Optimizing the impact of medications for opioid use disorder at release from prison and jail settings: A microsimulation modeling study

Abstract

Background: We examined the impact of expanded access to medications for opioid use disorder (MOUD) in a unified prison and jail system on post-release, opioid-related overdose mortality. Methods: We developed a microsimulation model to simulate a population of 55,000 persons at risk of opioidrelated overdose mortality in Rhode Island. The effect of an extended-release (XR) naltrexone only intervention and the effect of providing access to all three MOUD (i.e., methadone, buprenorphine, and XR-naltrexone) at release from incarceration on cumulative overdose death over eight years (2017-2024) were compared to the standard of care (i.e., limited access to MOUD). Results: In the standard of care scenario, the model predicted 2385 opioid-related overdose deaths between 2017 and 2024. An XR-naltrexone intervention averted 103 deaths (4.3% reduction), and access to all three MOUD averted 139 deaths (5.8% reduction). Among those with prior year incarceration, an XR-naltrexone only intervention and access to all three MOUD reduced overdose deaths by 22.8% and 31.6%, respectively. Conclusions: Expanded access to MOUD in prison and jail settings can reduce overdose mortality in a general, atrisk population. However, the real-world impact of this approach will vary by levels of incarceration, treatment enrollment, and post-release retention.

“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

“…Consistent with prior study findings, participants noted that transition programs helped individuals with OUD to re-enter society by providing material support, a network of relationships, and continuity of MOUD care [ 27 , 41 ]. The re-entry period is a time with high risk of overdose death, and better access to MOUD during this time is critical in reducing mortality [ 2 , 6 , 48 , 49 ]. Lack of treatment due to breaks in MOUD continuity may lead to substance use and in turn an increase in mortality risk [ 46 , 50 , 51 ].…”

Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia

“…Our estimates of prison OAT impact on fatal overdose in NSW are double that found by Macmadu et al . [ 65 ], which estimated that access to medications for OUD at release from prisons and jails in Rhode Island, USA could prevent 5.8% of opioid overdose deaths during 2017–24. Differences can be partially attributed to their lower assumption of OAT efficacy on overdose (relative risk of 0.22 in NSW versus 0.40 in RI) and differences in retention on OAT (1.74 years in NSW versus 1 year in RI).…”

Interventions Designed to Improve HIV Continuum of Care Outcomes for Persons with HIV in Contact with the Carceral System in the USA

“…Participants randomized to XR-NTX (1) exhibited improved VS and maximum VS from baseline to 6 months as compared to the placebo group (e.g., for < 50 copies/mL 31.0 to 56.7%, p = 0.001 versus 2.0 to 30.3%, p = 0.292, respectively) and (2) were more likely to achieve VS and maximum VS at 6 months than the placebo group (i.e., < 200 copies/mL: 64.2% vs. 42.4%, respectively; p = 0.041; < 50 copies/mL: 56.7% vs. 30.3% respectively; p = 0.015). Stabilizing substance use is an important component of improving the health and well-being of individuals with substance use disorder [ 57 , 58 ] and is critical for improving HIV care outcomes for PWH [ 49 ••]. Beginning treatment for substance use disorders inside carceral settings and upon release can improve HIV care outcomes for PWH reentering the community.…”