The relationship between reincarceration and treatment of opioid use disorder with extended-release naltrexone among persons with HIV

“…For those transitioning to the community from justice settings MOUD programs have been shown to reduce mortality due to overdoses. Overall buprenorphine and methadone maintenance have shown decreased rates of overdose, in studies of XR-NTX overdose risk was due to discontinuation of the medication ( Cates and Brown, 2023 ). A current NIDA funded randomized controlled trial comparing XR-NTX to extended-release buprenorphine among persons in jail and prison in 5 states evaluating the primary outcome of retention on treatment post-release and secondary outcomes include recurrence of opioid use and overdose ( Waddell et al., 2021 ).…”

“…While there is evidence that MOUD reduces justice involvement ( Belenko et al., 2013 ; Cates and Brown, 2023 ; Keen et al., 2000 ; Oliver et al., 2010 ), it is unknown if it decreases reincarceration ( Evans et al., 2022 ; Haas et al., 2021 ). Some studies focused on OUD treatment have found a decrease in the risk of recidivism for those offered buprenorphine after release ( Evans et al., 2022 ).…”

“…Given those with OUD have been linked to criminal activity such as acquisition crimes and parole violations ( Scott et al., 2021 ; Zaller et al., 2013 ), decreasing an individual's opioid use could reduce reincarcerations in this population. There is evidence that MOUD has been associated with reduced justice involvement and convictions ( Belenko et al., 2013 ; Cates and Brown, 2023 ; Keen et al., 2000 ; Oliver et al., 2010 ), yet data is limited for the relative efficacy of MOUD in decreasing reincarceration ( Evans et al., 2022 ; Haas et al., 2021 ). A recent systematic review revealed inconsistent associations between XR-NTX and criminal activity among those transitioning to the community from incarceration ( Cates and Brown, 2023 ).…”

“…There is evidence that MOUD has been associated with reduced justice involvement and convictions ( Belenko et al., 2013 ; Cates and Brown, 2023 ; Keen et al., 2000 ; Oliver et al., 2010 ), yet data is limited for the relative efficacy of MOUD in decreasing reincarceration ( Evans et al., 2022 ; Haas et al., 2021 ). A recent systematic review revealed inconsistent associations between XR-NTX and criminal activity among those transitioning to the community from incarceration ( Cates and Brown, 2023 ). One study found that those who received two or more injections of XR-NTX post release from an incarcerated setting had fewer arrests than those with one or no injections ( Lee et al., 2015 ), however, two other studies showed no significant differences among those who received XR-NTX and post release criminal activities ( Cates and Brown, 2023 ).…”

“…A recent systematic review revealed inconsistent associations between XR-NTX and criminal activity among those transitioning to the community from incarceration ( Cates and Brown, 2023 ). One study found that those who received two or more injections of XR-NTX post release from an incarcerated setting had fewer arrests than those with one or no injections ( Lee et al., 2015 ), however, two other studies showed no significant differences among those who received XR-NTX and post release criminal activities ( Cates and Brown, 2023 ). Thus, a need for additional research in this area.…”